Risk Factors for Donor Cornea Contamination

Linke, Stephan J.; Fricke, Otto; Eddy, Mau-Thek; Bednarz, J; Druchkiv, Vasyl; Kaulfers, Paul-Michael; Wulff, Birgit; Püschel, Klaus; Richard, Gisbert; Hellwinkel, Olaf

doi:10.1097/ico.0b013e31825d586b

Cited by 41 publications

(11 citation statements)

References 21 publications

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“…It is a severe complication of intraocular surgeries like penetrating keratoplasty (PK) or cataract surgery where the risk of bacterial or fungal infection increases with transplantation of a contaminated cornea [1, 2]. It has been shown that the microorganisms responsible for the postoperative endophthalmitis are usually derived from the transplanted corneas; however, involvement of other postoperative risk factors for ocular infection has also been determined [3].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the HB&L System for the Microbiological Screening of Storage Medium for Organ-Cultured Corneas

Camposampiero

Grandesso

Zanetti

et al. 2013

Journal of Ophthalmology

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Aims. To compare HB&L and BACTEC systems for detecting the microorganisms contaminating the corneal storage liquid preserved at 31°C. Methods. Human donor corneas were stored at 4°C followed by preservation at 31°C. Samples of the storage medium were inoculated in BACTEC Peds Plus/F (aerobic microorganisms), BACTEC Plus Anaerobic/F (anaerobic microorganisms), and HB&L bottles. The tests were performed (a) after six days of storage, (b) end of storage, and (c) after 24 hours of preservation in deturgescent liquid sequentially. 10,655 storage and deturgescent media samples were subjected to microbiological control using BACTEC (6-day incubation) and HB&L (24-hour incubation) systems simultaneously. BACTEC positive/negative refers to both/either aerobic and anaerobic positives/negatives, whereas HB&L can only detect the aerobic microbes, and therefore the positives/negatives depend on the presence/absence of aerobic microorganisms. Results. 147 (1.38%) samples were identified positive with at least one of the two methods. 127 samples (134 identified microorganisms) were positive with both HB&L and BACTEC. 14 HB&L+/BACTEC− and 6 BACTEC+/HB&L− were identified. Sensitivity (95.5%), specificity (99.8%), and positive (90.1%) and negative predictive values (99.9%) were high with HB&L considering a 3.5% annual contamination rate. Conclusion. HB&L is a rapid system for detecting microorganisms in corneal storage medium in addition to the existing methods.

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Section: Introductionmentioning

confidence: 99%

Evaluation of the HB&L System for the Microbiological Screening of Storage Medium for Organ-Cultured Corneas

Camposampiero

Grandesso

Zanetti

et al. 2013

Journal of Ophthalmology

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“…These differences are possibly due to variation in mean time before tissue collection. The study by Linke et al (2013) had a mean time to collection of 40 hours and found an association with contamination, while the Khouani et al (2014) had a much shorter mean time to collection (9.7 hours) and found no association with contamination. Instances of drowning may lead to longer time before tissue collection than hospital deaths, but the approximate added mean time of submersion (prior to the victim being pronounced deceased) for our sample was 38 min, and thereby likely minimal enough to not affect corneal contamination.…”

Section: Discussionmentioning

confidence: 82%

“…This practice has been debated because controversial evidence surrounding the risks to the transplant recipient. A study by Linke et al (2013), of the Hamburg eye bank, suggests that longer death-to-procurement times are associated with greater corneal contamination, possibly due to transfer of flora from skin and environment. However, a study by Khouani et al (2014) found no association between these factors.…”

Section: Discussionmentioning

confidence: 99%

Donor cornea tissue in cases of drowning or water submersion: eye banks practice patterns and tissue outcomes

Vijayakumar

Parikh

Tennant³

et al. 2017

Cell Tissue Bank

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Surgical use of donor corneal tissue from victims of water submersion (drowning or submersion secondary to death) remains controversial due to limited evidence about the quality of these tissues. To assess the safety of donor corneal tissue from victims of water submersion, an investigation of eye banks' practice patterns and tissue outcomes was conducted. All 79 Eye Bank Association of America accredited eye banks were contacted for a phone interview of practices regarding tissue from victims of water submersion. A retrospective review of corneal tissues from 2014 to 2016 from a large eye bank network was performed to identify all donors submerged in water. Corneal epithelial integrity, endothelial cell density (ECD), rim cultures, and adverse events were analyzed for associations with water submersion characteristics. 49 eye banks (62% response) participated in the survey. 55% of these eye banks had specific, written protocol for tissue eligibility from donors submerged in water. With or without specific protocol, eye banks reported considering water type (84%) and length of time submerged (92%) to determine eligibility. 22% of eye banks reported medical director involvement when eligibility determination was unclear. 79 tissues from 40 donors who were submerged were identified in 2014-2016 eye bank data. No donor tissues had pre-processing corneal infiltrates, positive rim cultures, or adverse events post-keratoplasty. Corneal epithelial integrity and ECD were not associated with water type or length of time submerged. In conclusion, data from a large eye bank network showed no adverse events or outcomes, indicating these tissues may be safe.

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“… 4 Another report showed that the median annual contamination rate was 5.3%. 14 In fact, it has been reported that Candida albicans is responsible for the majority of fungal infections post PKP and Descemet's stripping automated endothelial keratoplasty. 3 , 4 , 5 , 6 , 7 , 9 , 15 , 16 …”

Section: Discussionmentioning

confidence: 99%

A case of fungal keratitis and endophthalmitis post penetrating keratoplasty resulting from fungal contamination of the donor cornea

Kitazawa

Wakimasu²,

Yoneda

et al. 2017

American Journal of Ophthalmology Case Reports

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PurposeFungal infections post keratoplasty due to contamination of the donor corneal graft have become important issues that need to be addressed. Here we report a case of fungal keratitis and endophthalmitis post penetrating keratoplasty (PKP) due to fungal contamination of the donor corneal graft.ObservationsWe present a 52-year-old male who underwent PKP with a donor corneal graft that was later found to be contaminated with fungus. At 4-weeks postoperative, infectious infiltrates suddenly appeared at the border between the host and donor corneal graft, and endophthalmitis concomitantly occurred. A culture of the remnant donor corneoscleral rims and the vitreous fluid obtained during vitreous surgery was found to be positive for Candida albicans. At 6-months post vitreous surgery and intensive anti-fungal medical treatment, both corneal infiltrates and vitreous opacity completely disappeared, and the patient's best-corrected visual acuity recovered to 20/40, with a transparent cornea.Conclusions and importanceThe findings of this case show that prompt intensive medical treatment and surgical intervention effectively saved the vision in a patient with fungal keratitis and endophthalmitis due to contamination of the donor corneal graft.

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Risk Factors for Donor Cornea Contamination

Cited by 41 publications

References 21 publications

Evaluation of the HB&L System for the Microbiological Screening of Storage Medium for Organ-Cultured Corneas

Evaluation of the HB&L System for the Microbiological Screening of Storage Medium for Organ-Cultured Corneas

Donor cornea tissue in cases of drowning or water submersion: eye banks practice patterns and tissue outcomes

A case of fungal keratitis and endophthalmitis post penetrating keratoplasty resulting from fungal contamination of the donor cornea

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