Our experience with three cases of Streptococcus viridans endophthalmitis, following penetrating keratoplasty, prompted us to investigate the ability of gentamicin-supplemented McCarey-Kaufman (M-K) medium to kill S. viridans contaminants. After inoculation of 20 cc of gentamicin-supplemented M-K with S. viridans, the M-K was exposed to temperature conditions similar to those that would be encountered by a donor cornea during storage (4°C) and preoperative warming prior to keratoplasty (23°C). Colony counts were performed at regular intervals. After 1 h of warming, no reduction in the initial inoculum had occurred. This is in contrast to results from similar experiments with Staphylococcus aureus, Staphylococcus epidermidis, and Pseudomonas aeruginosa in which more than 1 log unit of killing occurred after 1 h. While previously reported clinical experience has demonstrated an overall low incidence of postkeratoplasty endophthalmitis using gentamicin-supplemented M-K, our own recent clinical and laboratory data suggest that additional or alternate antibiotic coverage for S. viridans may be prudent.
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