Endophthalmitis cluster from contaminated donor corneas following penetrating keratoplasty

OBJECTIVE: To attempt to identify common events or factors in four cases of endophthalmitis that developed after penetrating keratoplasty performed within a 1-week interval. DESIGN: Case series. SETTING: Tertiary care eye hospital in Riyadh, Saudi Arabia. PATIENTS: Four patients in whom endophthalmitis developed after penetrating keratoplasty performed in May 1993. OUTCOME MEASURES: Source of donor tissue, transportation of corneas, handling of corneas at the eye hospital, and causative organism and sensitivity profile. RESULTS: The donor tissue in all four cases originated from the same eye bank. Organisms were cultured from 10 of the 11 donor rims from eye bank A tissue used during the week in question. The causative organisms were Enterococcus faecalis in three patients and Torulopsis glabrata in one patient. In each case the same organism was cultured from the recipient eye and the corresponding donor rim. Two of the four patients had a favourable outcome. CONCLUSIONS: Donor rim culture is essential if the cause of endophthalmitis after penetrating keratoplasty is to be determined. Close communication between eye bank personnel, the microbiology laboratory and the operating surgeon is important as it may influence early detection, choice of treatment and outcome of endophthalmitis after penetrating keratoplasty. Epidemiologic studies from both the source eye bank and the recipient facility are required to fully investigate the cause of a cluster of endophthalmitis cases from contaminated donor tissue following penetrating keratoplasty.