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Endophthalmitis from contaminated donor corneas following penetrating keratoplasty
J A Cameron1, S R Antonios, J B Cotter
1King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
Abstract:
We encountered six (0.2%) cases of endophthalmitis resulting from contaminated donor corneas between January 1983 and July 1990 following a total of 3000 consecutive penetrating keratoplasties. Causative organisms in the three cases of fungal endophthalmitis were Torulopsis glabrata, Candida albicans, and Aspergillus flavus; the three cases of bacterial endophthalmitis were due to Klebsiella pneumoniae, Staphylococcus aureus, and Enterococcus faecalis. All organisms were resistant to gentamicin in the preservation media. A significantly higher incidence of endophthalmitis was noted in patients receiving corneas from a Sri Lankan eye bank (1.25%) than in those receiving US eye bank tissue (0.14%). Donor rim cultures are important to identify those patients at increased risk of developing endophthalmitis, enabling earlier diagnosis and more specific treatment should endophthalmitis occur.
Insights
Endophthalmitis after penetrating keratoplasty can result from contaminated donor corneas. Donor rim cultures are crucial for identifying high-risk patients and enabling timely treatment.
Area of Science:
- Ophthalmology
- Microbiology
- Transplantation Science
Background:
- Penetrating keratoplasty (corneal transplant) is a common procedure.
- Endophthalmitis, an inflammation within the eye, is a serious complication.
- Donor cornea contamination poses a risk for post-transplant infections.
Observation:
- A study of 3000 penetrating keratoplasties identified six cases (0.2%) of endophthalmitis.
- Infections were linked to contaminated donor corneas.
- Fungal (Torulopsis glabrata, Candida albicans, Aspergillus flavus) and bacterial (Klebsiella pneumoniae, Staphylococcus aureus, Enterococcus faecalis) pathogens were identified.
Findings:
- All identified organisms demonstrated resistance to gentamicin in preservation media.
- A higher incidence of endophthalmitis was observed with corneas from a Sri Lankan eye bank (1.25%) compared to US eye banks (0.14%).
Implications:
- Donor rim cultures are vital for risk stratification.
- Early identification of at-risk patients can lead to earlier diagnosis and targeted treatment for endophthalmitis.
- Eye bank screening protocols may need re-evaluation to minimize infection transmission.