A case series of donor tissue-transmitted keratitis and endophthalmitis following Descemet stripping automated endothelial keratoplasty

Abstract

Donor-transmitted infection is one of the most dreaded complications after cornea transplant. We report four cases of fulminant graft infection with endophthalmitis following descemet stripping automated endothelial keratoplasty (DSAEK); all of these resulted from donor contamination by multidrug-resistant gram-negative bacteria (Pseudomonas in two cases, Proteus and Enterobacter in the other two). All donor corneas were retrieved in hospital premises, either ward or mortuary suggesting a possible nosocomial origin of these microorganisms. All four patients required surgical intervention for control of infection and had dismal clinical outcomes. Furthermore, in three cases, mate cornea also showed similar contamination, and additional two of these recipients also developed graft infection indicating an infection rate as high as 86%. This case series highlights an important issue of fulminant nosocomial donor cornea-related infections, possible despite standard precautions, with emergence of multidrug-resistant virulent pathogens. Adequate training of eye bank and health-care personnel and ensuing stringent protocols for retrieval and storage of corneas may help in reducing such sight-threatening adverse reactions and also consequent further ramifications.