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Jung I, Ko BY. Analysis in Results of Microbiologic Exam Related to Donor Corneas. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2022. [DOI: 10.3341/jkos.2022.63.3.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: This study analyzed the microorganisms identified in donor corneas and their clinical significance.Methods: The medical records of 94 patients (114 eyes) who underwent keratoplasty and microbiological tests of the donor corneas from October 2008 to December 2020 at our hospital were reviewed retrospectively. During keratoplasty, we conducted microbiological tests of the corneoscleral rim of the donor cornea and preserving solution Optisol™-GS (Bausch & Lomb, Rochester, NY, USA), and examined the antibiotic susceptibility of bacterial isolates from the cultures.Results: Some isolates of domestic donor corneas revealed bacteria, but none of the imported corneas did. Gram-negative bacilli were detected from the corneoscleral rim in three eyes (2.6%): two cases of Acinetobacter baumannii/haemolyticus and one case of Pseudomonas aeruginosa. In one case (0.9%), Acinetobacter baumannii/haemolyticus was identified from preserving solution, with no bacteria found in the corneoscleral rim. Antibiotic susceptibility tests showed multi-drug resistance, except to colistin. In all cases where bacteria were detected, there was no keratitis or endophthalmitis after corneal transplantation.Conclusions: Although rare, bacteria can be identified from donor corneas or the preserving solution used in corneal transplantation. Therefore, caution is needed in all processes dealing with donor corneas. Empirical antibiotics that have sufficient antimicrobial activity to suppress multi-drug resistant bacteria should be selected in corneal transplantation.
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Sabater-Cruz N, Otero N, Dotti-Boada M, Ríos J, Gris O, Güell JL, Vilarrodona A, Casaroli-Marano RP. Eye bank and theatre factors for positive microbiological culture of corneoscleral rim and cornea storage medium in the real-world. Eye (Lond) 2021; 35:3087-3093. [PMID: 33469128 DOI: 10.1038/s41433-020-01342-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 11/12/2020] [Accepted: 11/25/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To evaluate microbiological culture rate and positivity of corneoscleral rim and cornea storage media as well as possible risk factors for contamination with real-world data. METHODS Data of consecutive cornea donors implanted in the reference centre from January 2013 to January 2018 were reviewed. Information about cornea characteristics (donor demographic data, endothelial cell density, type of cornea conservation, days of storage, and precut vs full-thickness tissue), and microbiological culture information (corneoscleral rim vs storage sample, positive result) were statistically analysed. RESULTS During the study period, 1369 corneas (737 donors) were implanted. Cultures were performed in 76.8% (n = 1052) of them and were positive in 3.2% of cases, mainly bacteria (84.4%). Corneas preserved in hypothermia represented 61.8% of all positive microbiology results (p < 0.001). Other analysed risk factors did not reach statistically significant association with microbiological positivity. None of the 34 cases with positive microbiological cultures reported ocular infection for the recipients in at least 6 months' follow-up. CONCLUSIONS Microbiological tests rate in real-world practice are high despite not being compulsory. Organotypic cultured corneas showed a statistically less positivity in corneoscleral and storage medium than hypothermic ones, resulting in another advantage of this kind of cornea storage. Although precut corneas are thought to present less microbiological positivity, a statistically significant association was not found in the present study.
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Affiliation(s)
- Noelia Sabater-Cruz
- Hospital Clinic de Barcelona, Barcelona, Spain. .,Department of Surgery, School of Medicine, University of Barcelona, Barcelona, Spain.
