1. 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

2. 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

3. Relative annual percentage of fungal and bacterial PKP endophthalmitis by USA
2005 AJO

4. 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

5. 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.

6. 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

7. 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

8. SEM of the porcine endothelium after 3 days of preservationMV

9. 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.

10. 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% ↓