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Contamination of donor cornea: postpenetrating keratoplasty endophthalmitis
S R Antonios1, J A Cameron, I A Badr
1King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
Abstract:
Nine cases (0.41%) of bacterial and fungal endophthalmitis developed out of a total of 2,210 consecutive penetrating keratoplasties performed between November 1983 and April 1989. Five of the nine cases (0.23%) had endophthalmitis related to donor tissue contamination. The donor tissue of these cases had a storage time of greater than 5 days. A retrospective analysis of 1,399 consecutive corneoscleral rim cultures showed a contamination rate of 29%. The most common organisms isolated were Propionibacterium 26%, diphtheroids 24%, Staphylococcus epidermidis 22%, and fungi 9%. There is a statistically significant increase (p less than 0.005) in the percentage of contaminated donor rims with a preservation time of more than five days. The risk of developing endophthalmitis is 12 times greater with a positive donor rim culture. Prolonged preservation of donor tissue can be a risk factor in developing endophthalmitis.
Insights
Prolonged storage of donor tissue for penetrating keratoplasty increases bacterial and fungal endophthalmitis risk. Donor tissue preservation over five days significantly elevates the chance of infection after corneal transplant surgery.
Area of Science:
- Ophthalmology
- Microbiology
- Transplantation
Background:
- Bacterial and fungal endophthalmitis are serious complications following penetrating keratoplasty.
- Donor tissue contamination is a potential source of post-keratoplasty infections.
Purpose of the Study:
- To investigate the relationship between donor tissue storage time and the incidence of endophthalmitis after penetrating keratoplasty.
- To identify the microbial contaminants commonly found in donor corneoscleral rims.
Main Methods:
- Retrospective analysis of 2,210 penetrating keratoplasty cases performed between November 1983 and April 1989.
- Cultures of corneoscleral rims from 1,399 donor tissues were analyzed.
- Incidence of endophthalmitis and correlation with donor tissue storage duration and culture results were examined.
Main Results:
- Nine cases (0.41%) of endophthalmitis occurred, with five cases (0.23%) linked to donor tissue contamination.
- Donor tissues stored for over five days showed a statistically significant increase in contamination rates (p < 0.005).
- Common contaminants included Propionibacterium (26%), diphtheroids (24%), Staphylococcus epidermidis (22%), and fungi (9%).
Conclusions:
- Prolonged preservation of donor tissue (>5 days) is a significant risk factor for developing endophthalmitis after penetrating keratoplasty.
- Positive donor rim cultures increase the risk of endophthalmitis by 12-fold.
- Optimizing donor tissue handling and storage protocols may reduce post-keratoplasty infection rates.