The prognostic role of donor corneoscleral rim cultures in corneal transplantation

TitleThe prognostic role of donor corneoscleral rim cultures in corneal transplantation
Publication TypeJournal Article
Year of Publication2007
AuthorsWilhelmus KR, Hassan SS
Pagination440 - 5
Date PublishedMar
ISSN1549-4713 (Electronic) 0161-6420 (Linking)
Accession Number17324694
Keywords*Tissue Donors, Bacteria / isolation & purification, Bacterial Infections, Bayes Theorem, Candidiasis, Cornea / *microbiology, Corneal Transplantation / *adverse effects, Endophthalmitis / epidemiology / *etiology / microbiology, Fungi / isolation & purification, Humans, Incidence, Prognosis, Sclera / *microbiology, Sensitivity and Specificity, Tissue Culture Techniques

PURPOSE: To examine the discriminatory performance of donor corneoscleral rim cultures for predicting endophthalmitis after corneal transplantation. DESIGN: Systematic literature review. PARTICIPANTS: Studies that reported the prevalence of donor rim cultures after refrigerated preservation of donor corneas distributed for keratoplasty. METHODS: Random-effects meta-analysis estimated pooled sensitivity, specificity, likelihood ratios, and diagnostic odds ratios. Meta-regression and stratification explored study-level reasons for diagnostic performance. MAIN OUTCOME MEASURES: Incidence of postkeratoplasty endophthalmitis. RESULTS: Of 17,614 corneal grafts, 2459 (14%) had a positive donor rim culture and 31 (0.2%) developed endophthalmitis. Twenty-one had concordant donor and recipient isolates, including 10 with Candida species. The sensitivity of donor rim cultures among 10 studies reporting postsurgical endophthalmitis was 67% (95% confidence interval [CI], 47%-83%), and specificity averaged 85%. Endophthalmitis occurred 12 (95% CI, 5-29) times more often among recipients of a culture-positive donor cornea. With Bayesian analysis, a culture-positive donor cornea would raise the infection risk to 1%, whereas fungal isolation from the donor rim predicts a 3% probability of fungal endophthalmitis. Pooling of studies was limited by a significant discrepancy among reports that could not be explained by differences in antibiotic supplementation of the preservation medium, method of culture inoculation, or type of culture medium. CONCLUSION: Endophthalmitis after penetrating keratoplasty is more likely with a culture-positive donor rim, notably candidal endophthalmitis from fungal contaminants, but better evidence is needed to determine the prognostic value and manner of routine microbiological screening.

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