Advertisement

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
Cornea
  • 27 Downloads

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

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

Notes

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.

References

  1. 1.
    Boynton GE, Woodward MA (2014) Eye-bank preparation of endothelial tissue. Curr Opin Ophthalmol 25(4):319–324.  https://doi.org/10.1097/ICU.0000000000000060 CrossRefGoogle Scholar
  2. 2.
    Sugar A, Gal RL, Beck r W, Ruedy KJ, Blanton CL, Feder RS, Hardten DR, Holland EJ, Lass JH, Mannis MJ, O'Keefe MB, Cornea Donor Study G (2005) Baseline donor characteristics in the Cornea Donor Study. Cornea 24(4):389–396CrossRefGoogle Scholar
  3. 3.
    Lass JH, Szczotka-Flynn LB, Ayala AR, Benetz BA, Gal RL, Aldave AJ, Corrigan MM, Dunn SP, TL MC, Pramanik S, Rosenwasser GO, Ross KW, Terry MA, Verdier DD, Writing Committee for the Cornea Preservation Time Study G (2015) Cornea preservation time study: methods and potential impact on the cornea donor pool in the United States. Cornea 34(6):601–608.  https://doi.org/10.1097/ICO.0000000000000417 CrossRefGoogle Scholar
  4. 4.
    Price MO, Baig KM, Brubaker JW, Price FW Jr (2008) Randomized, prospective comparison of precut vs surgeon-dissected grafts for descemet stripping automated endothelial keratoplasty. Am J Ophthalmol 146(1):36–41.  https://doi.org/10.1016/j.ajo.2008.02.024 CrossRefGoogle Scholar
  5. 5.
    Kitzmann AS, Goins KM, Reed C, Padnick-Silver L, Macsai MS, Sutphin JE (2008) Eye bank survey of surgeons using precut donor tissue for descemet stripping automated endothelial keratoplasty. Cornea 27(6):634–639.  https://doi.org/10.1097/QAI.0b013e31815e4011 CrossRefGoogle Scholar
  6. 6.
    Antonios SR, Cameron JA, Badr IA, Habash NR, Cotter JB (1991) Contamination of donor cornea: postpenetrating keratoplasty endophthalmitis. Cornea 10(3):217–220CrossRefGoogle Scholar
  7. 7.
    Farrell PL, Fan JT, Smith RE, Trousdale MD (1991) Donor cornea bacterial contamination. Cornea 10(5):381–386CrossRefGoogle Scholar
  8. 8.
    Fong LP, Gladstone D, Casey TA (1988) Corneo-scleral rim cultures: donor contamination a case of fungal endophthalmitis transmitted by K-Sol stored cornea. Eye 2(Pt 6):670–676.  https://doi.org/10.1038/eye.1988.123 CrossRefGoogle Scholar
  9. 9.
    Hagenah M, Bohnke M, Engelmann K, Winter R (1995) Incidence of bacterial and fungal contamination of donor corneas preserved by organ culture. Cornea 14(4):423–426CrossRefGoogle Scholar
  10. 10.
    Linke SJ, Fricke OH, Eddy MT, Bednarz J, Druchkiv V, Kaulfers PM, Wulff B, Puschel K, Richard G, Hellwinkel OJ (2013) Risk factors for donor cornea contamination: retrospective analysis of 4546 procured corneas in a single eye bank. Cornea 32(2):141–148.  https://doi.org/10.1097/ICO.0b013e31825d586b CrossRefGoogle Scholar
  11. 11.
    Mian SI, Aldave AJ, Tu EY, Ayres BD, Jeng BH, Macsai MS, Nordlund ML, Penta JG, Pramanik S, Szczotka-Flynn LB, Ayala AR, Liang W, Maguire MG, Lass JH (2018) Incidence and outcomes of positive donor rim cultures and infections in the cornea preservation time study. Cornea 37(9):1102–1109.  https://doi.org/10.1097/ICO.0000000000001654 CrossRefGoogle Scholar
  12. 12.
    Rehany U, Balut G, Lefler E, Rumelt S (2004) The prevalence and risk factors for donor corneal button contamination and its association with ocular infection after transplantation. Cornea 23(7):649–654CrossRefGoogle Scholar
  13. 13.
    Leveille AS, McMullan FD, Cavanagh HD (1983) Endophthalmitis following penetrating keratoplasty. Ophthalmology 90(1):38–39CrossRefGoogle Scholar
  14. 14.
    Caldwell MC, Perfect JR, Carlson AN, Proia AD (2009) Candida glabrata endophthalmitis following penetrating keratoplasty. J Cataract Refract Surg 35(3):598–602.  https://doi.org/10.1016/j.jcrs.2008.08.046 CrossRefGoogle Scholar
  15. 15.
    Weiss JL, Parker WT (1987) Candida albicans endophthalmitis following penetrating keratoplasty. Arch Ophthalmol 105(2):173CrossRefGoogle Scholar
  16. 16.
    Yamazoe K, Den S, Yamaguchi T, Tanaka Y, Shimazaki J (2011) Severe donor-related Candida keratitis after Descemet’s stripping automated endothelial keratoplasty. Graefes Arch Clin Exp Ophthalmol 249(10):1579–1582.  https://doi.org/10.1007/s00417-011-1710-0
  17. 17.
