Incidence and Outcomes of Positive Donor Corneoscleral Rim Fungal Cultures after Keratoplasty.
To determine the incidence of positive corneoscleral donor rim fungal cultures after keratoplasty and to report clinical outcomes of grafts with culture-positive donor rims.



Retrospective cohort study.



Consecutive donor corneas and keratoplasty recipients at a single tertiary referral center over 20 years.



Patient charts were reviewed to determine the incidence of positive donor rim fungal cultures and clinical outcomes of all grafts using contaminated tissue.



The primary outcome measures were positive donor rim fungal culture results and the development of postkeratoplasty fungal infection using corresponding corneal tissue. The secondary outcome measure was the impact of postoperative prophylaxis on donor tissue-associated infections.



A total of 3414 keratoplasty cases were included in the statistical analysis. Seventy-one cases (2.1%) were associated with a fungal culture-positive donor rim. Candida species were cultured in 40 cases (56.3%). There was a higher incidence of positive rim cultures over the last 5 years of the analytic period compared with the first 15 years (P = 0.018). Fungal keratitis developed in 4 cases (5.6%), and all patients required further surgical intervention to achieve cure. There were no cases of fungal endophthalmitis. Empiric antimycotic prophylaxis initiated at the time of positive culture result reduced the incidence of keratitis from 15.8% in untreated cases to 1.9% in treated cases (P = 0.056).



Positive donor rim fungal cultures are uncommon, but carry an unacceptably high risk of postoperative fungal infection. This risk may be reduced with prophylactic antimycotic therapy when culture-positive donor rims are identified.
Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, Iowa.
Jesse M
JM
Vislisel
Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, Iowa; Iowa Lions Eye Bank, Coralville, Iowa.
Kenneth M
KM
Goins
Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, Iowa; Cornea Research Center, Stephen A. Wynn Institute for Vision Research, Iowa City, Iowa.
Michael D
MD
Wagoner
Iowa Lions Eye Bank, Coralville, Iowa.
Gregory A
GA
Schmidt
Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, Iowa; Iowa Lions Eye Bank, Coralville, Iowa.
Benjamin T
BT
Aldrich
Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, Iowa; Iowa Lions Eye Bank, Coralville, Iowa.
Jessica M
JM
Skeie
Iowa Lions Eye Bank, Coralville, Iowa.
Cynthia R
CR
Reed
Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa.
M Bridget
MB
Zimmerman
Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, Iowa; Cornea Research Center, Stephen A. Wynn Institute for Vision Research, Iowa City, Iowa; Iowa Lions Eye Bank, Coralville, Iowa. Electronic address: mark-greiner@uiowa.edu.
Mark A
MA
Greiner
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D002648:Child; D003315:Cornea / Q000382:microbiology*; D009877:Endophthalmitis / Q000453:epidemiology* / Q000382:microbiology; D015821:Eye Infections, Fungal / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D005260:Female; D005658:Fungi / Q000302:isolation & purification*; D006801:Humans; D015994:Incidence; D007634:Keratitis / Q000453:epidemiology / Q000382:microbiology; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000382:microbiology*; D012044:Regression Analysis; D012189:Retrospective Studies; D012590:Sclera / Q000382:microbiology*; D014019:Tissue Donors; D055815:Young Adult
D000900:Anti-Bacterial Agents