| | | | | | - José Ríos
- Hospital Clinic de Barcelona, Barcelona, Spain.,Medical Statistics Core Facility (IDIBAPS) and Biostatistics Unit, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oscar Gris
- Instituto de Microcirugía Ocular (IMO), Barcelona, Spain
| | - José L Güell
- Instituto de Microcirugía Ocular (IMO), Barcelona, Spain
| | | | - Ricardo P Casaroli-Marano
- Hospital Clinic de Barcelona, Barcelona, Spain.,Department of Surgery, School of Medicine, University of Barcelona, Barcelona, Spain.,Barcelona Tissue Bank (BST-BTB), Barcelona, Spain
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Microorganism detection and contamination rate of donor eyes in Japan. Jpn J Ophthalmol 2020; 64:577-584. [PMID: 32924083 DOI: 10.1007/s10384-020-00772-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 05/14/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the microorganism detection and contamination rate of donor eyes. STUDY DESIGN Retrospective study. METHODS In this retrospective study, we reviewed all donor cornea data collected from Kyoto Prefectural University of Medicine (KPUM) Eye Bank, Kyoto, Japan from April 2015 to June 2018, including microbiologic data obtained from conjunctival swabs and preservation medium and findings of postoperative infection from the medical records. RESULTS During the study period, 77 eyes from 44 deceased individuals (mean age at time of death: 75 ± 17.3 years [range, 30-102 years]) were donated to the KPUM Eye Bank after being harvested using standard safety precautions and disinfection procedures. In 49 of the 77 eyes (63.6%), the conjunctival-swab culture revealed microorganisms, with the 3 most commonly detected being methicillin-resistant Staphylococcus epidermidis (MRSE), methicillin-sensitive S aureus (MSSA), and methicillin-resistant S aureus (MRSA). The data revealed positive microorganism detection in only 4 (5.2%) of the 77 donor-cornea storage-medium cultures. Positive microorganism detection was found in all the age groups, with no statistical difference between the groups (P > .05). In the eyes enucleated ≥ 2.5 h postmortem, a higher positive microorganism detection occurred (P = .03). During the postoperative follow-up period, there was no record of corneal infection. CONCLUSIONS The preenucleation conjunctival-swab-culture findings revealed that the rate of positive microorganism detection was similar for advanced-age and younger-age donors and that a shorter elapsed time from donor death to postmortem enucleation resulted in less donor-microorganism contamination.
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Chen NN, Wu PL, Chen HC, Huang TY, Lai LJ. Prevalence of microbial contamination in donor corneas. Taiwan J Ophthalmol 2019; 9:179-184. [PMID: 31572655 PMCID: PMC6759555 DOI: 10.4103/tjo.tjo_60_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/29/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND/PURPOSE: Postoperative infection is the most disastrous complication of penetrating keratoplasty (PK). Corneoscleral rim culture provided information regarding subsequent infections. Our aims were to identify the incidence of microbial contamination in donor corneas and to report the recovery of bacteria with two culture methods, i.e., conventional culture media after aerobic/anaerobic cotton swabs and blood culture media (Fastidious Antibiotic Neutralization [FAN]). MATERIALS AND METHODS: A total of 118 patients underwent PK. Corneoscleral rim cultures were performed using aerobic/anaerobic culture cotton swabs (Transystem™, COPAN, Italia) with subsequent convention media and blood culture media (FAN bottle, BD BACTEC™, USA). The results of the different methods were reported and analyzed. RESULTS: Microorganisms were recovered from 24 in total 118 cases (20.3%, n = 118), 14 from blood culture media (FAN) (11.8%, n = 118), 9 from conventional culture media after aerobic/anaerobic cotton swabs (7.63%, n = 118), and 2 from fungus culture (1.69%, n = 118). The most commonly identified pathogen was coagulase-negative Staphylococcus (CoNS) (n = 13, 54.2%), and more isolates of CoNS and staphylococcus aureus were recovered from blood culture media (FAN) than those from conventional culture media after aerobic/anaerobic cotton swabs (13 vs. 4, P = 0.05). Conversely, more nonfermentative Gram-negative bacilli were recovered from conventional culture media after aerobic/anaerobic cotton swabs. None of the 24 cases with positive corneoscleral rim cultures reported ocular infection for the recipients in at least 6 months’ follow-up. CONCLUSION: The conventional culture media after aerobic/anaerobic cotton swabs and blood culture media (FAN) did not yield identical isolates of bacteria. The blood culture media (FAN) could further yield Gram-positive bacteria in addition to those recovered from convention media. It seemed adding gentamicin and streptomycin could achieve bacteriostatic effect instead of the bactericidal effect. The administration of postoperative antibiotic in the recipient was suggested.
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Affiliation(s)
- Nan-Ni Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Pei-Lun Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Hung-Chi Chen
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Tsung-Yu Huang
- Department of Infection, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Li-Ju Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Röck T, Blumenstock G, Bartz-Schmidt KU, Bramkamp M, Landenberger J, Röck D. Donor-Dependent Factors Influencing Contamination Rates of Conjunctival Swabs of Human Donor Eyes. Ann Transplant 2019; 24:191-198. [PMID: 30967524 PMCID: PMC6476407 DOI: 10.12659/aot.912266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background This study investigated the effect of donor-dependent factors on contamination rates of conjunctival swabs of human donor eyes. Material/Methods From July 2015 to September 2017 a total of 1008 conjunctival swabs from 504 consecutive human donor eyes were analyzed. Cross-tabulation, chi-squared tests, and Fisher’s exact tests were used to evaluate the effect of donor-dependent factors on contamination rates of conjunctival swabs. Results The mean conjunctival swabs contamination rate was 28.4%. Donors with the diagnosis of carcinoma or metastases were associated with an increased conjunctival swab contamination rate [odds ratio (OR)=1.8, 95% confidence interval (CI)=1.2–2.6, p=0.007; OR=1.7, 95% CI=1.1–2.6, p=0.016; respectively]. However, the age, sex, diagnosis of diabetes mellitus, and donors who received chemotherapy did not significantly increase the conjunctival swab contamination risk. Conclusions Donors with the diagnosis of a carcinoma or metastases seemed to be predisposed to increased conjunctival swab contamination risk.
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Affiliation(s)
- Tobias Röck
- Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Gunnar Blumenstock
- Institute for Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany
| | | | - Matthias Bramkamp
- Department of General Medicine, Ruhr-University Bochum, Bochum, Germany
| | | | - Daniel Röck
- Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
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Röck T, Landenberger J, Buhl M, Yoeruek E, Bartz-Schmidt KU, Bramkamp M, Blumenstock G, Röck D. Factors influencing the contamination rates of the conjunctival swabs and organ culture media of human donor eyes. Medicine (Baltimore) 2018; 97:e11879. [PMID: 30235655 PMCID: PMC6160100 DOI: 10.1097/md.0000000000011879] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study assessed the influence of donor, environmental, and logistical factors on the contamination rates of the conjunctival swabs and organ culture media of human donor eyes.In total, 1008 conjunctival swabs and 418 organ culture media samples from 504 consecutive human donor eyes were analyzed. Cross-tabulation, chi-squared tests, and Fisher's exact tests were used to assess the influence of the different factors on the contamination rates of the conjunctival swabs and organ culture media.The overall contamination rates were 28.4% for the conjunctival swabs and 1.0% for the organ culture media. A prolonged time between death and the conjunctival swab collection was associated with an increased conjunctival swab contamination rate [odds ratio (OR) = 1.9, 95% confidence interval (CI) = 1.2-3.0, P = .007]. The highest conjunctival swab contamination rate was found in the corneas procured in external institutions (outside the university hospital) (44.1%, OR = 3.6, 95%CI = 1.5-8.4, P = .003). Hospitalization times of 2 to 7 days prior to death were associated with an increased conjunctival swab contamination risk (OR = 2.6, 95%CI = 1.1-5.8, P = .021). However, the sex, age, cause of donor death, differentiation between septic and aseptic donors, differentiation between heart-beating brain-dead multiorgan donors and cadaveric donors, a warmer mean monthly temperature, and death to corneoscleral disc excision time did not significantly increase the conjunctival swab contamination risk. In addition, none of these factors affected the organ culture media contamination risk. Moreover, a positive conjunctival swab did not significantly increase the media contamination risk (P = .08). Surprisingly, the microorganisms causing media contamination were present at 50% of the amount detected on the conjunctival surface of the respective donor eye.A prolonged time between death and the conjunctival swab collection, a hospitalization time of 2 to 7 days prior to death, and corneal collection outside the university hospital seemed to be the main factors responsible for an increased conjunctival swab contamination risk. In addition, our investigation illustrated that a positive conjunctival swab is not a strong indicator for organ culture media contamination. Critical discussion is necessary regarding the validity of conjunctival swabs as prognostic parameters for organ culture media contamination.
