A presentation of culture-positive corneal donors and the effect on clinical outcomes

  • Aida Hajjar SeséEmail author
  • Jens Lindegaard
  • Hanne Olsen Julian
  • Klavs Højgaard-Olsen
  • Niels Frimodt Møller
  • Steffen Heegaard



Donor-to-host transmission of infectious agents is a rare but well-recognised complication of corneal transplantation and may carry a grave visual prognosis. In this case series, we describe the clinical features and risk factors of using culture-positive donor corneas for transplantation.


Retrospective chart review of a series of patients who underwent either penetrating keratoplasty (PK) or Descemet’s stripping automated endothelial keratoplasty (DSAEK) with positive microbiology cultivation during routine assessment of donor corneal tissue obtained at the time of surgery. Donor and recipient characteristics, tissue preparation and surgical parameters, clinical signs and outcomes were registered.


Eleven patients who received culture-positive corneal grafts were identified: six with Candida, three with Gram-positive bacteria and two with Gram-negative bacteria. Three patients developed clinical keratitis after routine DSAEK using corneas contaminated with Candida species. The median death-to-preservation time (DPT) of these three donor corneas was 18.08 (range 18.08 to 20.90) h, while in the remaining eight donors, it was 12.27 (range 9.32 to 20.47) h. Despite the initiation of antifungal treatment, all three cases required explantation of the graft and a subsequent re-DSAEK.


The use of donor corneas that are culture-positive for Candida carries a risk for developing postoperative keratitis and the risk may be higher in DSAEK. Unlike the cold storage technique employed for donor corneas described in this case series, organ culture technique requires microbiological screening and supplementation of an antifungal agent which may reduce the risk of donor-to-host transmission of fungal infection.


Keratoplasty Descemet stripping automated endothelial keratoplasty Corneal donor tissue contamination Fungal keratitis Eye banking 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Aida Hajjar Sesé
    • 1
    Email author
  • Jens Lindegaard
    • 2
  • Hanne Olsen Julian
    • 3
  • Klavs Højgaard-Olsen
    • 4
  • Niels Frimodt Møller
    • 5
  • Steffen Heegaard
    • 4
    • 6
  1. 1.Department of Ophthalmology, Leeds Teaching Hospitals NHS TrustLeedsUK
  2. 2.Copenhagen Eye InfirmaryCopenhagenDenmark
  3. 3.Department of OphthalmologyMølholm Private HospitalVejleDenmark
  4. 4.Department of Ophthalmology, Rigshospitalet-GlostrupUniversity of CopenhagenGlostrupDenmark
  5. 5.Department of Microbiology, RigshospitaletUniversity of CopenhagenGlostrupDenmark
  6. 6.Department of Pathology, Eye Pathology Section, RigshospitaletUniversity of CopenhagenGlostrupDenmark

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