Corneo-scleral rim cultures: donor contamination a case of fungal endophthalmitis transmitted by K-Sol stored cornea.
This retrospective study of 549 corneo-scleral rim cultures shows that gentamicin, used in MK and K-Sol medium storage at 4 degrees C, has decreased donor contamination from 43% in whole-globe storage to 13%, but failed to eliminate coagulase negative staphylococci (37%), streptococci (28%) and fungi (28%). Donor-to-host transmitted staphylococcal and streptococcal endophthalmitis have been reported previously. We present the first documented case of donor-to-recipient transmitted fungal endophthalmitis following corneal transplantation using corneas stored in MK or K-Sol solution at 4 degrees C; Candida albicans was isolated. Recommendations are made to assess critically the true incidence of donor fungal contamination and the necessity of adding anti-mycotic agents to preservation medium for 4 degrees C storage. In the absence of ideal antimicrobial cover for corneal preservation solutions, stringent prophylactic measures to reduce contamination and continued monitoring of corneo-scleral rim cultures are warranted, if the poor visual consequences of donor-to-host transmitted endophthalmitis are to be avoided.
Fong
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LP
Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, Sussex.
Gladstone
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Casey
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TA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002177:Candidiasis / Q000635:transmission; D002648:Child; D002675:Child, Preschool; D002809:Chondroitin Sulfates; D016039:Corneal Transplantation; D009877:Endophthalmitis / Q000209:etiology*; D005839:Gentamicins / Q000627:therapeutic use; D006531:HEPES; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000635:transmission*; D009926:Organ Preservation; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000635:transmission; D013290:Streptococcal Infections / Q000635:transmission
D005839:Gentamicins; C051174:K-Sol preserving medium; D002809:Chondroitin Sulfates; D006531:HEPES