Fungal infection after PKP CMC Department of Ophthalmology and Visual Science Fungal infection after PKP Su-Young Kim Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea
Endophthalmitis after PKP Incidence :0.05% to 0.4% Bacterial : fungal = 8 : 2 M/C : Staphylococcus Epidermidis Candida fungal endophthalmitis is more concordant than bacterial endophthalmitis in aspect of the rim culture and patient cultures
Relative annual percentage of fungal and bacterial PKP endophthalmitis by USA 2005 AJO
Candida endophthalmitis after PKP Recipient : keratoconus Donor : CHF, COPD POD 2 day : edema, fibrin, white exudate Ant. Chamber, donor rim : candida Intracameral injection of 5 ug amphotericin B Fluconazole 400mg , 0.3 % topical ampho. Q1hr. POD 3 day : rePKP, injection of ampho ->fail, HM 2001 Cornea
Culture positivity of the donor rim Optisol-G : 14-29% Gentamicin resistance : 60-70% Optisol-GS : 11% Optisol-GS + moxifloxacin : 2.5% (2006 cornea) In an effort to eradicate donor contamination, Optisol-GS® mixed with moxifloxacin (250µg/ml) plus voriconazole (100µg/ml) may be the optimal choice.
Safety of Moxifloxacin and Voriconazole in Corneal Storage Media on Porcine Corneal endothelial cells Porcine cornea : 28 eyes Control group (C group) : Optisol-GS® for 3 days M group : Optisol-GS® + 250µg/ml moxifloxacin V group : Optisol-GS® + 100µg/ml voriconazole MV group : Optisol-GS® + moxi + vori Specular microscopy SEM
Endothelial cell count before & after 3 days of preservation C group M group V group MV group Mean endothelial cell counts before preservation 4082 ±253.8 3859 ±281.6 3843 ±265.7 3986 ±244.9 P value P = 0.299 Mean endothelial cell counts after preservation 3964 ±284.2 3564 ±518.9 3443 ±435.5 3307 ±196.9 P=0.228 P=0.075 P=0.017 Rate of endothelial cell loss after 3 days of preservation (%±SD) 2.9 ±0.02 8.0 ±0.09 10.2 ±0.10 16.7 ±0.08 P=0.649 P=0.346 P=0.021
SEM of the porcine endothelium after 3 days of preservation MV
Supplementary antibiotics in corneal storage media Preservation in Optisol-GS® mixed with moxifloxacin (250µg/ml) or voriconazole (100µg/ml) did not show significant toxicity on the endothelial cells compared with the control group in porcine corneas. Preservation in Optisol-GS® mixed with moxifloxacin (250µg/ml) plus voriconazole (100µg/ml) showed significant toxicity on the endothelial cells compared with the control group in porcine corneas.
What is appropriate choice? moxi or vori Fungal concordance rate > bacterial concordance rate Postop. Bacterial antiboitics routinely use , not antifungal agent Voriconazole in Optisol GS Risk of fungal contamination Donors : cardiac disease, cancer, prolonged ventilator Op time : June, July Preservation to surgery time > 5 days Povidone iodine 1.0% to decontaminate the globe : candida 85.7% ↓