Increasing Povidone-Iodine Exposure in Endothelial Keratoplasty Tissue Processing and Fungal Infection Impact
Conclusions: Increasing the povidone-iodine exposure time during the donor cornea recovery process decreased the rate of positive donor corneal rim fungal cultures (P = 0.001), positive donor corneal rim bacterial cultures (P = 0.04), and postoperative fungal infections (P = 0.06).
Condition: Fuchs' Endothelial Dystrophy Intervention: Drug: Amphotericin B Sponsor: Cornea Research Foundation of America Withdrawn
Conclusions: AmpB at a concentration of 0.255 μg/mL in Optisol-GS at cold storage (2°C–8°C) over 48 hours did not eliminate yeast from corneal tissue.
Conclusion: Most patients with endophthalmitis secondary to corneal fungal infection were successfully managed by penetrating keratoplasty, vitrectomy, or intravitreal antifungal therapy. Multiple risk factors for endophthalmitis were identified. Timely diagnosis and risk factor assessment were essential for ensuring early surgical intervention for fungal keratitis–related endophthalmitis.
Conclusions: Reports of infections remained low despite increased use of eye bank-prepared tissue. These results suggest that factors other than eye bank tissue preparation should be considered when investigating potential sources of pathogen contamination in donor corneas.
Conclusions: Fungal IK is a rare complication after DMEK. Based on our experience, we believe that treatment of early fungal IK with aggressive presentation should include both immediate graft exchange and intracameral application of voriconazole and amphotericin, in addition to topical and systemic antifungal treatment. Graft exchange seems not to be mandatory in late infections.
Conclusions: The incidence of nosocomial fungal infections, particularly non-albicans Candida, is increasing, as are the rates of positive fungal cultures from corneal donor tissue and postkeratoplasty fungal infections. Prospective studies are needed to assess the value of routine donor cultures, compare the safety and efficacy of various prophylactic treatments, and evaluate addition of antifungals to cold storage media.
Conclusions: We postulate that perioperative antibiotic prophylaxis in cornea transplant recipients is important in preventing bacterial infections derived from the donor cornea. We believe that the addition of an antifungal agent to commercially available cornea preservation fluids should also be considered. PMID: 29765440 [PubMed]