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Affiliation(s)
| | | | - Michael Buhl
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen
| | | | | | | | - Gunnar Blumenstock
- Institute for Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany
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Gruenert AK, Rosenbaum K, Geerling G, Fuchsluger TA. The influence of donor factors on corneal organ culture contamination. Acta Ophthalmol 2017; 95:733-740. [PMID: 28266143 DOI: 10.1111/aos.13402] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 01/02/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the contamination rate and the corresponding spectrum of microbes and to identify donor risk factors for corneal organ culture contaminations. METHODS A total of 3306 organ-cultured donor corneas were included in the study. We performed a retrospective database analysis to evaluate donor factors such as gender, age, death-to-explantation interval (DEI), procurement site and cause of death and to determine their influence on donor cornea contaminations. Odds ratios (ORs) were calculated for each factor. RESULTS The overall contamination rate was 7.8% (n = 259). Younger donor age (OR: 2.2, p = 0.003, chi-squared test), a DEI of more than 24 hr (OR: 1.6, p < 0.001), hospitalization prior to death (OR: 2.2, p < 0.001) and death caused by sepsis (OR: 2.7, p < 0.001) were associated with an increased risk of contamination, whereas donor gender did not have an effect on donor cornea contaminations. The most frequently isolated microbes were Enterococci (19%), Staphylococci (10.8%) and Candida (37.4%). CONCLUSION This study helps to estimate the contamination risk of a cultured cornea based on specific donor factors. However, donors with risk factors should not be generally excluded from cornea donation. Further studies including antibiograms might clarify whether a change in the antibiotic composition of the culture medium would be useful to deal with the increasing number of multi-resistant microbes.
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Affiliation(s)
- Anja K. Gruenert
- Department of Ophthalmology; Friedrich-Alexander-University Erlangen-Nürnberg; Erlangen Germany
| | - Katja Rosenbaum
- Department of Ophthalmology; Heinrich-Heine-University Düsseldorf; Düsseldorf Germany
| | - Gerd Geerling
- Department of Ophthalmology; Heinrich-Heine-University Düsseldorf; Düsseldorf Germany
| | - Thomas A. Fuchsluger
- Department of Ophthalmology; Friedrich-Alexander-University Erlangen-Nürnberg; Erlangen Germany
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Kiatos E, Armstrong JJ, Hutnik CML, Tsioros SM, Malvankar-Mehta MS, Hodge WG. The value of corneoscleral rim cultures in keratoplasty: a systematic review and cost-effectiveness analysis. CLINICOECONOMICS AND OUTCOMES RESEARCH 2017; 9:459-474. [PMID: 28848354 PMCID: PMC5557112 DOI: 10.2147/ceor.s139949] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study evaluated the performance of donor corneoscleral rim cultures for predicting infection after corneal transplantation, and determines if there is a correlation between positive corneoscleral rim cultures and postkeratoplasty infection. DESIGN AND DATA SOURCES This was a systematic review, prognostic accuracy analysis, and cost-effectiveness analysis. Databases searched were: Medline (Ovid), Embase (Ovid), CINAHL, Cochrane Library, Web of Science, and BioSis Previews. Grey literature was also explored. MATERIALS AND METHODS A systematic review was conducted to locate published and unpublished studies. All studies examining corneal button contamination and its association with endophthalmitis and keratitis posttransplantation were included. Extracted data were used to calculate sensitivity, specificity, positive predictive value, and negative predictive value. Cost data from the London Laboratory Services Group in London, ON were used to calculate the cost-effectiveness of culturing donor rim cultures. RESULTS Of 7,870 grafts, 954 had a positive rim culture (12.1%), with 12 patients going on to develop keratitis or endophthalmitis (1.3%). The prevalence of keratitis and endophthalmitis in this study was 0.15%, and the positive predictive value 1.5%. Of the 12 infections, nine were fungal and three bacterial. The estimated cost of a positive and negative test result was CAD$45.99 and $14.15, respectively. The cost to run all 7,870 tests was estimated to be $141,735.86, with an incremental cost-effectiveness ratio of $40,215.70. CONCLUSION There was a significant divergence between bacterial and fungal rim-culture results. Bacterial cultures predicted clinical infection poorly, did not change management, and were expensive. Fungal cultures predicted clinical infection in over 10% of patients, had the potential to change management, and were 40% less expensive than full rim culturing (bacterial and fungal tests). Fungal rim cultures may be considered in areas where fungal infection rates are high.
