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