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Infectious Disease6 papers

Exogenous fungal endophthalmitis

Last edited: 4/10/2026

Overview

Exogenous fungal endophthalmitis can occur following corneal transplantation, particularly when donor rims culture positive for fungus 1. Candida is a common fungal agent identified in positive donor rim cultures 1. The risk of intraocular fungal infection in endothelial keratoplasty recipients is approximately 7% if the donor rim was culture-positive 1.

Diagnosis

  • Routine culturing of corneal donor rims is useful for identifying potential risk and prompting careful monitoring of keratoplasty recipients for any signs of fungal infection 1.

    • Management

  • Routine antifungal prophylaxis after a positive donor rim fungal culture is problematic due to a lack of definitive data regarding optimal route, duration, and efficacy 1.
  • Topical antifungal prophylaxis alone has not been proven effective 1.
    • Systemic antifungal agents (e.g., azoles for Candida*) carry risks of liver toxicity and drug interactions 1.
  • Treatment of established post-keratoplasty fungal infection typically involves graft replacement 1.
  • Selective removal of involved areas has been successfully used with Descemet membrane endothelial keratoplasty (DMEK) for fungal infection 1.

    • Key Recommendations

  • Routine culturing of corneal donor rims is useful to alert surgeons to carefully monitor keratoplasty recipients for any signs of fungal infection 1. (Evidence: Moderate)
  • Routine antifungal prophylaxis after a positive donor rim fungal culture is not recommended due to a lack of definitive data on optimal administration, duration, and efficacy, and the potential for systemic side effects 1. (Evidence: Moderate)
  • Treatment of post-keratoplasty fungal infection typically involves graft replacement, though selective removal of involved areas has been successful with Descemet membrane endothelial keratoplasty 1. (Evidence: Weak)

    • References

    1 Price FW. The Role of Antifungal Prophylaxis After Receipt of a Positive Donor Rim Fungal Culture: The Case for Not Routinely Treating Prophylactically. Cornea 2021. link

    Original source

    1. [1]
      The Role of Antifungal Prophylaxis After Receipt of a Positive Donor Rim Fungal Culture: The Case for Not Routinely Treating Prophylactically. — Price FW Cornea (2021)
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