The prognostic role of donor corneoscleral rim cultures in corneal transplantation.
OBJECTIVE
To examine the discriminatory performance of donor corneoscleral rim cultures for predicting endophthalmitis after corneal transplantation.


METHODS
Systematic literature review.


METHODS
Studies that reported the prevalence of donor rim cultures after refrigerated preservation of donor corneas distributed for keratoplasty.


METHODS
Random-effects meta-analysis estimated pooled sensitivity, specificity, likelihood ratios, and diagnostic odds ratios. Meta-regression and stratification explored study-level reasons for diagnostic performance.


METHODS
Incidence of postkeratoplasty endophthalmitis.


RESULTS
Of 17,614 corneal grafts, 2459 (14%) had a positive donor rim culture and 31 (0.2%) developed endophthalmitis. Twenty-one had concordant donor and recipient isolates, including 10 with Candida species. The sensitivity of donor rim cultures among 10 studies reporting postsurgical endophthalmitis was 67% (95% confidence interval [CI], 47%-83%), and specificity averaged 85%. Endophthalmitis occurred 12 (95% CI, 5-29) times more often among recipients of a culture-positive donor cornea. With Bayesian analysis, a culture-positive donor cornea would raise the infection risk to 1%, whereas fungal isolation from the donor rim predicts a 3% probability of fungal endophthalmitis. Pooling of studies was limited by a significant discrepancy among reports that could not be explained by differences in antibiotic supplementation of the preservation medium, method of culture inoculation, or type of culture medium.


CONCLUSIONS
Endophthalmitis after penetrating keratoplasty is more likely with a culture-positive donor rim, notably candidal endophthalmitis from fungal contaminants, but better evidence is needed to determine the prognostic value and manner of routine microbiological screening.
Wilhelmus
Kirk R
KR
Sid W. Richardson Ocular Microbiology Laboratory, Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas 77030, USA. kirkw@bcm.tmc.edu
Hassan
Sohela S
SS
D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections; D001499:Bayes Theorem; D002177:Candidiasis; D003315:Cornea / Q000382:microbiology*; D016039:Corneal Transplantation / Q000009:adverse effects*; D009877:Endophthalmitis / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D005658:Fungi / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D011379:Prognosis; D012590:Sclera / Q000382:microbiology*; D012680:Sensitivity and Specificity; D046509:Tissue Culture Techniques; D014019:Tissue Donors