Microbial Analysis of Donor Corneoscleral Rims and Storage Media.

Purpose: We aim to investigate bacterial and fungal cultures of hypothermic donor corneal storage media (Optisol-GS) and donor rims. Methods: All corneal transplants performed from January 1, 2015 to June 30, 2016 by a single surgeon at a single facility were retrospectively reviewed. Aerobic, anaerobic, and fungal cultures were routinely obtained from all donor rims and cornea storage media. Culture results and clinical courses were recorded. Results: Eighty-four corneal transplants were performed. Five of 84 grafts (5.95%) had positive bacteria donor rim cultures. Fungal donor rim cultures were positive in 5/84 grafts (5.95%) of which two grew Candida spp. Storage media bacterial cultures were positive in 2/84 (2.4%) cultures. Storage media fungal cultures were positive in 1/84 (1.2%) cultures. No patients developed any evidence of clinical infection. Conclusions: Given the increasing rates of postkeratoplasty fungal infections, the identification of positive fungal cultures from donor rims and storage media warrants further evaluation of adding antifungals to storage media.

Candida Interface Infections After Descemet Stripping Automated Endothelial Keratoplasty.

PURPOSE: To describe 2 Candida interface keratitis infections occurring in the setting of positive donor rim cultures from precut corneal tissue used for Descemet stripping automated endothelial keratoplasty (DSAEK) and the ensuing public health investigation. METHODS: Following 2 clinical Candida interface keratitis infections, patients from 2012 to 2014 in the same surgical center were evaluated for bacterial and fungal rim cultures and subsequent infection. All cases of fungal infections occurring post-DSAEK were analyzed. Data included patient demographics, surgical technique, donor rim cultures, donor mate outcomes, clinical courses, and outcomes. A review of the relevant literature was also undertaken. RESULTS: From 2012 to 2014, among 99 DSAEK procedures performed, 7 (7.1%) donor rim cultures were positive for fungi. Use of this tissue with positive donor rim cultures resulted in 2 (28.6%) episodes of confirmed fungal interface keratitis, both Candida species, and presumptive treatment in an additional 2 patients. An investigation did not identify any breach in sterile technique or procedures by the surgeon or surgery center. Our literature review identified 15 reports of postoperative fungal infection associated with DSAEK, of which 11 involved Candida spp. CONCLUSIONS: While postoperative infection remains rare, our 2 additional cases along with those previously reported suggest that DSAEK may be susceptible to infection with Candida spp. Furthermore, this report of correlated rim cultures and clinical infection suggests a need for reevaluation of the utility of obtaining routine corneoscleral donor rim fungal culture.