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Increased vigilance urged after two cases of clostridial endophthalmitis
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Corneal transplants from donors with metastatic colon cancer carry a previously unrecognized risk, health officials said, after two cases of clostridial endophthalmitis were linked to a patient with the disease. Those cases were reported in the Centers for Disease Control and Prevention’s Dec. 5 issue of Morbidity and Mortality Weekly Report.
“Because corneas are not vascular, there’s a thinking that the contamination risk is very low,” Dan Jernigan, MD, a medical epidemiologist at the Division of Healthcare Quality Promotion at the CDC’s National Center for Infectious Disease, told Ocular Surgery News. “The main point for reporting this case was to raise awareness among those who make decisions about donors. It’s to cue them to really think long and hard about whether to use those corneas.”
Both recipients received the corneas on the same day at the same facility. Within hours, the first patient presented with severe eye pain, nausea and vomiting as well as increased IOP and decreased light perception. The second patient had decreased visual acuity to 20/400 at the 1-day follow-up and suspected early endophthalmitis.
Subsequent cultures obtained from both recipients and the donor found Clostridium perfringens, which tends to enter the eye through ocular trauma. The cases represent the first two incidents of clostridia-induced endophthalmitis in the United States since 1991, according to the Eye Bank Association of America (EBAA).
The presence of bacteria in a corneal culture is not predictive of whether the recipient will develop endophthalmitis, nor does a negative culture exclude this possibility, said David B. Glasser, MD, vice chairman of the medical advisory board of the EBAA. Dr. Glasser cited this statistic: While 5% to 20% of cultured corneas grow bacteria, the incidence of endophthalmitis from corneal transplantation is just 0.77%, comparable to the incidence rate in cataract surgery, despite the larger incision and added risk of introducing foreign tissue.
“If you eliminated all those corneas, you’d probably be eliminating a huge number of viable corneas without preventing significant, if any, cases of endophthalmitis,” Dr. Glasser said.
For more details of the report, see the Feb. 1 issue of Ocular Surgery News U.S. Edition.