Abstract
Purpose :
To analyze effects of revised Eye Bank practices since 2017 on the rates of donor tissue contamination and post-keratoplasty fungal infections.
Methods :
We conducted a retrospective chart review of a single-center, single Eye Bank database of corneal transplant patients from January 2018 - October 2023. Importantly, the single center cultures all donor rims and the Eye Bank has not offered antifungal supplementation. Clinical records were reviewed for positive donor rim cultures of any type. Recipients of positive fungal donor rim cultures (FDRCs) were analyzed for prior diagnosis, use of post-surgical antifungal prophylaxis with development of keratoplasty-related infection as the primary outcome measure. Therapeutic keratoplasties for fungal keratitis and Keratoprostheses were excluded.
Results :
111 positive donor rims were detected in 804 consecutive corneal transplant records reviewed. Of 28 positive FDRCs, 23 (20.7%) were Candida sp. The remaining FDRCs included 2 molds (Rhodotorula and Aspergillus species), 2 Cryptococcus sp. and 1 Clavispora sp. Penetrating keratoplasty (PKP)/deep anterior lamellar keratoplasty (DALK) and Descemet's stripping endothelial keratoplasty (DSAEK)/Descemet's membrane endothelial keratoplasty (DMEK) comprised 49.8% and 44.5% of all transplants, respectively. Candida was detected in 11 of 400 (2.8%) PKP/DALK and 12 of 358 (3.4%) DSAEK/DMEK tissues. Chi-square testing did not detect a a significant difference (p = .64) between the two groups. No patients received antifungal prophylaxis for a positive FDRC, and no fungal infections identified post-operatively.
Conclusions :
Prior studies demonstrated a 3 x greater rate of FDRC positivity for processed (DSAEK/DMEK) vs. unprocessed (PKP/DALK) tissues. These current results strongly suggest recent eye banking modifications, e.g. limiting warming times and double Betadine soaks, have largely eliminated the additional risk posed by tissue preparation on FDRCs without antifungal supplementation. Further, the rate of infection associated with a positive FDRC was far lower than previously reported without the use of antifungal prophylaxis. The lack of infections may be related to alterations in pathogenicity or infective load induced by new processing guidelines but should be accounted for in studies evaluating the benefit of post-surgical antifungal prophylaxis.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.