One of the most dreaded complications of penetrating keratoplasty is postoperative endophthalmitis, the incidence of which has been reported to be approximately 0.2% to 0.77%.1 Of these, 75% have been reported to be bacterial in origin whereas 20% have a fungal etiology.2 Several improvements have been made in both preoperative and intraoperative processes to reduce the rate of postoperative endophthalmitis. These have been standardized by the Eye Bank Association of America (EBAA) and have included:
- The addition of streptomycin to gentamicin in the corneal storage medium (July 1993, Optisol GS versus historical Optisol, Bausch and Lomb, Irvine, CA)
- A shift to in-situ excision of donor corneoscleral tissue rather than enucleation (this shift began in mid-1995)
- The addition of whole globe immersion in 5% povidone-iodine for 2 minutes followed by 2 rinses in sterile saline (January 1996)
- Serial irrigation of donor eyes with povidone-iodine eye drops (June 1997)
- The cold storage of tissue in its preservative medium at 4° C.3
However, even with these changes, postoperative endophthalmitis has not been eliminated and the surgeon continues to endure the question of whether to perform donor corneoscleral rim cultures at the time of surgery.