The incidence of fungal keratitis and endophthalmitis following penetrating keratoplasty

TitleThe incidence of fungal keratitis and endophthalmitis following penetrating keratoplasty
Publication TypeJournal Article
Year of Publication2005
AuthorsKeyhani K, Seedor JA, Shah MK, Terraciano AJ, Ritterband DC
Pagination288 - 91
Date PublishedApr
ISSN0277-3740 (Print) 0277-3740 (Linking)
Accession Number15778600
Keywords*Keratoplasty, Penetrating, *Postoperative Complications, Aged, Aged, 80 and over, Candidiasis / *epidemiology / microbiology / transmission, Cornea / microbiology / pathology, Corneal Edema / surgery, Disease Transmission, Infectious, Endophthalmitis / *epidemiology / microbiology / transmission, Eye Infections, Fungal / *epidemiology / microbiology / transmission, Female, Follow-Up Studies, Humans, Incidence, Keratitis / *epidemiology / microbiology, Middle Aged, New York / epidemiology, Tissue Donors

PURPOSE: To determine the incidence of postkeratoplasty fungal endophthalmitis and keratitis at the New York Eye and Ear Infirmary. To determine whether there is a relationship between culture-positive corneoscleral donor material and postoperative infection. METHODS: The microbiologic records of corneoscleral donor rims submitted for culture following penetrating keratoplasty at the New York Eye and Ear Infirmary between January 1998 and January 2003 were reviewed. The incidence of rim cultures positive for fungi was tabulated. Clinical outcome measures were recorded for each patient receiving corneal donor tissue. RESULTS: Of 2466 donor corneoscleral rims cultured during the study period, 344 were positive for microbial growth (13%). Of those rims with positive cultures, 28 (8.6%) were positive for fungus. All fungi cultured were Candida species. Four of the 28 recipient eyes (14%) who received contaminated donor material went on to develop postkeratoplasty fungal infections. There were no cases of fungal infection in any postkeratoplasty patients in the absence of contaminated donor rims during the study period. Overall, there was a 0.16% incidence of fungal infection (4/2466) following penetrating keratoplasty. There were 18 positive donor rims identified in the first 4 years of the study, but there were 10 cases in the last 10 months of the study. CONCLUSIONS: The overall incidence of fungal infection following penetrating keratoplasty is low, but all cases in our study were associated with positive rim cultures. Whether prophylactic antifungal therapy would be of any benefit in the presence of a positive corneoscleral rim culture has not yet been determined.

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