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Updated: Aug 12, 2025
Corneal Donor Tissue Preparation for Descemet's Membrane Endothelial Keratoplasty
Published on: September 17, 2014
Fungal Infection After Descemet Membrane Endothelial Keratoplasty: Incidence and Outcomes
Brittany M Wong1, Clémence Bonnet1,2, Reza Ghaffari1
1Stein Eye Institute, University of California Los Angeles, Los Angeles, CA.
Purpose:
The aim of the study was to describe the incidence, presentation, management, and outcomes of fungal infection after Descemet membrane endothelial keratoplasty (DMEK).
Methods:
Retrospective case series of culture-proven fungal infections after DMEK reported in the literature, directly by surgeons, and to the Eye Bank Association of America from January 1, 2011, to December 31, 2020.
Results:
The domestic incidence of fungal infections, fungal keratitis, and fungal endophthalmitis after DMEK from 2011 to 2020 was 3.5, 1.3, and 2.2 per 10,000 cases, respectively, with no significant increasing trend. Thirty-four cases were identified, 14 (41.2%) published and 20 (58.8%) unpublished. Donor tissue fungal cultures were performed in 20 of the 34 (58.8%) cases and were positive in 19 of the 20 (95.0%), all but one Candida species. Recipient fungal cultures were performed in 29 of the 34 (85.3%) cases and were positive in 26 of the 29 (89.7%), all but one Candida species. Infection presented a mean of 33 ± 38 days (median 23, range 2-200, outlier 949) after transplantation: 25 (73.5%) with endophthalmitis and 9 (26.5%) with keratitis. Topical, intrastromal, intracameral, intravitreal, or systemic antifungal therapy was used in all 27 eyes with treatment data. Surgical intervention (DMEK explantation or partial removal, repeat endothelial keratoplasty, penetrating keratoplasty, and/or pars plana vitrectomy) was required in 21 of the 27 (77.8%) eyes. The corrected distance visual acuity at the last follow-up was ≥20/40 in 13 of the 27 (48.1%) eyes and counting fingers or worse in 6 of the 27 (22.2%) eyes.
Conclusions:
Fungal infection is a rare but serious complication of DMEK that results in counting fingers or worse corrected distance visual acuity in nearly a quarter of eyes.
Insights
Fungal infections following Descemet membrane endothelial keratoplasty (DMEK) are rare but serious, impacting visual acuity. Early detection and treatment are crucial for managing this complication.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Corneal Surgery
Background:
- Descemet membrane endothelial keratoplasty (DMEK) is an advanced endothelial keratoplasty technique.
- Fungal infections are a potential, though uncommon, complication following DMEK.
Purpose of the Study:
- To investigate the incidence, clinical presentation, management strategies, and visual outcomes of fungal infections after DMEK.
Main Methods:
- A retrospective analysis of culture-proven fungal infections post-DMEK.
- Data collected from literature, surgeon reports, and the Eye Bank Association of America (2011-2020).
Main Results:
- The incidence of fungal infections post-DMEK was 3.5 per 10,000 cases.
- Candida species were the most common fungal pathogens identified in donor and recipient cultures.
- Nearly a quarter of affected eyes experienced severe vision loss (counting fingers or worse).
Conclusions:
- Fungal infection is a rare but significant complication of DMEK.
- Management often requires a combination of antifungal therapy and surgical intervention.
- Visual outcomes can be poor in a substantial proportion of cases.
