Table of Contents
Investigation of Contamination of Corneal Tissue Processed within the Utah Lions Eye Bank
Trevor Annis, Kaidi Wang MD, Mark Mifflin MD, Amy Lin MD
Corneal transplant, endothelial keratoplasty, eye bank, fungal endophthalmitis
Introduction: The number of fungal endophthalmitis cases following endothelial keratoplasty (EK) increased in the mid-2010s and has plateaued in recent years. The cause remains unclear.
Objectives: Four post-EK endophthalmitis cases occurred at the ULEB within a 10-month period. The primary aim of this study was to examine the safety and quality of the cornea preparation and handling processes carried out at the ULEB.
Methods: This was a prospective observational study conducted in two parts. In the first part, study technicians tested 27 corneas for fungal or bacterial contamination before preparation for EK.
In the second part, technicians tested ten corneas for fungal or bacterial contamination via swab before and after a one-month storage period in Optisol-GS at room temperature.
Results: Part one: Zero of the 27 corneas were positive for contamination before preparation for EK. Part two: One of the corneal tissues was positive for bacterial and fungal growth before the storage period. After the storage period, the contaminated cornea and its mate tested positive only for Candida species.
Conclusion: Part one: All corneal tissues were free from contamination, indicating that ULEB tissue procurement procedures are safe and do not introduce contaminants. Part two: Positive fungal culture results from the same donor suggest that donor characteristics, rather than eye bank factors, were the cause of
the contamination. We speculate that preexisting fungal contamination may be detected via storage in Optisol-GS for one month at room temperature and that the addition of antifungal agents to corneal storage media should be considered.