# Optimization of corneal preservation media with novel antifungal agents

## TL;DR

This study explores new antifungal agents to improve corneal preservation for eye transplants by reducing fungal contamination without harming the tissue.

## Contribution

The study introduces a novel combination of antifungal agents that effectively inhibit fungal growth and biofilm formation in corneal preservation media.

## Key findings

- The combination of voriconazole, amphotericin B, and clioquinol showed excellent antibiofilm action on corneas.
- The antifungal combination reduced fungal load without causing endothelial toxicity.
- The tested compounds are promising additives for corneal preservation media.

## Abstract

The performance of ophthalmic surgeries, particularly penetrating keratoplasty, is associated with an increased risk of ocular infections, especially fungal keratitis. In addition to infections such as post-surgical occlusions, microbial contamination of the donor’s tissue, predominantly fungal in nature, can also lead to the disposal of said tissue. The genus Fusarium, along with several species from the Candida genus, emerge as the primary fungal agents, displaying notable biofilm-forming abilities on surfaces. To address these issues, the addition of antifungals to preservation media vials has been explored, although conventional antifungal agents exhibit limitations. In light of this, compounds such derived from 8-hydroxyquinoline, clioquinol (CLQ) and PH151, emerge as promising alternatives. Hence, this study aimed to assess the efficacy of two derivatives of 8-hydroxyquinoline, both individually and in combination with antifungal agents, as additives in preservation media for human corneas intended for transplantation. Given the antifungal potential of CLQ and the combination voriconazole-amphotericin B-clioquinol, the ability to inhibit fungal growth and biofilm formation in human corneas preserved in Optisol-GS medium was investigated, as well as the endothelial viability of this tissue in the presence of these compounds. Among the tested antifungal agents, the combination of voriconazole, amphotericin B, and clioquinol stood out for its excellent antibiofilm action and potential to reduce the fungal load on the surface of the corneas, did not present endothelial toxicity. Thus, the results underscore the promising nature of this combination as a potential additive in hypothermic corneal preservation media, outlining a viable pathway to enhance corneal transplant efficacy.

The online version contains supplementary material available at 10.1007/s00203-026-04848-z.