Increasing Povidone-Iodine Exposure in Endothelial Keratoplasty Tissue Processing and Fungal Infection Impact

Salisbury, Charles D; Kirk, Carter; Lee, W Barry; Hamilton, Stephen M.; Kozarsky, Alan M.; Meinecke, Eric; Stulting, R. Doyle

doi:10.1097/ico.0000000000002006

Cited by 16 publications

(16 citation statements)

References 8 publications

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“…35,39 Yeast infections after keratoplasty tend to be more common than infection by other organisms. 18,19,40 Also, the fungal specimen which is more frequently isolated in the donor rim is Candida spp. 33 A higher incidence of post-keratoplasty fungal infection has been reported by the Eye Bank Association of America when comparing endothelial keratoplasty procedures with penetrating keratoplasty procedures.…”

Section: Discussionmentioning

confidence: 99%

“…Other ways of reducing positivity of donor rim cultures include that described by Salisbury et al which increased the exposure time to povidone iodine during donor tissue recovery diminishing the proportion of positive donor tissue rim fungal cultures (p = 0.001), positive donor tissue rim bacterial cultures (p = 0.04), and postoperative fungal infections (p = 0.06). 19…”

Section: Discussionmentioning

confidence: 99%

“…20 The opportunity for proliferation in a potential space between host and donor tissue, sequestered from immune response, can lead to infectious complications ranging from interface keratitis to endophthalmitis. [17][18][19][20] The latter is an extremely devastating condition with poor functional and anatomic prognosis. Even though rates of endophthalmitis are low and there are few reports in EK, it has been shown that endophthalmitis incidence tends to be higher in EK than PK and the majority are fungal related.…”

Section: Introductionmentioning

confidence: 99%

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Endophthalmitis secondary to donor to host infection in posterior lamellar keratoplasties: A systematic review

Maticorena-Quevedo

Anduaga-Beramendi

Beas

et al. 2022

European Journal of Ophthalmology

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Donor to host transmission of infectious agents is a well-recognized entity, more commonly related to Endothelial Keratoplasty (EK) than to Penetrating Keratoplasty (PK), that involves complications ranging from interface keratitis to endophthalmitis. A systematic review of the literature was conducted to identify the published articles until December 2020 reporting cases of endophthalmitis secondary to corneal graft contamination in posterior lamellar keratoplasties (DSAEK and DMEK) along with donor characteristics, microbiological profile, treatment and outcomes. Each identified article was assessed to meet donor to host infection criteria, defined as a post-procedural infection in which the same microbiological agent was identified in both the donor corneoscleral rim or preservation medium and receptor ocular tissue. From 23 research articles, eight reports of endophthalmitis in nine patients following DSAEK or DMEK secondary to donor to host infection fulfilled the inclusion criteria. The majority were male and the median age was 72.0 (45.0–81.0) years old. Indications of surgery were primarily pseudophakic bullous keratopathy and Fuchs dystrophy. A fungal pathogen was identified in eight of nine patients. All the cases underwent surgical management with lenticule removal or endothelial plaque aspiration. The final corrected distance visual acuity (CDVA) in all cases was 20/200 or better. Endophthalmitis after an EK procedure is a rare complication whose outcome depends on the aggressive and precocious treatment. Identification of early signs of interface keratitis and lenticule removal seems mandatory in patients undergoing DSAEK or DMEK to prevent further involvement of the globe.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Endophthalmitis secondary to donor to host infection in posterior lamellar keratoplasties: A systematic review

Maticorena-Quevedo

Anduaga-Beramendi

Beas

et al. 2022

European Journal of Ophthalmology

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“…By doubling the exposure time of povidone iodine 5% during the corneal donor preparation, from 5 minutes to 10 minutes, Salisbury et al were able to decrease the prevalence of positive bacterial rim cultures from 6.5% to 4.0% and decrease positive fungal rim cultures 2.9% to 0.6%. 45 Corneal rim culture is not routinely performed at all centers, but it may provide invaluable data. Early fungal rim cultures may help warn surgeons of a possible infection, sometimes even before any clinical signs or symptoms are detected in the recipient.…”

