1. Evaluation of Decontamination Protocols for In-Situ Donor Corneal Retrieval in Hospital Mortuaries Radhika Tandon, MD, DNB, FRCSEd, FRCOphth Prabhakar Singh, MBBS J.S.Titiyal, MD; Gita Satpathy, MD; Niranjan Nayak, MD Dr. Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences, New Delhi. The authors have no financial interests ID NO. 16559

2. AIMS AND OBJECTIVES To evaluate the efficacy of povidone iodine alone vs the adjunctive use of antibiotics for minimizing microbiological load in donor cornea retrieved from hospital mortuaries. To study spectrum and sensitivity pattern of isolated micro- organisms

3. MATERIALS & METHODS Study design: Prospective randomized study. Place of study: Dr. Rajendra Prasad Centre for Ophthalmic Sciences & Mortuaries at All India Institute of Medical Sciences, New Delhi. Study subjects: All donors between JUNE 2013 to NOV 2013 were screened. Inclusion criteria: Eligible donor. Donor’s family consent for eye donation. Both the eyes suitable for donation. Exclusion criteria: None.

4. MATERIALS & METHODS All deceased potential donors handled by hospital mortuaries were screened. Written consent from the legal next of kin for eye donation as well as for participating in study was obtained. Under aseptic precaution eyelids and skin around the eyes were cleaned with povidone iodine (5%) soaked cotton swabs Eyes were draped with surgical drape.

5. MATERIALS & METHODS Speculum was inserted gently avoiding damage to corneal epithelium. Cornea, conjunctival sac and fornices were irrigated with saline. Drops of 5% povidone iodine were instilled. Povidone iodine was washed off thoroughly with saline after 3 mins. Limbal swabs were taken and sent for microbial analysis. Eyes were treated with 3 drops of 0.5% gatifloxacin eye drops in one and 0.5% chloramphenicol with 10000 IU of polymyxin-B eye drops in the other as per the randomization treatment allocation.

6. MATERIALS & METHODS Repeat limbal swabs were taken after 3 minutes and sent for microbial analysis. In-situ harvesting of corneoscleral rims were performed & buttons were transferred in M.K. media. Corneoscleral rims stored in M.K. media were transported in an insulated box with ice packs to eye bank for storage.

7. OUTCOME MEASURES Primary Outcome Measure :Percentage Decrease In Bacterial Culture Positivity of donor eyes. Secondary Outcome Measure :Bacterial Spectrum And Sensitivity Pattern of donor eyes.

8. RESULTS PERCENTAGE DECREASE IN BACTERIAL CULTURE POSITIVITY : P value:0.0018 P value: 0.0005

9. RESULTS COMPARISON OF PERCENTAGE DECREASE IN BACTERIAL CULTURE POSITIVITY BETWEEN THE ANTIBIOTIC REGIMENS: P VALUE: 0.683 There was no significant difference between the two antibiotic regimens in decreasing the microbiological load.

10. OrganismsFrequencySensitivity pattern S.epidermidis37 (11.7%)S60 (19.4%) Pseudomonas23 (7.1%)S’14 (4.5%) E. Coli8 (2.5%)S’’12 (3.8%) Diphtheroids6 (1.9%)Total cultures sent308 (100%) Klebsiella7 (2.2%) Staph. aureus2 (0.6%) Enterococcus1 (0.3%) Strept. Viridans4(1.2%) Proteus0 (0%) Aceinatobacter1 (0.3%) Str. pneumoniae2 (0.6%) Total % positivity91 (29.5%) Total cultures sent308 (100%) S: Sensitive to all, S’: Resistant to all antibiotics but sensitive to polymyxin-B, S’’: sensitive to amikacin, gentamycin, tobramycin, polymyxin-B, chloramphenicol, cloxacillin, gatifloxacin, resistant to cefazolin, ceftriaxone BACTERIAL SPECTRUM & SENSITIVITY PATTERN: RESULTS Resistance were seen more commonly among gram negative organisms like Pseudomonas, Klebsiella, E.Coli.

11. CONCLUSION Povidone iodine 5% alone does not eliminate microbiological load in donor corneas from hospital mortuaries. Subsequent application of adjunctive antimicrobial agents further significantly reduces the contamination frequency.

12. Corresponding author:Dr Radhika Tandon, MD, DNB, FRCSEd, FRCOphth Professor of Ophthalmology Dr Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences New Delhi-110029 E-mail address: radhikatandon@aiims.ac.in