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Clostridium perfringens Endophthalmitis After Penetrating Keratoplasty With Contaminated Corneal Allografts

A Case Series

Hou, Joshua H. MD; Tannan, Anjali MD; Rubenstein, Jonathan B. MD; Lopez, Osvaldo I. MD; McCoy, Kristen CEBT; Epstein, Randy J. MD; Grostern, Richard J. MD; Sugar, Joel MD

doi: 10.1097/ICO.0000000000000303
Clinical Science
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Purpose: To report the postoperative clinical course of 3 patients who underwent corneal transplantation with corneal allografts contaminated with Clostridium perfringens and to evaluate the risk factors for anaerobic contamination in 2 donors.

Methods: Patient records and adverse reaction reports from a single eye bank related to cases of posttransplant C. perfringens endophthalmitis were reviewed. Records regarding the mated corneas, donor autopsy reports, and other pertinent data were also reviewed.

Results: Three adverse reactions associated with transplantation of corneal allografts contaminated with C. perfringens were reported. Two cases were from mated corneas. Both patients developed fulminant endophthalmitis after undergoing uncomplicated penetrating keratoplasty and required subsequent enucleation. Another isolated case (with no adverse reaction in the mate cornea) developed hypopyon postoperatively that resolved with intravitreal and topical antibiotics. Possible risk factors for anaerobic tissue contamination in the donors included illicit drug use in the first donor and exposure to sewage at the time of death in the second donor.

Conclusions: Clostridial endophthalmitis is an aggressive rapidly progressive infection with potentially poor visual outcomes that can be transmitted from infected corneal allografts. Further investigation is needed to clarify the role of anaerobic donor rim cultures and the donor risk factors associated with recovering corneal allograft tissue contaminated with C. perfringens.

*Department of Ophthalmology and Visual Sciences, University of Illinois Eye and Ear Infirmary, Chicago, IL;

Department of Ophthalmology, Rush University Medical Center, Chicago, IL;

Chicago Eye Institute, Chicago, IL; and

§Midwest Eye-Banks, Ann Arbor, MI.

Reprints: Joel Sugar, MD, 1855 W. Taylor St, Suite 3.164, Chicago, IL 60612 (e-mail: joelsuga@uic.edu).

Supported in part by an unrestricted grant to the Department of Ophthalmology, University of Illinois Eye and Ear Infirmary, from Research to Prevent Blindness.

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

Received June 17, 2014

Received in revised form September 23, 2014

Accepted September 28, 2014

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.