Bacterial And Fungal Culture Positivity Of Preservation Media For Imported Donor Corneas In South Korea: Rates And Associated Factors

To determine bacterial and fungal culture positivity of preservation media from imported donor corneas used in South Korea, to identify donor- and preservation-related factors associated with culture results, and to evaluate postoperative infection after corneal transplantation.

This retrospective study included 125 imported donor corneas used for corneal transplantation at Seoul National University Hospital. Preservation media included Optisol-GS (n=56), Life4C (n=50), Eusol-C (n=12), and Kerasave (n=7). Postoperative infections were assessed for 1 year using medical records.

Preservation medium from each donor cornea was directly inoculated onto bacterial and fungal culture media in the operating room. Cases were classified as culture-positive or culture-negative and compared according to transplantation type, preservation medium type, donor age, death-to-preservation time, death-to-surgery time, duration of ventilator use, and endothelial cell density (ECD). All recipients were followed for 1 year for postoperative infection.

Transplantation procedures included PKP (n=73), DSAEK (n=22), and DMEK (n=30). Positive cultures were identified in 12 of 125 samples (9.6%). All isolates were Gram-positive bacteria, and no fungal growth was detected. Transplantation type and preservation medium type were not significantly associated with culture results. Donor age (52±13 years), death-to-preservation time (675±264 minutes), death-to-surgery time (127±18 hours), ventilator duration (2±3 days), and ECD (2856±279 cells/mm²) did not differ significantly between culture-positive and culture-negative groups. No recipient in the culture-positive group developed postoperative infection during the 1-year follow-up.

Preservation media from imported donor corneas demonstrated a 9.6% culture-positivity rate, with exclusively Gram-positive bacterial isolates and no fungal growth. Culture positivity was not associated with donor characteristics or preservation-related factors and did not result in postoperative infection during follow-up. The absence of Gram-negative isolates may be related to antibiotic components in the preservation media, such as gentamicin and streptomycin. Overall, imported donor corneal transplantation demonstrated favorable clinical safety; however, careful monitoring for potential infection remains necessary.