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Corneal Donor Tissue Preparation for Endothelial Keratoplasty
Published on: June 12, 2012
Donor cornea bacterial contamination
P L Farrell1, J T Fan, R E Smith
1Doheny Eye Institute, Los Angeles, California.
Abstract:
The incidence of culture-positive cornea rims from 446 consecutive donor corneas cultured at the Doheny Eye Institute between 1986 and 1988 was determined. Both the identity and antibiotic sensitivities of the contaminating organisms were reviewed. Sixty-three (14.1%) of 446 cornea rims were culture-positive, but none of the 63 patients who received these contaminated donor corneas developed endophthalmitis. Streptococcus (26 of 63), Propionibacterium (15 of 63), Stphylococcus (14 of 63) species and diptheroids (8 of 63) were the most common cornea rim contaminants, and in most cases were resistant to gentamicin (i.e., 21 of 26 or 81%, 9 of 15 or 60%, 10 of 14 or 71%, 4 of 8 or 50%, respectively). Virtually all of the gentamicin-resistant bacteria isolated from cornea rims were found to be sensitive to vancomycin. Eye banks should consider the addition of other antibiotics to storage media to reduce donor cornea contamination. Surgeons performing corneal transplantation should also consider these results when selecting antibiotics for use at the time of surgery and in the postoperative period.
Insights
Cornea rim contamination in donor corneas was 14.1%, with common bacteria resistant to gentamicin. However, vancomycin proved effective against these resistant organisms, suggesting improved antibiotic strategies for corneal transplantation.
Area of Science:
- Ophthalmology
- Microbiology
- Transplantation Science
Background:
- Donor cornea contamination is a potential risk in corneal transplantation.
- Understanding the prevalence and antibiotic resistance patterns of contaminating organisms is crucial for patient safety.
Purpose of the Study:
- To determine the incidence of culture-positive cornea rims from donor corneas.
- To identify common contaminating organisms and their antibiotic sensitivities.
- To inform strategies for reducing contamination and guiding perioperative antibiotic selection.
Main Methods:
- Prospective culture of 446 consecutive donor cornea rims.
- Identification of bacterial isolates.
- Antimicrobial susceptibility testing, focusing on gentamicin and vancomycin resistance.
Main Results:
- 14.1% (63/446) of cornea rims were culture-positive.
- Common contaminants included Streptococcus, Propionibacterium, Staphylococcus, and diptheroids.
- Most isolates showed resistance to gentamicin, but were sensitive to vancomycin.
- No patients who received contaminated corneas developed endophthalmitis.
Conclusions:
- Donor cornea contamination is prevalent but may not always lead to adverse outcomes.
- Gentamicin resistance is common among cornea rim contaminants.
- Vancomycin is a viable alternative for treating gentamicin-resistant bacteria in this context.
- Eye banks and surgeons should reconsider current antibiotic protocols for storage media and perioperative use.
