Record number:
2
Adverse Occurrence type:
MPHO Type:
Alerting signals, symptoms, evidence of occurrence:
3 cases of fungal infection transmitted by penetrating keratoplasty (PK) were found in a review of 3000 PK procedures, one of 3 being Aspergillus flavius. Aspergillus nidulans was responsible for one of three post-corneal lamellar transplant fungal infections but no pretransplant samples were cultured. They then cultured over 100 stored eyes and found nearly 30% contaminated by fungi.
Demonstration of imputability or root cause:
Aspergillus flavius - definite, organism recovered from cornea (before use) and from patient.
Aspergillus nidulans - inconclusive, no donor tissue tested.
Keywords: