Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Eye bank and theatre factors for positive microbiological culture of corneoscleral rim and cornea storage medium in the real-world



To evaluate microbiological culture rate and positivity of corneoscleral rim and cornea storage media as well as possible risk factors for contamination with real-world data.


Data of consecutive cornea donors implanted in the reference centre from January 2013 to January 2018 were reviewed. Information about cornea characteristics (donor demographic data, endothelial cell density, type of cornea conservation, days of storage, and precut vs full-thickness tissue), and microbiological culture information (corneoscleral rim vs storage sample, positive result) were statistically analysed.


During the study period, 1369 corneas (737 donors) were implanted. Cultures were performed in 76.8% (n = 1052) of them and were positive in 3.2% of cases, mainly bacteria (84.4%). Corneas preserved in hypothermia represented 61.8% of all positive microbiology results (p < 0.001). Other analysed risk factors did not reach statistically significant association with microbiological positivity. None of the 34 cases with positive microbiological cultures reported ocular infection for the recipients in at least 6 months’ follow-up.


Microbiological tests rate in real-world practice are high despite not being compulsory. Organotypic cultured corneas showed a statistically less positivity in corneoscleral and storage medium than hypothermic ones, resulting in another advantage of this kind of cornea storage. Although precut corneas are thought to present less microbiological positivity, a statistically significant association was not found in the present study.

This is a preview of subscription content, access via your institution

Access options

Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Fig. 1: Flowchart of the study design (real-world data).


  1. European Eye Bank Association. Annual Directory. 28th Edition. Venice, Italy; 2020.

  2. Builles N, Perraud M, Reverdy M, Burillon C, Crova P, Brun F, et al. Reducing contamination when removing and storing corneas: a multidisciplinary, transversal, and environmental approach. Cornea. 2006;25:185–92.

    Article  Google Scholar 

  3. Gruenert AK, Rosenbaum K, Geerlling G, Fuchsluger TA. The influence of donor factors on corneal organ culture contamination. Acta Ophthalmol. 2017;95:733–40.

    Article  Google Scholar 

  4. Röck D, Wude J, Bartz-Schmidt KU, Yoeruek E, Thaler S, Röck T. Factors influencing the contamination rate of human organ-cultured corneas. Acta Ophthalmol. 2017;95:e706–12.

    Article  Google Scholar 

  5. Rehany U, Balut G, Lefler E, Rumelt S. The Prevalence and Risk Factors for Donor Corneal Button. Cornea. 2004;23:649–54.

    Article  Google Scholar 

  6. Kloess PM, Stulting RD, Waring GO, Wilson LA. Bacterial and fungal endophthalmitis after penetrating keratoplasty. Am J Ophthalmol. 1993;115:309–16.

    CAS  Article  Google Scholar 

  7. Keyhani K, Seedor JA, Shah MK, Terraciano AJ, Ritterband DC. The incidence of fungal keratitis and endophthalmitis following penetrating keratoplasty. Cornea. 2005;24:288–91.

    Article  Google Scholar 

  8. Sharma RA, Park JSY, Wang Y, Zhang T, Sharpen L, Dixon W, et al. Association between positive corneal rim cultures and microbiology screening protocols in Ontario. Can J Ophthalmol. 2018;53:272–7.

    Article  Google Scholar 

  9. Chen JY, Jones MN, Srinivasan S, Neal TJ, Armitage WJ, Kaye SB. Endophthalmitis After Penetrating Keratoplasty. Ophthalmology. 2015;122:25–30.

    CAS  Article  Google Scholar 

  10. Hassan SS, Wilhelmus KR. Eye-banking risk factors for fungal endophthalmitis compared with bacterial endophthalmitis after corneal transplantation. Am J Ophthalmol. 2005;139:685–90.

    Article  Google Scholar 

  11. Leveille AS, McMullan FD, Cavanagh HD. Endophthalmitis following penetrating keratoplasty. Ophthalmology. 1983;90:38–9.

    CAS  Article  Google Scholar 

  12. Antonios S, Cameron J, Badr I, Habash N, Cotter J. Contamination of donor cornea: postpenetrating keratoplasty endophthalmitis. Cornea. 1991;10:217–20.

    CAS  Article  Google Scholar 

  13. Matsumoto M, Suzuma K, Miyamura N, Imamura N, Kitaoka T. Conjunctival swabs and corneoscleral rim cultures from corneal transplantation donors as possible early indicators for posttransplant endopthalmitis. Jpn J Ophthalmol. 2011;55:321–6.

    Article  Google Scholar 

  14. Kiatos E, Armstrong JJ, Hutnik CML, Tsioros SM, Malvankar-Mehta MS, Hodge WG. The value of corneoscleral rim cultures in keratoplasty: a systematic review and cost-effectiveness analysis. Clin Outcomes Res. 2017;9:459–74.

    Article  Google Scholar 

  15. Wilhelmus KR, Hassan SS. The prognostic role of donor corneoscleral rim cultures in corneal transplantation. Ophthalmology. 2007;114:440–5.

    Article  Google Scholar 

  16. Everts RJ, Fowler WC, Chang DH, Reller LB. Corneoscleral rim cultures: lack of utility and implications for clinical decision-making and infection prevention in the care of patients undergoing corneal transplantation. Cornea. 2001;20:586–9.

    CAS  Article  Google Scholar 

  17. Hajjar Sesé A, Lindegaard J, Julian HO, Højgaard-olsen K, Møller NF, Heegaard S. A presentation of culture-positive corneal donors and the effect on clinical outcomes. Graefe’s Arch Clin Exp Ophthalmol. 2019;257:135–41.

    Article  Google Scholar 

  18. Linke SJ, Fricke OH, Eddy M, Bednarz J, Druchkiv V, Kaulfers P, et al. Risk factors for donor cornea contamination: retrospective analysis of 4546 procured corneas in a single eye bank. Cornea. 2013;32:141–8.

    Article  Google Scholar 

  19. Linke SJ, Eddy M, Fricke OH, Wulff B, Schro A, Hassenstein A, et al. Thirty years of cornea cultivation: long-term experience in a single eye bank. Acta Ophthalmol. 2013;91:571–8.

    Article  Google Scholar 

  20. Zanetti E, Bruni A, Mucignat G, Camposampiero D, Frigo AC, Ponzin D. Bacterial contamination of human organ-cultured corneas. Cornea. 2005;24:603–7.

    Article  Google Scholar 

  21. Rauen MP, Goins KM, Sutphin JE, Kitzmann AS, Schmidt GA, Wagoner MD. Impact of eye bank lamellar tissue cutting for endothelial keratoplasty on bacterial and fungal corneoscleral donor rim cultures after corneal transplantation. Cornea. 2012;31:376–9.

    Article  Google Scholar 

  22. Mian SI, Aldave AJ, Tu EY, Ayres BD, Jeng BH, Macsai MS, et al. Infections in the cornea preservation time study. Cornea. 2018;37:1102–9.

    Article  Google Scholar 

  23. Palma-Carvajal F, Morales P, Salazar-Villegas A, Figueroa-Vercellino JP, Spencer F, Peraza-Nieves J, et al. Trends in corneal transplantation in a single center in Barcelona, Spain. Transitioning to DMEK. J Fr Ophtalmol. 2020;43:1–6.

    CAS  Article  PubMed  Google Scholar 

  24. Tsui E, Luong PM, Fogel J, Fogel ES, Zegans ME. Microbial analysis of donor corneoscleral rims and storage media. Ocul Immunol Inflamm. 2019;27:817–20.

    Article  Google Scholar 

  25. Nan-ni C, Pei-Lun W, Hung-Chi C, Tsung-Yu H, Li-Ju L. Prevalence of microbial contamination in donor corneas. Taiwan J Ophthalmol. 2019;9:179–84.

    Article  Google Scholar 

  26. Röck T, Hofmann J, Thaler S, Bramkamp M, Bartz-Schimdt K, Yoeruek E, et al. Factors that influence the suitability of human organ-cultured corneas. Graefe’s Arch Clin Exp Ophthalmol. 2016;254:135–41.

    Article  Google Scholar 

  27. Devasahayam R, Georges P, Hodge C, Treloggen J, Cooper S, Petsoglou C, et al. Implementation of organ culture storage of donor corneas: a 3 year study of its impact on the corneal transplant wait list at the Lions New South Wales Eye Bank. Cell Tissue Bank. 2016;17:377–85.

    Article  Google Scholar 

  28. Cunningham WJ, Moffatt SL, Brookes NH, Twohill HC, Pendergrast DGC, Stewart JM, et al. The New Zealand National Eye Bank Study: trends in the acquisition and storage of corneal tissue over the decade 2000 to 2009. Cornea. 2012;31:538–45.

    Article  Google Scholar 

  29. Fontana L, Errani PG, Zerbinati A, Musacchi Y, Di Pede B, Tassinari G. Frequency of positive donor rim cultures after penetrating keratoplasty using hypothermic and organ-cultured donor corneas. Cornea. 2007;26:552–6.

    Article  Google Scholar 

Download references


No government or non-government funds were granted for this research study.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Noelia Sabater-Cruz.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sabater-Cruz, N., Otero, N., Dotti-Boada, M. et al. Eye bank and theatre factors for positive microbiological culture of corneoscleral rim and cornea storage medium in the real-world. Eye 35, 3087–3093 (2021).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


Quick links