Candida Interface Infections After Descemet Stripping Automated Endothelial Keratoplasty

Tsui, Edmund; Fogel, Erin; Hansen, Katrina; Talbot, Elizabeth A.; Tammer, Roza; Fogel, Jessa; Daly, Elizabeth R.; Noble, J; Caine, Lynda; Zegans, Michael E.

doi:10.1097/ico.0000000000000778

Cited by 32 publications

(31 citation statements)

References 28 publications

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“…Table 2 shows the study characteristics and outcomes of each study. Studies were conducted in the US, 5 , 13 , 32 – 37 Israel, 38 Italy, 39 Saudi Arabia, 40 and Japan. 16 All articles were published between 2001 and 2016.…”

Section: Resultsmentioning

confidence: 99%

The value of corneoscleral rim cultures in keratoplasty: a systematic review and cost-effectiveness analysis

Kiatos¹,

Armstrong²,

Hutnik

et al. 2017

CEOR

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PurposeThis study evaluated the performance of donor corneoscleral rim cultures for predicting infection after corneal transplantation, and determines if there is a correlation between positive corneoscleral rim cultures and postkeratoplasty infection.Design and data sourcesThis was a systematic review, prognostic accuracy analysis, and cost-effectiveness analysis. Databases searched were: Medline (Ovid), Embase (Ovid), CINAHL, Cochrane Library, Web of Science, and BioSis Previews. Grey literature was also explored.Materials and methodsA systematic review was conducted to locate published and unpublished studies. All studies examining corneal button contamination and its association with endophthalmitis and keratitis posttransplantation were included. Extracted data were used to calculate sensitivity, specificity, positive predictive value, and negative predictive value. Cost data from the London Laboratory Services Group in London, ON were used to calculate the cost-effectiveness of culturing donor rim cultures.ResultsOf 7,870 grafts, 954 had a positive rim culture (12.1%), with 12 patients going on to develop keratitis or endophthalmitis (1.3%). The prevalence of keratitis and endophthalmitis in this study was 0.15%, and the positive predictive value 1.5%. Of the 12 infections, nine were fungal and three bacterial. The estimated cost of a positive and negative test result was CAD$45.99 and $14.15, respectively. The cost to run all 7,870 tests was estimated to be $141,735.86, with an incremental cost-effectiveness ratio of $40,215.70.ConclusionThere was a significant divergence between bacterial and fungal rim-culture results. Bacterial cultures predicted clinical infection poorly, did not change management, and were expensive. Fungal cultures predicted clinical infection in over 10% of patients, had the potential to change management, and were 40% less expensive than full rim culturing (bacterial and fungal tests). Fungal rim cultures may be considered in areas where fungal infection rates are high.

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Section: Resultsmentioning

confidence: 99%

The value of corneoscleral rim cultures in keratoplasty: a systematic review and cost-effectiveness analysis

Kiatos¹,

Armstrong²,

Hutnik

et al. 2017

CEOR

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show abstract

“…[1,9] A significant percentage, perhaps as high as 67% of these cases, will go on to develop fungal endophthalmitis following EK surgery with fungal contaminated tissue [1-2]. EBAA data shows a trend towards increased rates of fungal infections following EK in comparison to PKP.…”

Section: Discussionmentioning

confidence: 99%

“…However case reports indicate a high rate of poor outcomes following fungal infections with the majority requiring further surgical intervention [2]. While it is outside of the scope of this report, a cost analysis would be a valuable study to determine the cost effectiveness of antifungal prophylaxis.…”

Section: Discussionmentioning

confidence: 99%

“…At this time the literature contains reports of 24 cases of fungal endopthalmitis following descemet stripping endothelial keratoplasty (DSEK) [2]. Here we present the first published case of fungal endophthalmitis related to contaminated donor material following descemet membrane endothelial keratoplasty (DMEK) along with 22 months of follow up.…”

Section: Introductionmentioning

confidence: 99%

“…Fungal infections primarily are from Candida species [2] and are difficult to eradicate, with 15 of 24 cases reported in the literature requiring surgical intervention, and 9 of 24 cases being treated medically [2-8]. …”

Section: Introductionmentioning

confidence: 99%

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First Reported Case of Donor Related Candida Endophthalmitis after Descemet Membrane Endothelial Keratoplasty

Thompson

Carli

2017

TOOPHTJ

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Purpose: To report the first case of Candida donor to host transmission following descemet membrane endothelial keratoplasty (DMEK)Methods:A retrospective case report.Results:A patient underwent uneventful DMEK. Following surgery the donor rim was culture positive for Candida. The patient developed fungal endophthalmitis that was treated medically with multiple injections of voriconazole and amphotericin. Medical treatment was unable to clear the infection and removal of the donor material was required. Following removal the infection subsided.Conclusion:Candida interface keratitis and endophthalmitis can occur following DMEK and may be difficult to treat medically. Early removal of the donor material should be considered.

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Excisional penetrating keratoplasty for fungal interface keratitis after endothelial keratoplasty: surgical timing and visual outcome

et al. 2020

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Candida Interface Infections After Descemet Stripping Automated Endothelial Keratoplasty

Cited by 32 publications

References 28 publications

The value of corneoscleral rim cultures in keratoplasty: a systematic review and cost-effectiveness analysis

The value of corneoscleral rim cultures in keratoplasty: a systematic review and cost-effectiveness analysis

First Reported Case of Donor Related Candida Endophthalmitis after Descemet Membrane Endothelial Keratoplasty

Excisional penetrating keratoplasty for fungal interface keratitis after endothelial keratoplasty: surgical timing and visual outcome

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