The Role of Corneal Donor Rim Fungal Cultures: Pro Side
Related Experiment Video
Updated: Nov 2, 2025
Corneal Donor Tissue Preparation for Endothelial Keratoplasty
Published on: June 12, 2012
1Department of Ophthalmology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Manhattan Eye, Ear & Throat Hospital (MEETH), New York, NY.
Abstract:
Fungal infection after corneal transplantation is a rare but potentially devastating complication. It is of paramount concern for transplant surgeons and the eye banking community. The value of universal corneal rim cultures for keratoplasty remains controversial. In 2016, The Eye Bank Association for America reported an increasing trend in the incidence of post keratoplasty fungal infections and a higher incidence of post keratoplasty [penetrating keratoplasty and endothelial keratoplasty (EK)] fungal endophthalmitis cases. This increasing trend in rate over time from previous Eye Bank Association for America reports was disproportionately associated with EK and Candida species. Additionally, several studies confirmed a high correlation between positive corneoscleral donor rim fungal cultures and postoperative infections, and a higher risk to the mate eye of a cornea that had the positive fungal corneal rim culture and developed an infection. Positive fungal donor rim cultures-especially in the setting of interface keratitis after EK surgery-can raise the index of suspicion for a fungal cause and may help direct therapy, especially in the early stages, where the symptoms and signs of spread may not be obvious and obtaining direct cultures is inherently difficult without surgical intervention.
Insights
Fungal infections after corneal transplants are increasing, particularly with endothelial keratoplasty (EK) and Candida species. Positive donor rim cultures may indicate infection risk and guide early treatment.
Area of Science:
- Ophthalmology
- Microbiology
- Transplantation Science
Background:
- Fungal infections post-corneal transplantation are rare but severe complications.
- The incidence of fungal infections, especially fungal endophthalmitis, has increased.
- Endothelial keratoplasty (EK) and Candida species are disproportionately associated with this trend.
Purpose of the Study:
- To evaluate the significance of universal corneal rim cultures in keratoplasty.
- To assess the correlation between positive fungal rim cultures and postoperative infections.
- To understand the implications for the mate eye and guiding early therapeutic interventions.
Main Methods:
- Review of incidence trends reported by the Eye Bank Association for America.
- Analysis of studies correlating positive corneoscleral donor rim fungal cultures with postoperative infections.
- Examination of the role of rim cultures in diagnosing early-stage fungal keratitis, particularly after EK.
Main Results:
- An increasing trend in post-keratoplasty fungal infections was reported in 2016.
- EK procedures showed a disproportionately higher incidence of fungal endophthalmitis.
- Positive fungal donor rim cultures correlate highly with postoperative infections and pose a risk to the mate eye.
Conclusions:
- Universal corneal rim cultures' value in keratoplasty remains debated.
- Positive fungal rim cultures, especially with interface keratitis post-EK, raise suspicion for fungal etiology.
- Rim cultures can aid in directing early therapy when direct intraocular cultures are difficult.
