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Incidence and outcome of transplantation of fungal-culture-positive donor corneoscleral tissue in optical keratoplasty

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Abstract

Purpose

This study aims to determine the incidence of fungal-culture-positive corneoscleral donor rim in patients undergoing keratoplasty and evaluate clinical outcomes of eyes that received these contaminated donor tissues.

Methods

Patients who had optical keratoplasty between 2006 and 2016 and were found to have fungal-culture-positive donor rim were included. Microbiological and eye bank records were reviewed to determine the incidence of positive fungal rim cultures. Data were collected on visual and clinical outcomes. The main outcome measures were fungal-culture-positive donor rim and development of fungal keratitis or endophthalmitis post keratoplasty. Long-term clinical outcome and associated complications were the secondary outcome measures.

Results

Out of 9620 cases of corneal transplants, 145 (1.5%) had fungal-culture-positive donor rim. Candida was the most common organism, cultured in 127 (87.6%) cases. There were no cases of postoperative fungal keratitis or endophthalmitis. Median follow-up was 4.8 years (interquartile range 3.8–7.2 years). Only eight cases (5.5%) received prophylactic antifungal treatment. There were 34 (23.4%) cases of rejection, 13 (8.9%) developed glaucoma, and 7 (4.8%) developed late bacterial keratitis. At last follow-up, best corrected visual acuity was 20/60 or better in 88 cases (60.7%) and 115 eyes (79.3%) had a clear graft.

Conclusion

The incidence of fungal-culture-positive donor rim is extremely low. The risk of developing fungal keratitis or endophthalmitis in patients who received contaminated donor tissue was almost negligible. Further studies are warranted to prove whether prophylaxis or adding amphotericin B in Optisol-GS confers any added benefit.

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Acknowledgements

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Funding

This study was not funded by an internal, external, or international agency, institute, or organization.

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Authors and Affiliations

  1. Anterior Segment Division, King Khalid Eye Specialist Hospital, Al Oruba Road, P.O. Box 7191, Riyadh, 11462, Saudi Arabia

    Rawan Saleh Alshabeeb, Ahmed Abdullah Aldayel, Hernan Martinez-Osorio & Muhammad Ali Ahad

Authors
  1. Rawan Saleh Alshabeeb
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  2. Ahmed Abdullah Aldayel
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  3. Hernan Martinez-Osorio
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  4. Muhammad Ali Ahad
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Corresponding author

Correspondence to Muhammad Ali Ahad.

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All authors declare that they have no conflicts of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was not obtained from individual participants included in the study. This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of the hospital approved this study.

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Alshabeeb, R.S., Aldayel, A.A., Martinez-Osorio, H. et al. Incidence and outcome of transplantation of fungal-culture-positive donor corneoscleral tissue in optical keratoplasty. Int Ophthalmol 41, 867–873 (2021). https://doi.org/10.1007/s10792-020-01641-9

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  • DOI: https://doi.org/10.1007/s10792-020-01641-9

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