Ready to upload
Adverse Occurrence type:
Among patients in this series (precut corneas, Descemet's stripping automated endothelial keratoplasty, DSAEK, at single surgical center), 7 had positive fungal donor corneal rim cultures, with 2/7 developing interface keratitis; among those 3 had positive donor rim cultures for Candida species, with 2/3 developing interface keratitis.
Time to detection:
9-20 days post-DSAEK
Alerting signals, symptoms, evidence of occurrence:
Infiltrates visible in two cases, preemptive therapy provided to one, and preemptive removal and replacement occurred in another.
Demonstration of imputability or root cause:
Cultures from infected patients matched donor rim cultures. No pre-DSAEK cultures. Other possible source of infection were considered, with donor cornea infection in these two cases being the most likely explanation (see text).
Suggest new keywords:
pre-cut cornea; Candida; DSEAK; cold storage; corneoscleral culture
Candida Interface Infections After Descemet Stripping Automated Endothelial Keratoplasty. Tsui E et al. Cornea. 35(4):456-64, 2016 Apr.
Expert comments for publication:
This case series suggests high index of suspicion for fungal infection when donor rim samples from pre-cut cornea are positive. Processing of DSAEK offers opportunities for microbial contamination when compared to penetrating keratoplasty; positive fungal culture, particularly for C. albicans is associated with increased frequency of post procedural complications. Therefore authors suggest that corneoscleral culture should be done in all cases of DSAEK.