Endophthalmitis secondary to donor to host infection in posterior lamellar keratoplasties: A systematic review

Jesus Maticorena-Quevedo, Alexander Anduaga-Beramendi, Renato Beas, José Canahuire-Cairo, Rubén D. Berrospi, Alejandro Tello

Research output: Articles / NotesScientific Articlepeer-review


Donor to host transmission of infectious agents is a well-recognized entity, more commonly related to Endothelial Keratoplasty (EK) than to Penetrating Keratoplasty (PK), that involves complications ranging from interface keratitis to endophthalmitis. A systematic review of the literature was conducted to identify the published articles until December 2020 reporting cases of endophthalmitis secondary to corneal graft contamination in posterior lamellar keratoplasties (DSAEK and DMEK) along with donor characteristics, microbiological profile, treatment and outcomes. Each identified article was assessed to meet donor to host infection criteria, defined as a post-procedural infection in which the same microbiological agent was identified in both the donor corneoscleral rim or preservation medium and receptor ocular tissue. From 23 research articles, eight reports of endophthalmitis in nine patients following DSAEK or DMEK secondary to donor to host infection fulfilled the inclusion criteria. The majority were male and the median age was 72.0 (45.0–81.0) years old. Indications of surgery were primarily pseudophakic bullous keratopathy and Fuchs dystrophy. A fungal pathogen was identified in eight of nine patients. All the cases underwent surgical management with lenticule removal or endothelial plaque aspiration. The final corrected distance visual acuity (CDVA) in all cases was 20/200 or better. Endophthalmitis after an EK procedure is a rare complication whose outcome depends on the aggressive and precocious treatment. Identification of early signs of interface keratitis and lenticule removal seems mandatory in patients undergoing DSAEK or DMEK to prevent further involvement of the globe.

Original languageEnglish
Pages (from-to)3163-3173
Number of pages11
JournalEuropean Journal of Ophthalmology
Issue number6
StatePublished - 11 Mar 2022


  • cornea
  • descemet membrane endothelial keratoplasty
  • descemet stripping automated endothelial keratoplasty
  • endophthalmitis
  • interface infection


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