    Vislisel JM, Goins KM, Wagoner MD, Schmidt GA, Aldrich BT, Skeie JM, Reed CR, Zimmerman MB, Greiner MA (2017) Incidence and outcomes of positive donor corneoscleral rim fungal cultures after keratoplasty. Ophthalmology 124(1):36–42.  https://doi.org/10.1016/j.ophtha.2016.09.017 CrossRefGoogle Scholar
  18. 18.
    Chu YI, Penland RL, Wilhelmus KR (2000) Colorimetric indicators of microbial contamination in corneal preservation medium. Cornea 19(4):517–520CrossRefGoogle Scholar
  19. 19.
    Forster RK, Rebell G (1975) Animal model of Fusarium solani keratitis. Am J Ophthalmol 79(3):510–515CrossRefGoogle Scholar
  20. 20.
    Agarwal LP, Malik SR, Mohan M, Khosla PK (1963) Mycotic corneal ulcers. Br J Ophthalmol 47:109–115CrossRefGoogle Scholar
  21. 21.
    Berson EL, Kobayashi GS, Becker B, Rosenbaum L (1967) Topical corticosteroids and fungal keratitis. Investig Ophthalmol 6(5):512–517Google Scholar
  22. 22.
    Shi W, Wang T, Xie L, Li S, Gao H, Liu J, Li H (2010) Risk factors, clinical features, and outcomes of recurrent fungal keratitis after corneal transplantation. Ophthalmology 117(5):890–896.  https://doi.org/10.1016/j.ophtha.2009.10.004 CrossRefGoogle Scholar
  23. 23.
    O'Day DM, Ray WA, Head WS, Robinson RD (1984) Influence of the corneal epithelium on the efficacy of topical antifungal agents. Invest Ophthalmol Vis Sci 25(7):855–859Google Scholar
  24. 24.
    O'Day DM, Head WS, Robinson RD, Clanton JA (1986) Corneal penetration of topical amphotericin B and natamycin. Curr Eye Res 5(11):877–882CrossRefGoogle Scholar
  25. 25.
    Tappeiner C, Goldblum D, Zimmerli S, Fux C, Frueh BE (2009) Donor-to-host transmission of Candida glabrata to both recipients of corneal transplants from the same donor. Cornea 28(2):228–230.  https://doi.org/10.1097/ICO.0b013e318183a3e3 CrossRefGoogle Scholar
  26. 26.
    Quindos G (2014) Epidemiology of candidaemia and invasive candidiasis. A changing face. Rev Iberoam Micol 31(1):42–48.  https://doi.org/10.1016/j.riam.2013.10.001 CrossRefGoogle Scholar
  27. 27.
    Ratra D, Saurabh K, Das D, Nachiappan K, Nagpal A, Rishi E, Bhende P, Sharma T, Gopal L (2015) Endogenous endophthalmitis: a 10-year retrospective study at a tertiary hospital in South India. Asia Pac J Ophthalmol (Phila) 4(5):286–292.  https://doi.org/10.1097/APO.0000000000000120
  28. 28.
    Borderie VM, Laroche L (1998) Microbiologic study of organ-cultured donor corneas. Transplantation 66(1):120–123CrossRefGoogle Scholar
  29. 29.
    Aldave AJ, DeMatteo J, Glasser DB, Tu EY, Iliakis B, Nordlund ML, Misko J, Verdier DD, Yu F (2013) Report of the Eye Bank Association of America medical advisory board subcommittee on fungal infection after corneal transplantation. Cornea 32(2):149–154.  https://doi.org/10.1097/ICO.0b013e31825e83bf CrossRefGoogle Scholar
  30. 30.
    Ritterband DC, Shah MK, Meskin SW, Seedor JA, Koplin RS, Perez W, Yang R, Hu DN, Dahl P (2007) Efficacy and safety of voriconazole as an additive in Optisol GS: a preservation medium for corneal donor tissue. Cornea 26(3):343–347.  https://doi.org/10.1097/ICO.0b013e31802d82e8 CrossRefGoogle Scholar
  31. 31.
    Layer N, Cevallos V, Maxwell AJ, Hoover C, Keenan JD, Jeng BH (2014) Efficacy and safety of antifungal additives in Optisol-GS corneal storage medium. JAMA Ophthalmol 132(7):832–837.  https://doi.org/10.1001/jamaophthalmol.2014.397
  32. 32.
    Duncan K, Parker J, Hoover C, Jeng BH (2016) The effect of light exposure on the efficacy and safety of amphotericin B in corneal storage media. JAMA Ophthalmol 134(4):432–436.  https://doi.org/10.1001/jamaophthalmol.2016.0008
  33. 33.
    Seiler TG, Tschopp M, Zimmerli S, Tappeiner C, Wittwer VV, Frueh BE (2016) Time course of antibiotic and antifungal concentrations in corneal organ culture. Cornea 35(1):127–131.  https://doi.org/10.1097/ICO.0000000000000671 CrossRefGoogle Scholar
  34. 34.
    Nelson JD, Mindrup EA, Chung CK, Lindstrom RL, Doughman DJ (1983) Fungal contamination in organ culture. Arch Ophthalmol 101(2):280–283CrossRefGoogle Scholar
  35. 35.
    Merchant A, Zacks CM, Wilhelmus K, Durand M, Dohlman CH (2001) Candidal endophthalmitis after keratoplasty. Cornea 20(2):226–229CrossRefGoogle Scholar
  36. 36.
    Chen Y, Liao C, Gao M, Belin MW, Wang M, Yu H, Yu J (2015) Efficacy and safety of corneal transplantation using corneas from foreign donors versus domestic donors: a prospective, randomized, controlled trial. J Ophthalmol 2015:178289.  https://doi.org/10.1155/2015/178289 Google Scholar

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

Personalised recommendations