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Updated: Aug 5, 2026
Corneal Donor Tissue Preparation for Endothelial Keratoplasty
Published on: June 12, 2012
Microbial contamination of donor corneoscleral rims and storage medium in keratoplasty
Atsuhiko Fukuto1, Suzu Deie2, Yurie Shimizu2
1Department of Ophthalmology and Visual Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan. fukuto@hiroshima-u.ac.jp.
Purpose:
To investigate the prevalence and spectrum of microbial contamination of donor corneoscleral rims and storage medium in keratoplasty and to report a case of donor-derived fungal keratitis.
Study Design:
Single-center, retrospective study.
Methods:
We reviewed 285 eyes that underwent keratoplasty at Hiroshima University Hospital between October 2022 and January 2025. Donor corneas were preserved using Optisol®-GS. The donor rim and storage medium were separately cultured intraoperatively, and the minimum inhibitory concentrations (MICs) were determined.
Results:
Culture positivity was identified in 10 of the 285 eyes (3.5%): six from donor rims and four from storage media, with no eye yielding positive results in both. All tested bacterial isolates were Gram-positive; three of six tested were not susceptible to levofloxacin and gatifloxacin (MIC ≥4 μg/mL), including methicillin-resistant Staphylococcus aureus, but retained susceptibility to vancomycin and meropenem. All fungal isolates were Candida with low MICs for voriconazole and micafungin. C. albicans and C. glabrata were recovered from the mate corneas of a single donor; the recipient of the cornea contaminated with C. albicans developed keratitis requiring repeat penetrating keratoplasty, whereas the recipient of the C. glabrata-contaminated cornea did not.
Conclusion:
Adding storage medium to the rim culture improved the detection of donor-associated microorganisms. When donor-derived C. albicans keratitis developed, susceptibility data from contemporaneous cultures enabled prompt targeted antifungal therapy and globe preservation, although repeated penetrating keratoplasty was ultimately required.
Insights
Microbial contamination of donor corneas occurs in 3.5% of cases. Culturing storage medium alongside donor rims improves detection, aiding prompt treatment of fungal keratitis, such as Candida albicans, in corneal transplantation recipients.
Area of Science:
- Ophthalmology
- Microbiology
- Transplantation Science
Background:
- Microbial contamination of donor corneas poses a risk in keratoplasty.
- Early detection and characterization of contaminants are crucial for patient outcomes.
Purpose of the Study:
- To determine the prevalence and types of microbial contamination in donor corneoscleral rims and storage media.
- To report a case of fungal keratitis originating from a donor cornea.
Main Methods:
- Retrospective analysis of 285 keratoplasty cases.
- Intraoperative cultures of donor rims and storage media (Optisol-GS).
- Minimum inhibitory concentration (MIC) testing for bacterial and fungal isolates.
Main Results:
- Culture positivity in 3.5% of cases (10/285), with 6/10 from rims and 4/10 from media.
- Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus, showed resistance to fluoroquinolones but remained susceptible to vancomycin and meropenem.
- Candida species were identified, with low MICs for voriconazole and micafungin. One recipient developed Candida albicans keratitis.
Conclusions:
- Culturing storage medium enhances the detection of donor-associated microorganisms.
- Susceptibility data guided targeted antifungal therapy for donor-derived Candida albicans keratitis, preserving the globe but requiring repeat keratoplasty.
