Descemet stripping automated endothelial keratoplasty success in the early and entire postoperative period is more likely when the donor did not have diabetes and was without operative complications and in the long-term postoperative period in recipients with Fuchs dystrophy compared with those with PACE. Mechanisms whereby diabetic donors and PACE recipients reduce the rate of graft success after DSAEK warrant further study.

IMPORTANCE Optisol-GS, the most common corneal storage medium in the United States, contains antibacterial but no antifungal supplementation. Most postkeratoplasty endophthalmitis and keratitis cases are now of a fungal origin.OBJECTIVE To assess the efficacy and safety of voriconazole and amphotericin B in reducing Candida species contamination of Optisol-GS under normal storage conditions. DESIGN, SETTING, AND PARTICIPANTSIn vitro laboratory study using 15 pairs of research-grade donor corneas and 20-mL vials of Optisol-GS.INTERVENTIONS Twenty vials of Optisol-GS were supplemented with either voriconazole at 1×, 10×, 25×, or 50× minimum inhibitory concentration (MIC) or amphotericin B at 0.25×, 0.5×, 1×, or 10× MIC. Known concentrations of Candida albicans and Candida glabrata were each added to a set of vials. Safety studies were performed by separating 15 pairs of donor corneas into unsupplemented Optisol-GS or Optisol-GS plus an antifungal.MAIN OUTCOMES AND MEASURES Efficacy outcomes were viable fungal colony counts determined from samples taken on days 2, 7, and 14 immediately after removal from refrigeration and after warming to room temperature for 2 hours. Safety outcomes included percentage of intact epithelium and endothelial cell density on days 0, 7, and 14, as well as percentage of nonviable endothelial cells by vital dye staining on day 14.RESULTS Growth of C albicans and C glabrata was observed in all voriconazole-supplemented vials. In contrast, there was no growth of either organism in amphotericin B-supplemented vials, except at 0.25× and 0.5× MIC on day 2, when viable counts of C glabrata were reduced by 99% and 96%, respectively. Compared with paired controls, with the exception of Optisol-GS plus amphotericin B at 10× MIC, donor corneas in supplemented Optisol-GS appeared to have no difference in endothelial cell density reduction, percentage of intact epithelium, or percentage of nonviable endothelial cells. CONCLUSIONS AND RELEVANCEThe addition of amphotericin B to Optisol-GS may significantly improve activity against contamination with Candida species, the primary cause of fungal infection after corneal transplantation. This study found significant endothelial toxic effects at the maximal concentration of amphotericin B.

IMPORTANCE The proportion of postkeratoplasty fungal infections is rising steadily. However, the most commonly used corneal storage medium in the United States, Optisol-GS, does not contain an antifungal additive. OBJECTIVES To determine the lowest concentration of amphotericin B supplementation in Optisol-GS that will eliminate fungal contaminants effectively without resulting in toxic effects to the cornea and to determine what role light exposure plays in the efficacy and safety of amphotericin B supplementation. DESIGN, SETTING, AND MATERIALS An in vitro laboratory efficacy study measured fungal colony growth in 10 vials of Optisol-GS supplemented with different concentrations of amphotericin B after inoculation with Candida albicans in light-exposed and light-protected conditions. Two vials each were supplemented with amphotericin B at concentrations of 0.06, 0.12, or 0.225 μg/mL; the remaining 2 vials received no C albicans inoculation and no antifungal supplementation (negative controls). After 24 hours, 1 vial from each pair was exposed to light for the remainder of the study. On days 2, 7, and 14, 1 mL of solution was removed from each vial and incubated at 36°C for 48 hours. In a separate safety study, 12 pairs of corneas were divided between amphotericin B supplementation and the control condition; 4 corneas each received the different amphotericin B concentrations. An additional 4 pairs of corneas were stored in the 0.225-μg/mL concentration, and 1 cornea from each pair was exposed to light for the duration of the study.

Analysis of a large sample of donor corneas continues to show age but not sex as a predictor of decreased ECD. African American and Asian ethnicities tend to have slightly higher ECD than that of white donors, whereas Hispanic donors have slightly lower ECD; however, ethnicity was not a predictor of suitability for transplantation. Clinical significance of these findings is yet to be determined.

Purpose: To determine how early body refrigeration affects corneal donor transplant suitability and endothelial cell density.Methods: Donor information was obtained from the CorneaGen Eye Bank including demographics, time of death to preservation, and body refrigeration status, for donors between 2012 and 2016. The death to preservation interval was classified into 3 categories: 0 to 10, 10 to 20, and 20+ hours. Two primary logistic method models were fit using a main effects model and an interaction model to determine the association of body refrigeration on unsuitability of transplantation and endothelial cell density.Results: Analysis was from 42,929 donor eyes, with a mean (standard deviation) endothelial cell count of 2743 (415) cells/mm 2 . Fifty-nine percent of donor eyes were from male donors in the eye bank data set, and the mean death to preservation interval was 11.0 (5.6) hours for all eyes. Unsuitability for transplantation demonstrated a reduced adjusted odds ratio by 22% (OR = 0.78, P = 0.009) when the body was refrigerated during the death to preservation interval versus when the body was not refrigerated. Eyes that were refrigerated, however, exhibited no statistically significant difference in endothelial cell count from eyes that were not refrigerated (P = 0.12). Conclusions:We demonstrate an appreciable effect of early body refrigeration on transplant suitability in this large cohort of eye bank eyes. There was no beneficial effect of body refrigeration on endothelial cell count.