A Cluster of Fungal Corneal Transplant Infections, and the Surprisingly High Rate of Positive Cultures from Banked Corneal Tissue

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Background. Due to changes in corneal transplant techniques, most procedures are now done with pre-cut donor tissue from centralized eye banks. Cultures of the donor tissue are rarely performed at the time of implantation. We describe a cluster of patients who sustained fungal infections at the corneal transplant interface, and the surprising percentage of positive cultures from banked tissue. Methods. From 2012 to 2014, two post-operative candidal infections were identified in corneal transplant recipients in our institution, both performed by a single surgeon. This surgeon had a practice of routinely culturing the unused corneal rim tissue at the time of implantation. An outbreak investigation ensued. Results. Two confirmed case of fungal keratitis and additional two corneal rim cultures positive for fungi were identified in transplanted patients related to banked corneal tissue from a single tissue bank. Nine out of 99 routine cultures of eye bank corneal tissue also recovered fungal species, for a percentage of 9.1%. The most common fungal pathogen identified was candidal species. Of the two patients with proven invasive fungal eye infections, the organism was matched to the culture from the banked tissue taken prior to implantation. No lapses in surgical technique or infection prevention procedures were identified during the investigation of these cases. Conclusion. Surprisingly, nearly 1 in 10 corneas from banked donor tissue may be positive for fungal pathogens. While post-transplant infection rates are not nearly as high, there were two proven post-op invasive candidal infections with the same organism as found in the banked tissue, and two additional probable/possible infections. Further research is indicated to better understand the risk of fungal infection associated with with lamellar corneal transplantation, and the impact of centralized banked donor tissue and associated pre-implantation graft preservation techniques. It is important to consider fungal pathogens in the differential diagnosis of post-corneal transplant infections. Disclosures. All authors: No reported disclosures.

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