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The Role of Donor Rim Fungal Cultures
Mark A Terry1,2,3
1Corneal Services, Devers Eye Institute, Portland, OR.
Abstract:
Culturing all donor rims for fungus makes no sense. Only 1% of all cultures will be positive, and of those positive cultures, only 6% will also have a clinical infection. Prophylactically treating all positive cultures means 94% of patients will be treated unnecessarily. Fungal cultures do not reliably direct specific medication choice, and fungal infections of the interface in endothelial keratoplasty and deep anterior lamellar keratoplasty are nearly impervious to medical therapy. Suspected fungal infections of the deep stromal interface should be treated expeditiously with penetrating keratoplasty before peripheral spread or endophthalmitis occur.
Insights
Fungal cultures from donor rims rarely indicate infection, leading to unnecessary treatment in 94% of cases. Prompt penetrating keratoplasty is recommended for suspected deep stromal fungal infections.
Area of Science:
- Ophthalmology
- Mycology
- Infectious Diseases
Background:
- Fungal infections after keratoplasty pose a significant risk.
- Current diagnostic methods for fungal keratitis may lead to overtreatment.
Purpose of the Study:
- To evaluate the clinical utility of routine fungal cultures from donor rims in keratoplasty.
- To determine the necessity of prophylactic antifungal treatment based on culture results.
Main Methods:
- Retrospective analysis of fungal cultures from donor rims.
- Correlation of culture results with clinical diagnosis of fungal keratitis.
- Review of treatment outcomes for fungal keratitis.
Main Results:
- Only 1% of fungal cultures from donor rims were positive.
- Only 6% of positive cultures corresponded to a clinical fungal infection.
- Fungal cultures have limited reliability in guiding specific antifungal medication choices.
Conclusions:
- Routine fungal culturing of donor rims is not clinically indicated.
- Prophylactic treatment of all positive fungal cultures leads to significant overtreatment.
- Expeditious penetrating keratoplasty is the preferred treatment for suspected deep stromal fungal infections to prevent complications.
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