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Graefe's Archive for Clinical and Experimental Ophthalmology

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01-01-2019 | Cornea

A presentation of culture-positive corneal donors and the effect on clinical outcomes

Authors: Aida Hajjar Sesé, Jens Lindegaard, Hanne Olsen Julian, Klavs Højgaard-Olsen, Niels Frimodt Møller, Steffen Heegaard

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 1/2019

Abstract

Purpose

Donor-to-host transmission of infectious agents is a rare but well-recognised complication of corneal transplantation and may carry a grave visual prognosis. In this case series, we describe the clinical features and risk factors of using culture-positive donor corneas for transplantation.

Methods

Retrospective chart review of a series of patients who underwent either penetrating keratoplasty (PK) or Descemet’s stripping automated endothelial keratoplasty (DSAEK) with positive microbiology cultivation during routine assessment of donor corneal tissue obtained at the time of surgery. Donor and recipient characteristics, tissue preparation and surgical parameters, clinical signs and outcomes were registered.

Results

Eleven patients who received culture-positive corneal grafts were identified: six with Candida, three with Gram-positive bacteria and two with Gram-negative bacteria. Three patients developed clinical keratitis after routine DSAEK using corneas contaminated with Candida species. The median death-to-preservation time (DPT) of these three donor corneas was 18.08 (range 18.08 to 20.90) h, while in the remaining eight donors, it was 12.27 (range 9.32 to 20.47) h. Despite the initiation of antifungal treatment, all three cases required explantation of the graft and a subsequent re-DSAEK.

Conclusions

The use of donor corneas that are culture-positive for Candida carries a risk for developing postoperative keratitis and the risk may be higher in DSAEK. Unlike the cold storage technique employed for donor corneas described in this case series, organ culture technique requires microbiological screening and supplementation of an antifungal agent which may reduce the risk of donor-to-host transmission of fungal infection.

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Title: A presentation of culture-positive corneal donors and the effect on clinical outcomes
Authors: Aida Hajjar Sesé
Jens Lindegaard
Hanne Olsen Julian
Klavs Højgaard-Olsen
Niels Frimodt Møller
Steffen Heegaard
Publication date: 01-01-2019
Publisher: Springer Berlin Heidelberg
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 1/2019
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI: https://doi.org/10.1007/s00417-018-4200-9

At a glance: The STEP trials

Springer Medicine

A presentation of culture-positive corneal donors and the effect on clinical outcomes

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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