Brothers KM, et al. - This research examined if the eyebank-processed endothelial keratoplasty tissue was at greater risk of contamination than unprocessed tissue and to model the eyebank processing in terms of room temperature exposure on Candida growth in optisol–gentamicin and streptomycin (GS) with and without antifungal supplementation. The endothelial keratoplasty tissue revealed detectable Candida growth in donor rim cultures, related to a higher rate of post-keratoplasty infection than with other uses at the time of transplantation. This appeared to be partly attributed to the eyebank preparation processes extending the time of tissue warming. A decrease was noted in the growth of Candida species in optisol-GS through therReduced room temperature incubation and the addition of antifungal agents. This finding warranted advanced studies in order to reduce the risk of infection.

Methods

• This study undertook an assessment of the 2013 Eversight Eyebank Study follow-up database for the risk factors related to post-keratoplasty infection.
• An increased risk was detected of the positive fungal rim culture results in tissue processed for endothelial keratoplasty vs unprocessed tissue.
• Processing steps at room temperature were presented as a potential risk factor for promotion of fungal growth between these 2 processes.
• During this trial, Candida albicans, Candida glabrata, and Candida parapsilosis endophthalmitis isolates were each inoculated into optisol-GS and subjected to 2 different room temperature incubation regimens reflective of current corneal tissue handling protocols.
• The main outcome comprised of the Eversight Eyebank Study outcomes and measures which were follow-up inquiries from 6592 corneal transplants.
• The fungal colony–forming units from inoculated vials of optisol-GS taken at 2 different processing temperatures were the efficacy study outcomes and measures.

Results

• Donor rim culture results exhibited 3 times greater tendency of being positive for fungi in endothelial keratoplasty-processed eyes (1.14%) than for other uses (0.37%) (difference, 0.77%; 95% CI, 0.17-.1.37) (P = .009).
• In vitro, increased room temperature incubation of optisol-GS caused a rise in the growth of Candida species over time.
• Decreased growth of Candida in a species-dependent manner was yielded through the addition of caspofungin and voriconazole.