Section: Preventionmentioning

confidence: 99%

Posterior Segment Complications of Endothelial Keratoplasty

Gibbons¹,

Chang²,

Yannuzzi³

2020

International Ophthalmology Clinics

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Endothelial keratoplasty is the most commonly performed type of corneal transplant in the United States, currently accounting for 60% of total grafts. The anterior segment complications are well documented; however, the posterior segment complications may not be as familiar to the anterior segment surgeon. These include endophthalmitis, cystoid macular edema (CME), choroidal detachment, graft dislocation to the posterior segment, and retinal detachment. CME is the most common postoperative retinal complication with a reported incidence of up to 12.5%, which usually responds well to topical therapy. This article will review the incidence, prevention and management of posterior segment complications after endothelial keratoplasty.

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“…2,5 Up to 1.5% of corneal tissues have positive fungal rim cultures, with Candida species being the most commonly identified organisms, with 5.6% to 13.5% of patients subsequently developing clinical infections. [2][3][4][5][6][7][8][9] In the United States, corneal tissue is most commonly stored at hypothermic conditions (4 C) for up to 14 days in antibiotic-supplemented cold storage media (CSM). 8,10 The risk of infection increases after 3 days of storage, so most grafts are used quickly.…”

mentioning

confidence: 99%

Cost-Effectiveness of Antifungal Supplementation of Corneal Cold Storage Media

2020

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Purpose: To evaluate the cost-effectiveness of supplementing hypothermic cold storage media (CSM) with antifungal therapy.Design: Cost-effectiveness analysis (CEA). Participant: Base case of a patient with Fuch's endothelial dystrophy undergoing a first eye keratoplasty. Methods: Cost-effective analysis of the base case with corneal tissue stored in CSM or CSM supplemented with antifungal therapy over a 16-year time horizon. Multiple clinical scenarios were considered, including endothelial keratoplasty (EK) and penetrating keratoplasty (PK); amphotericin B, voriconazole, caspofungin, and combination therapy; and third-party payer and societal perspectives. The incidences were derived from PubMed literature searches and average wholesale prices of medications; all costs were discounted 3% per annum and adjusted for inflation to 2019 US dollars.Main Outcome Measures: Incremental cost-effectiveness ratios (ICERs).Results: In the reference case, a corneal endothelial graft stored in amphotericin Besupplemented CSM was the most cost-effective approach from a third-party payer and societal perspective. Probability sensitivity analysis (PSA) of the societal model for the EK was robust, with 93.5% being below an arbitrary willingness-to-pay threshold (WTP) of $20 000 per fungal infection averted. Voriconazole, caspofungin, and combination antifungals were less cost-effective than amphotericin B. The main factors influencing the CEA were the incidences of postkeratoplasty fungal infections, potential increases in graft failures, and antifungal costs. For grafts intended for PKs, antifungal supplementation was less cost-effective than for EKs.Conclusions: Antifungal supplementation with amphotericin B for EK grafts was the most cost-effective approach of the studied antifungals; however, the CEA was sensitive to potential changes in graft failure rates, underlining the importance of long-term safety studies. For full-thickness corneal grafts, antifungal supplementation was less cost-effective.

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Increasing Povidone-Iodine Exposure in Endothelial Keratoplasty Tissue Processing and Fungal Infection Impact

Cited by 16 publications

References 8 publications

Endophthalmitis secondary to donor to host infection in posterior lamellar keratoplasties: A systematic review

Endophthalmitis secondary to donor to host infection in posterior lamellar keratoplasties: A systematic review

Posterior Segment Complications of Endothelial Keratoplasty

Cost-Effectiveness of Antifungal Supplementation of Corneal Cold Storage Media

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