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Incidence and Outcomes of Positive Donor Corneoscleral Rim Fungal Cultures after Keratoplasty
- Source :
- Ophthalmology. 124:36-42
- Publication Year :
- 2017
- Publisher :
- Elsevier BV, 2017.
-
Abstract
- Purpose 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. Design Retrospective cohort study. Participants Consecutive donor corneas and keratoplasty recipients at a single tertiary referral center over 20 years. Methods Patient charts were reviewed to determine the incidence of positive donor rim fungal cultures and clinical outcomes of all grafts using contaminated tissue. Main Outcome Measures 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. Results 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). Conclusions 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.
- Subjects :
- Adult
Male
medicine.medical_specialty
Adolescent
Keratitis
Cornea
Young Adult
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
medicine
Humans
Fungal keratitis
Antibiotic prophylaxis
Young adult
Child
Aged
Retrospective Studies
Aged, 80 and over
Endophthalmitis
business.industry
Incidence
Incidence (epidemiology)
Fungi
Retrospective cohort study
Antibiotic Prophylaxis
Middle Aged
Eye infection
medicine.disease
Tissue Donors
Anti-Bacterial Agents
Surgery
Ophthalmology
Descemet Stripping Endothelial Keratoplasty
030221 ophthalmology & optometry
Regression Analysis
Female
business
Eye Infections, Fungal
Keratoplasty, Penetrating
Sclera
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 01616420
- Volume :
- 124
- Database :
- OpenAIRE
- Journal :
- Ophthalmology
- Accession number :
- edsair.doi.dedup.....eb7cfa091e25eb4d3225b3d5661dc49b