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Maria Elena Galimi, Julia M Weller, Friedrich E Kruse, Victor A Augustin, Theofilos Tourtas; Supplementation of amphotericin B in Optisol-GS for Descemet membrane endothelial keratoplasty (DMEK). Invest. Ophthalmol. Vis. Sci. 2019;60(9):6300.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the safety and benefit of supplementation of amphotericin B in Optisol-GS for corneal tissue used for DMEK surgery.
Retrospective, single-center case series of 250 consecutive eyes which underwent DMEK or triple-DMEK between April 2017 and January 2018 for Fuchs endothelial corneal dystrophy. The corneal tissues were stored in Optisol-GS without amphotericin B in the first 125 eyes (control group), and in Optisol-GS supplemented with amphotericin B (0.255 μg/mL) in the following 125 eyes (study group). Main outcome measures were: rate of fungal contamination of the medium, best-corrected visual acuity (BCVA, logMAR), endothelial cell density (ECD), and central corneal thickness (CCT) 3 months after DMEK.
Donor age was 63.4 ± 5.7 years (control group) and 65.3 ± 5.8 years (study group). Mean storage duration was 6.5 ± 1.35 days in the control group and 7.0 ± 1.3 days in the study group. Mean death-to-preservation time was 11.2 ± 4.5 hours in the control group and 11.1 ± 5.1 hours in the study group. Main preoperative parameters: BCVA: 0.56 ± 0.37 (control group), 0.62 ± 0.44 (study group), CCT 622 ± 82 µm (control group), 643 ± 129 µm (study group) and donor ECD 2488 ± 235/mm2(control group), 2430 ± 222/mm2(study group).The rate of positive microbiological results of the medium cultures was reduced in the study group, but there was no significant difference (control group: n=9, 7%; study group: n=4, 3%; p = 0.254, exact fisher test). No significant differences were found regarding BCVA (control group: 0.25 ± 0.22, study group: 0.26 ± 0.26; p= 0.797), CCT (control group: 513 ± 42 µm, study group: 517 ± 64 µm, p= 0.556), and ECD (control group: 1325 ± 362/mm2, study group: 1437 ± 413/mm2, p= 0.079) 3 months after surgery.
We found a non-significant trend for a reduced rate of fungal contaminations in the group with amphotericin B supplementation.Our data provide evidence that amphotericin B has no detectable negative impact on the postoperative performance of DMEK grafts. In particular there was no effect on the endothelial cell density. We therefore recommend adding amphotericin B to corneal storage media in cold culture to reduce the risk of postoperative fungal keratitis after DMEK.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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