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

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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.

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Author information

Authors and Affiliations

  1. Department of Ophthalmology, Leeds Teaching Hospitals NHS Trust, Leeds, UK

    Aida Hajjar Sesé

  2. Copenhagen Eye Infirmary, Copenhagen, Denmark

    Jens Lindegaard

  3. Department of Ophthalmology, Mølholm Private Hospital, Vejle, Denmark

    Hanne Olsen Julian

  4. Department of Ophthalmology, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark

    Klavs Højgaard-Olsen & Steffen Heegaard

  5. Department of Microbiology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark

    Niels Frimodt Møller

  6. Department of Pathology, Eye Pathology Section, Rigshospitalet, University of Copenhagen, Glostrup, Denmark

    Steffen Heegaard

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  1. Aida Hajjar Sesé
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  3. Hanne Olsen Julian
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Correspondence to Aida Hajjar Sesé.

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The authors declare that they have no conflict of interest.

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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.

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

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Hajjar Sesé, A., Lindegaard, J., Julian, H.O. et al. A presentation of culture-positive corneal donors and the effect on clinical outcomes. Graefes Arch Clin Exp Ophthalmol 257, 135–141 (2019). https://doi.org/10.1007/s00417-018-4200-9

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  • DOI: https://doi.org/10.1007/s00417-018-4200-9

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