Clostridium perfringens endophthalmitis after penetrating keratoplasty with contaminated corneal allografts: a case series.
OBJECTIVE
To report the postoperative clinical course of 3 patients who underwent corneal transplantation with corneal allografts contaminated with Clostridium perfringens and to evaluate the risk factors for anaerobic contamination in 2 donors.


METHODS
Patient records and adverse reaction reports from a single eye bank related to cases of posttransplant C. perfringens endophthalmitis were reviewed. Records regarding the mated corneas, donor autopsy reports, and other pertinent data were also reviewed.


RESULTS
Three adverse reactions associated with transplantation of corneal allografts contaminated with C. perfringens were reported. Two cases were from mated corneas. Both patients developed fulminant endophthalmitis after undergoing uncomplicated penetrating keratoplasty and required subsequent enucleation. Another isolated case (with no adverse reaction in the mate cornea) developed hypopyon postoperatively that resolved with intravitreal and topical antibiotics. Possible risk factors for anaerobic tissue contamination in the donors included illicit drug use in the first donor and exposure to sewage at the time of death in the second donor.


CONCLUSIONS
Clostridial endophthalmitis is an aggressive rapidly progressive infection with potentially poor visual outcomes that can be transmitted from infected corneal allografts. Further investigation is needed to clarify the role of anaerobic donor rim cultures and the donor risk factors associated with recovering corneal allograft tissue contaminated with C. perfringens.
*Department of Ophthalmology and Visual Sciences, University of Illinois Eye and Ear Infirmary, Chicago, IL; †Department of Ophthalmology, Rush University Medical Center, Chicago, IL; ‡Chicago Eye Institute, Chicago, IL; and §Midwest Eye-Banks, Ann Arbor, MI.
Joshua H
JH
Hou
Anjali
A
Tannan
Jonathan B
JB
Rubenstein
Osvaldo I
OI
Lopez
Kristen
K
McCoy
Randy J
RJ
Epstein
Richard J
RJ
Grostern
Joel
J
Sugar
D000368:Aged; D000369:Aged, 80 and over; D064591:Allografts; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D058491:Bacterial Load; D003015:Clostridium Infections / Q000175:diagnosis / Q000188:drug therapy / Q000635:transmission*; D003016:Clostridium perfringens / Q000302:isolation & purification*; D003315:Cornea / Q000382:microbiology*; D004359:Drug Therapy, Combination; D009877:Endophthalmitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000635:transmission*; D005260:Female; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D014019:Tissue Donors
D000900:Anti-Bacterial Agents