Reducing Fungal Risk in Corneal Transplants: Insights from Nicole Fram, M.D.’s Amphotericin B Research

December 10, 2025

CorneaGen’s recent discussion with Dr. Nicole Fram highlights a current question in corneal transplantation: Is amphotericin B (Ampho B) safe to add to corneal storage media? Dr. Fram’s research explores this through a large-scale retrospective review and offers valuable insights for clinicians and eye banks.

Why This Matters

Fungal infections are among the most dreaded complications in corneal transplantation. They are rare but devastating, are difficult to treat and often lead to poor outcomes. As Dr. Fram explains, “I can redo an EK or PKP. I can’t redo a fungal infection.” This underscores the importance of prevention.

Key Insights from our Interview with Dr. Fram

• Massive Data Set: The study analyzed 53,000 grafts over four years, with about half supplemented with amphotericin B.
• 10-Fold Reduction in Fungal Infection: Supplementation led to a dramatic decrease in fungal infections compared to non-supplemented tissue.
• Safety Confirmed for EK Cohorts: For DSEK and DMEK patients, there was no statistically significant increase in primary graft failure or early regraft rates when Ampho B was used.
• Mixed Results in PK Cohorts: When all patients were combined, there was a statistical difference in primary graft failure rates, suggesting the need for further analysis of PK cases.

Risk-Benefit Perspective

Surgeons weigh the risk of fungal infection against the possibility of slightly higher graft failure rates. As Dr. Fram notes, “If you’ve ever had a fungal infection in your career, it’s something you never want to see again.” This makes Ampho B supplementation a compelling option for many clinicians.

Next Steps in Research

The discussion emphasizes:

• Better Reporting Systems: Real-time outcome tracking for graft failures and regrafts.
• Prospective Studies: To confirm findings and explore optimal concentrations and formulations (pellet vs. liquid).
• Further PK Analysis: Understanding why PK cases influenced overall statistical outcomes.

CorneaGen’s Commitment

CorneaGen continues to lead innovation by being the first eye bank to provide the option of adding Ampho B to corneal preservation media. For more details on adding Ampho B to your next request or to access educational resources, visit CorneaGen.com/AmphoB or email tissue@corneagen.com.

The Bottom Line: Ampho B supplementation offers a significant reduction in fungal infection risk without compromising safety in EK procedures. While questions remain for PK cases, the evidence strongly supports its role in improving patient outcomes.