Ocular Microbiology and Immunology Group
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2015 OMIG Abstract 20

Candida interface infections among a cluster of positive fungal corneoscleral rim cultures used in Descemet’s stripping automated endothelial keratoplasty
Edmund Tsui, MD^1,2, Erin Fogel, MD³, Katrina Hansen, MPH⁴, Elizabeth A. Talbot, MD^4,5,
Roza Tammer, MPH⁴, Elizabeth R. Daly, MPH⁴, James Noble, MD⁶, Lynda Caine, MPH⁶, Jessa Fogel⁷, Michael E. Zegans, MD^1,5
1Dartmouth-Hitchcock Medical Center, ²New York University School of Medicine, ³Concord Eye Center,
⁴New Hampshire Department of Health and Human Services, ⁵Geisel School of Medicine at Dartmouth,
⁶Concord Hospital, ⁷Dartmouth College

Purpose: To describe two Candida interface keratitis infections occurring in the setting of positive donor rim cultures from pre-cut corneal tissue used for Descemet’s stripping automated endothelial keratoplasty (DSAEK) and the ensuing public health investigation.

Methods: Following two clinical Candida interface keratitis infections, patients from 2012-2014 in the same surgical center were evaluated for bacterial and fungal rim cultures and subsequent infection. All cases of fungal infections occurring post-DSAEK were analyzed. Data included patient demographics, surgical technique, donor rim cultures, donor mate outcomes, clinical courses and outcomes. A review of the relevant literature was also undertaken.

Results: From 2012-2014, among 99 DSAEK procedures performed, 7 (7.1%) of the donor rim cultures were positive for fungi. Use of this tissue with positive donor rim cultures resulted in two (28.6%) episodes of confirmed fungal interface keratitis, both Candida species, and presumptive treatment in an additional two patients. An investigation did not identify any breach in sterile technique or procedures. Our literature review of case report data documented 15 reports of post-operative fungal infection associated with DSAEK, of which 11 involved Candida spp.

Conclusions: This report of correlated rim cultures and clinical infection suggest a need for re-evaluation of the utility of obtaining routine corneoscleral donor rim fungal culture. Furthermore, our cases along with those previously reported suggest that DSAEK utilizing pre-cut tissue may be particularly susceptible to infection with Candida spp. 
Disclosure: N

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