Post on 13-Jan-2016
To study demographic profile of eye donors and to evaluate clinical and microbiological
spectrum of donor corneas
Namrata Sharma,Amarendra Samal, Rasik Vajpayee,Jeewan S Titiyal, Radhika Tandon,Gita Satpathy,Seema Sen
Dr. R.P. Centre for Ophthalmic SciencesAIIMS,New Delhi
None of the authors have any financial/ proprietary interest
National eye bank, RPC 600-700 eyes obtained annually
Current method of decontamination : Amikacin + Betadine
Emergence of resistance to gentamicin and amikacin
Gatifloxacin is 4th generation fluoroquinolone, acts by inhibiting DNA gyrase enzyme
To evaluate Demographic profile of eye donors Clinical & microbiological profile of donor corneas
Efficacy of 0.3 % gatifloxacin in decontamination of donor corneas
Inclusion criteria Donor eyes received at National Eye Bank,RPC
between March 2005 & August 2006 Exclusion criteria
Eyes received from areas other than Delhi Long death processing time(>30hr) Eyes with poor endothelial status Positive donors with HIV,HBsAg,HCV,Syphilis
1st swabs (A1:Right &B1:Left eye ) 1% Betadine for 3min+ 1% Amikacin for next 3min Saline wash 2nd swabs (A2:Right & B2:Left eye) Right eye :0.3% Gatifloxacin,5-8 eye drops over 5
mins 3rd swab taken (A3) Corneal button were excised and stored in MK media
513 pairs of eyes ( 1026 eyes ) 16 pairs of eyes : Systemic malignancy 8 pairs of eyes : Confirmed septicemic donors
Prior pledging were obtained in 1.6% cases Prior knowledge about eye donation were
obtained 58 % : Grief Counselling 42% : Self Motivation
Grade Descemet’s folds Corneal thickness Stromal hazeExcellent (A+) None Nil NilVery good (A) None Increased 10% Nil
Good (B+)
Mild peripheral descemet’s fold
Few paracentral folds, disappear on pressure
Increase 10-25% Nil
Fair (B)
Moderate peripheral folds and Few central folds that disappear on pressure
Increase 25-33%Mild stromal edema +
NSFS (B–)Folds reaching center persist with increase in pressure
Increase 33-50% Edema ++
Total no. of eyes = 513 pairs
45
50 50 50
48 48.4
40.3
40.2
5
27.2
28.5
0
10
20
30
40
50
Per
cen
tag
e
< 1 yr 1-10 yr 10-40 yr 40-70 yr > 70 yr
Optical grade
% of total donor
2765
2240
.254
38.5
3952
10
5155
7.2
37.2
5 508
100
500.
5
47.3 55
19.9
0
20
40
60
80
100
Perc
enta
ge
Natural Ch.illness
Sepsis CHD
Optical grade
Culture
% of total
11stst swab RT swab RT 22ndnd swab RT swab RT 33rdrd swab RT swab RT 11stst swab LT swab LT 22ndnd swab LT swab LT
PseudomoPseudomo 30.430.4 27.127.1 13.313.3 31.231.2 27.927.9
St. albSt. alb 1616 12.712.7 4.34.3 11.711.7 9.29.2
AlkligensAlkligens 2.92.9 2.72.7 00 3.13.1 2.32.3
EnerocociEnerococi 1.21.2 1.21.2 0.60.6 1.21.2 0.60.6
St. aureusSt. aureus 1.91.9 1.21.2 1.41.4 2.12.1 1.81.8
St. viridansSt. viridans 0.60.6 0.40.4 0.20.2 0.60.6 0.40.4
AcinebacteAcinebacte 2.32.3 1.61.6 1.61.6 1.61.6 1.81.8
E. ColiE. Coli 1.41.4 0.80.8 0.20.2 0.60.6 0.20.2
KlebsiellaKlebsiella 1.41.4 0.40.4 0.20.2 1.61.6 0.40.4
PneumocoPneumoco 0.60.6 0.60.6 0.40.4 0.60.6 0.60.6
CandidaCandida 0.20.2 0.40.4 0.20.2 0.40.4 0.60.6
FusariumFusarium 00 00 0.20.2 00 00
PreptocociPreptococi 1.21.2 0.40.4 0.40.4 0.80.8 0.40.4
MicrocociMicrococi 0.20.2 0.80.8 0.40.4 00 0.20.2
Growth +veGrowth +ve 6060 50.350.3 23.223.2 55.455.4 46.446.4
A1 & A2 i.e. p = 0.155 A2 & A3 i.e. p = 0.001 A2 & B2 i.e. p = 0.571 B2 & A3 i.e. p = 0.001 A1 & B1 i.e. p = 0.471 A1 & A3 i.e. p = 0.001
Most common:Pseudomonas(52%),Staphylococcus albus(24%)
No difference between left and right eye (p=0.153)
Significant difference in culture positivity in both eyes after treatment with betadine(p=0.002 & 0.049 in rt & lt eyes )
Significant difference(p=0.001) found in culture positivity after treatment with gatifloxacin
A1A1 A2A2 A3A3 B1B1 B2B2 Avg.Avg.
PseudomoPseudomo 92.292.2 8888 9292 9494 95.595.5 9292
St. albSt. alb 97.597.5 92.592.5 100100 9595 91.191.1 95.295.2
AlkligensAlkligens 93.393.3 100100 100100 100100 100100 9999
EnerocociEnerococi 100100 100100 100100 100100 100100 100100
St. aureusSt. aureus 9090 7878 85.785.7 100100 8888 86.386.3
St. viridansSt. viridans 100100 100100 100100 100100 100100 100100
AcinebacteAcinebacte 100100 100100 100100 100100 100100 100100
E. ColiE. Coli 100100 100100 100100 100100 100100 100100
KlebsiellaKlebsiella 100100 100100 100100 100100 100100 100100
PneumocoPneumoco 100100 100100 100100 100100 100100 100100
PreptocociPreptococi 100100 100100 100100 100100 100100 100100
MicrocociMicrococi 100100 100100 100100 100100 100100 100100
19 pairs of eyes found to have multiple drug resistance to all 4 drugs used
All are sensitive to Polymyxin B 5 pairs were sensitive to amikacin 63%were accidental death with young donor 65% were of death enucleation time less
than 6hr
Gatifloxacin 0.3 % can be used effectively for microbial contamination of donor eyes