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Risk Factors for Donor Cornea Contamination: Retrospective Analysis of 4546 Procured Corneas in a Single Eye Bank

Linke, Stephan J. MD; Fricke, Otto H. MD; Eddy, Mau-Thek MD; Bednarz, Jürgen PhD; Druchkiv, Vasyl BA; Kaulfers, Paul-Michael MD; Wulff, Birgit MD; Püschel, Klaus MD; Richard, Gisbert MD; Hellwinkel, Olaf J. C. PhD

doi: 10.1097/ICO.0b013e31825d586b
Clinical Science

Purpose: Microbiological contamination is a common cause for elimination of organ-cultured donor corneas. The aims of the present study were to analyze contamination rates and identify risk factors for contamination.

Methods: Retrospectively, the contamination rates of 4546 organ-cultured corneas and the causative species were studied. The impact of sex, age, death-to-explantation interval, explantation technique, cause of death, and mean monthly temperature on contamination rate was analyzed.

Results: The median annual contamination rate was 5.3% (range: 3%–19%). Most contaminations were of fungal origin (61.9%), with Candida species (45%) being predominant. Bacterial contaminations (34.4%) were dominated by Staphylococcus species (12.8%). Sex, donor age, and mean monthly temperature had no statistically significant influence on the contamination rate. The median death-to-explantation interval of contaminated corneas (44 hours) was longer than that of sterile corneas (39 hours; P < 0.001; n = 4437). Cardiopulmonary failure was associated with the highest contamination rate (13.6%) of all death causes. The switch from whole globe to in situ excision was followed by a temporary increase in contamination rate (12.5%–19.4%).

Conclusions: Although the genesis of donor cornea contamination seems to be multifactorial, resident species from physiological skin flora are the main contaminants indicating that the donor corpses could be the main source of microbiological contamination. A change in the explantation technique was followed by an increase in the contamination rate.

*Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

t2Cure GmbH, Frankfurt, Germany

Departments of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf

§Forensic Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Reprints: Stephan J. Linke, Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Building W40, Martinistr. 52, Hamburg 20246, Germany (e-mail: slinke@uke.uni-hamburg.de).

The first and the second authors contributed equally to this work.

The authors have no funding or conflicts of interest to disclose.

Received October 11, 2011

Accepted May 2, 2012

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.