Propionibacterium Acnes Infection Following Lamellar Keratoplasty: The Importance Of Donor Tissue Bacterial Cultures And Pcr Testing

To present a rare case of Propionibacterium acnes lamellar graft infection in two patients from the same corneal donor, demonstrating the critical role of routine bacterial cultures and PCR testing in identifying post-keratoplasty infections.

Ophthalmology department performing corneal transplantations.

Case report of two patients who received lamellar corneal transplants from the same donor. An 82-year-old male with Fuchs' dystrophy received a DSAEK graft, while a 79-year-old female with endothelial failure post-cataract surgery received a DMEK graft. At two months, almost simultaneously, both patients presented with endothelial graft infection, stromal infiltrates, and keratic precipitates. Both patients were admitted to the ophthalmology department and underwent Tap and Inject procedures with Vancomycin and Vigamox. PCR testing from both patients revealed no identifiable pathogen. 

The donor tissue harvesting and preparation procedures were reviewed, and the vitreous tap, collected during harvesting, was found to be sterile. However, bacterial culture from the corneal graft margin revealed Propionibacterium acnes. Following this identification of the pathogen in the donor tissue, an intense antibiotic treatment regimen was targeted specifically against Propionibacterium acnes. Both patients experienced significant clinical improvement with targeted antibiotic therapy, avoiding the need for lamellar graft removal.

This case demonstrates the critical role of bacterial cultures and PCR testing of donor corneal tissue in identifying pathogens and guiding appropriate treatment.The identification of Propionibacterium acnes in this case was crucial in guiding appropriate antibiotic therapy. This avoided unnecessary and prolonged antifungal treatment, which is often employed in cases of indolent graft infection that can mimic fungal infections. This case strongly supports the implementation of routine bacterial culture and PCR testing of donor corneal tissue to improve post-transplant outcomes and optimize patient care.