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Report of the Eye Bank Association of America Medical Advisory Board Subcommittee on Fungal Infection After Corneal Transplantation

Aldave, Anthony J. MD; DeMatteo, Jennifer MCM, CIC; Glasser, David B. MD; Tu, Elmer Y. MD; Iliakis, Bernardino MHA, CEBT; Nordlund, Michael L. MD, PhD; Misko, Jachin CEBT; Verdier, David D. MD; Yu, Fei PhD

doi: 10.1097/ICO.0b013e31825e83bf
Clinical Science

Purpose: To investigate the incidence of fungal infections after corneal transplantation to determine whether storage media supplementation with an antifungal should be considered.

Methods: Adverse reactions reported to the Eye Bank Association of America through the online adverse reaction reporting system between January 1, 2007, and December 31, 2010, were reviewed to identify cases of recipient fungal infection. Data were collected regarding the donor, the donor cornea, recovery and processing, and mate culture and clinical course of the recipients.

Results: Thirty-one cases of culture-proven fungal keratitis (n = 14) and endophthalmitis (n = 17) were reported out of 221,664 corneal transplants performed using corneal tissue distributed by domestic eye banks (1.4 cases per 10,000 transplants performed). Although the annual incidence of postkeratoplasty fungal infection has not increased significantly since 2005, a trend toward an increasing rate of fungal infection has been observed. Fungal infections were more commonly reported after endothelial keratoplasty procedures (0.022%) than penetrating keratoplasty procedures (0.012%), but the difference was not statistically significant (P = 0.076). Additionally, no association was found between fungal infection after endothelial keratoplasty and whether the lamellar tissue cut was performed by the surgeon or the eye bank technician. Seventy-three percent (16 of 22) of the fungal cultures performed on the mate corneas were positive, with infection developing in 67% (10 of 15) of recipient eyes (endophthalmitis in 6 eyes and keratitis in 4 eyes).

Conclusions: Although a nonsignificant increasing trend in the rate of fungal infection has been observed over the past 6 years, it is not sufficiently compelling to pursue antifungal supplementation of donor storage media.

*The Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA

Eye Bank Association of America, Washington, DC

Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD and

§Patapsco Eye MDs, Columbia, MD

Department of Ophthalmology, University of Illinois Eye and Ear Infirmary, Chicago, IL

SightLife, Seattle, WA

**Cincinnati Eye Institute, Cincinnati, OH

††Heartland Lions Eye Bank, Columbia, MO

‡‡Verdier Eye Center, Grand Rapids, MI.

Reprints: Anthony J. Aldave, Jules Stein Eye Institute, 100 Stein Plaza, UCLA, Los Angeles, CA 90095 (e-mail:

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

Received October 10, 2011

Accepted May 8, 2012

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