Incidence and Implications of Culture-Positive Corneoscleral Rims in Corneal Transplantation.

Abstract

Background: Corneal transplantation is a critical procedure for restoring vision affected by different corneal pathologies. However, postoperative infections threaten graft survival, particularly microbial keratitis and endophthalmitis.

Objective: This study aims to evaluate the incidence of culture-positive corneoscleral rims (CPCR) among transplanted corneas at a tertiary eye hospital and explore its association with death-preservation and preservation-surgery times.

Methods: A retrospective analysis of keratoplasty surgeries performed in 2015 was conducted, involving 603 cases meeting the study criteria.

Results: The incidence of CPCR was found to be 4.6%, predominantly bacterial (68%), with Methicillin-resistant Staphylococcus epidermidis (MRSE) being the most common isolate, followed by fungal (32%) species, notably Candida. However, none of the cases developed subsequent keratitis or endophthalmitis post-transplantation. Statistical analysis revealed no significant association between CPCR occurrence and death-preservation or preservation-surgery times.

Conclusion: The study underscores the reduced impact of contaminated CPCR on graft outcomes, advocating for targeted fungal culturing, intraoperative practices to mitigate post-transplant infections, and maintaining current prophylactic antibiotic regimens, such as optisolGS ™, which contains streptomycin and gentamicin.