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Microbiological spectrum and probability of transmission of infection from ocular tissues of enucleated eyes harvested from septicemic donors
Aditi Dubey, Priyanka, Deepak Soni, Deepti Chaurasia, Brindha Periasamy, Nikhila C Jain, Deepayan Sarkar, Mamta Singh, Srishti Khullar, Kavita Kumar, Pragyil Chaturvedi, Bhavana Sharma
Aditi Dubey, Kavita Kumar, Department of Ophthalmology, Gandhi Medical College Bhopal, Bhopal 462001, Madhya Pradesh, India
Priyanka, Deepak Soni, Brindha Periasamy, Nikhila C Jain, Deepayan Sarkar, Pragyil Chaturvedi, Bhavana Sharma, Department of Ophthalmology, All India Institute of Medical Sciences Bhopal, Bhopal 462020, Madhya Pradesh, India
Deepti Chaurasia, Department of Microbiology, Gandhi Medical College Bhopal, Bhopal 462001, Madhya Pradesh, India
Mamta Singh, Department of Ophthalmology, All India Institute of Medical Sciences, Rajkot 360110, Gujarāt, India
Srishti Khullar, Department of Ophthalmology, Military Hospital, Agra 282001, Uttar Pradesh, India
Co-first authors: Aditi Dubey and Priyanka.
Author contributions: Sharma B contributed to conceptualization, design, manuscript preparation and editing; Dubey A and Priyanka contributed equally to this manuscript as co-first authors; Dubey A and Kumar K contributed to data acquisition; Soni D, Priyanka, Sarkar D, Chaurasia D, Jain NC, Periasamy B, Singh M, Khullar S, and Chaturvedi P contributed to material preparation and analysis. All authors approved to submit the final version.
Institutional review board statement: The research adheres to the tenets of the Declaration of Helsinki and was approved by the Institutional Ethics Committee of both the study centers (approval No. IHEC-LOP/2018/IM0200).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Data will be made available upon reasonable request and approval from the corresponding author at
drbavana_s@yahoo.co.in.
Corresponding author: Bhavana Sharma, Professor, Department of Ophthalmology, All India Institute of Medical Sciences Bhopal, Saket Nagar, Bhopal 462020, Madhya Pradesh, India.
drbhavana_s@yahoo.co.in
Received: December 31, 2025
Revised: January 19, 2026
Accepted: March 20, 2026
Published online: June 18, 2026
Processing time: 150 Days and 3.5 Hours
BACKGROUND
Tissues from septicemic donor are considered contraindication for transplantation. However, a definite evidence is lacking to link these corneas as a potential source of post-transplantation infection.
AIM
To assess corneal tissue microbiology in septicemic donors and correlate postmortem blood cultures with ocular isolates to determine transplant suitability.
METHODS
A bicentric cross-sectional study evaluated 264 eyes from 136 septicemic and non-septicemic donors at two eye banks of tertiary eye centers. Culture report of tissue samples (conjunctival swab, aqueous and vitreous tap, cornea, sclera, and post- mortem blood sample) was compared with the culture results of post-mortem blood samples. Additionally, correlation if any was evaluated between culture positivity of harvested tissue with death to retrieval time. Statistical results were analyzed using Pearson χ2 and Fisher’s exact tests.
RESULTS
Among 21 septicemic donors, microbial growth was observed in 28.6%, 7.1%, 9.5%, 4.8%, and 2.4% of non-utilized conjunctival, corneal, scleral, aqueous, and vitreous samples respectively as opposed to 16.7 [odds ratio (OR) = 10.6, 95% confidence interval (CI): 0.938-4.263, P = 0.058], 9.0 (OR = 0.777, 95%CI: 0.141-2.815, P = 0.485), 10.8 (OR = 0.868, 95%CI: 0.207-2.739, P = 0.530), 2.2 (OR = 2.162, 95%CI: 0.199-13.78, P = 0.308) and 1.3% (OR = 1.776, 95%CI: 0.033-22.74, P = 0.502) of 115 non-septicemic donors. Only one tissue of cornea and sclera, yielded the same organism as the blood culture. The microbiological spectrum of pathogens from culture-positive tissues was reflective of commensal pathogens. A strong positive correlation was seen between death to retrieval time in relation to microbial growth.
CONCLUSION
These findings suggest that sepsis does not significantly impact ocular tissue sterility. Thus, current transplantation guidelines may benefit from further review, particularly in light of the potential to increase the availability of transplantable tissue, consequent to reduced rejection and wastage.
Core Tip: Corneal transplantation remains an important sight restoring procedure, but has major demand-supply gap of donor corneas, worsened by exclusion of septicemic donors due to presumed infection risk. This bicentric cross-sectional study evaluated the microbiological spectrum of ocular tissues harvested from septicemic donors and their potential risk of infection transmission. Cultures from conjunctiva, cornea, sclera, aqueous, vitreous, and post-mortem blood were assessed and correlated. Microbial growth rates were comparable between groups, with organisms largely reflecting commensal flora. Only one corneal and scleral sample matched blood culture isolates. A strong association was found between longer death-to-retrieval time and contamination. Overall, septicemia did not significantly compromise tissue sterility, suggesting potential reconsideration of transplantation guidelines to reduce tissue wastage.
