Corneoscleral rim cultures - Lack of utility and implications for clinicaldecision-making, and infection prevention in the care of patients undergoing corneal transplantation

Purpose. To assess the utility of donor corneoscleral rim cultures. Methods . A retrospective review of the culture results of 774 corneoscleral rims t hat remained after trephination of corneas for transplantation into patient s at our academic medical center between January 1992 and November 1997. Re sults. Forty-one (5.3%) corneoscleral rim cultures yielded microorganisms, mostly coagulase-negative staphylococci. Two patients developed endophthalm itis (one with Staphylococcus aureus and one with Pseudomonas aeruginosa) w ithin 3 months after transplantation; each had a negative corneoscleral rim culture and neither patient's infection was temporally related to the tran splant procedure. Conclusions. Preoperative donor corneoscleral rim culture s are unreliable predictors of endophthalmitis complicating corneal transpl antation and, therefore, are not useful in the clinical management of patie nts having corneal transplants. Moreover, the discrepancy between the resul ts of corneoscleral rim cultures and subsequent endophthalmitis renders the m invalid as a quality assurance procedure. Instead, for patients with susp ected endophthalmitis after corneal transplantation, we recommend that corn eal surgeons select antimicrobial therapy based on current guidelines and t he results of directed sampling. Furthermore, eye banks should prospectivel y track recipients who develop clinical endophthalmitis. immediately notify the corneal surgeon who transplanted the matched cornea of that used for t he index case, and, in selected situations, attempt to identify a possible source of contamination.