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Affiliation(s)
| | - James J Armstrong
- Department of Pathology
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, Western University
| | - Cindy ML Hutnik
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, Western University
- Department of Ophthalmology, Ivey Eye Institute, St Joseph’s Health Care London
| | | | - Monali S Malvankar-Mehta
- Department of Epidemiology and Biostatistics
- Department of Ophthalmology, Ivey Eye Institute, St Joseph’s Health Care London
| | - William G Hodge
- Department of Epidemiology and Biostatistics
- Department of Ophthalmology, Ivey Eye Institute, St Joseph’s Health Care London
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Inomata T, Ono K, Matsuba T, Shiang T, Di Zazzo A, Nakatani S, Yamaguchi M, Ebihara N, Murakami A. Pre-banking microbial contamination of donor conjunctiva and storage medium for penetrating keratoplasty. Jpn J Ophthalmol 2017; 61:369-377. [PMID: 28597192 DOI: 10.1007/s10384-017-0521-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 05/09/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE The aims of this study were to investigate the incidence of positive donor tissue cultures before transfer to preservation medium (Optisol™-GS) for penetrating keratoplasty, to verify the efficacy of antibiotics contained in Optisol™-GS by examining the drug susceptibility and to assess the relationship between the results of our microbial assessments as well as donor factors and the incidence of contamination. METHODS We conducted a retrospective, cross-sectional study using Juntendo Eye Bank records for all corneal transplantations. Two hundred donor conjunctiva harvestings and storage medium (EP-II®) cultures were performed between July 2008 and June 2011. We analyzed the associations between donor factors (age, gender, history of cataract surgery, death-to-preservation interval, cause of death) and contamination rates using multivariate analysis by the generalized estimating equation model. RESULTS We obtained positive bacterial cultures from 154 of the 200 eyes (77.0%). The isolated bacteria were indigenous, such as coagulase-negative Staphylococci, Corynebacterium sp., and methicillin-resistant Staphylococcus aureus (MRSA). There was significant resistance to levofloxacin (18 eyes, 9.0%) and gentamicin (12 eyes, 6.0%), and no vancomycin-resistant bacteria were detected. The donor factors did not correlate with the prevalence of bacterial contamination in our criteria. CONCLUSIONS Pre-banking microbial assessment allows for microbial detection, bacterial susceptibility and resistance testing. This is useful for developing preservation mediums containing effective spectrum antibiotic agents for high quality control of corneal banking.
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Affiliation(s)
- Takenori Inomata
- Department of Ophthalmology, Juntendo University Faculty of Medicine, Bunkyo-ku, 2-1-1 Hongo, Tokyo, 113-0033, Japan.
| | - Koichi Ono
- Department of Ophthalmology, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Koto-ku, Tokyo, Japan
| | - Tsuyoshi Matsuba
- Advanced Research Center for Human Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Tina Shiang
- Department of Ophthalmology, Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Antonio Di Zazzo
- BioMolecular and Cellular Laboratories in Ophthalmology, IRCCS, G.B. Bietti Foundation, Rome, Italy
| | - Satoru Nakatani
- Department of Ophthalmology, Juntendo University Faculty of Medicine, Bunkyo-ku, 2-1-1 Hongo, Tokyo, 113-0033, Japan
| | - Masahiro Yamaguchi
- Department of Ophthalmology, Juntendo University Faculty of Medicine, Bunkyo-ku, 2-1-1 Hongo, Tokyo, 113-0033, Japan
| | - Nobuyuki Ebihara
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Tomioka, Chiba, Japan
| | - Akira Murakami
- Department of Ophthalmology, Juntendo University Faculty of Medicine, Bunkyo-ku, 2-1-1 Hongo, Tokyo, 113-0033, Japan
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Analysis of Intraocular Lens Biofilms and Fluids After Long-Term Uncomplicated Cataract Surgery. Am J Ophthalmol 2016; 169:46-57. [PMID: 27318074 DOI: 10.1016/j.ajo.2016.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 06/05/2016] [Accepted: 06/06/2016] [Indexed: 11/21/2022]
Abstract
PURPOSE Postoperative endophthalmitis is a potentially sight-threatening complication of cataract surgery. However, the pathophysiological mechanisms are not completely understood. We sought to study and evaluate the intraocular environment (aqueous and vitreous humors), the capsular tissue, and the intraocular lens (IOL) surfaces of normal eyes after long-term uncomplicated cataract surgery. DESIGN Experimental laboratory investigation. METHODS We studied 69 eyes donated for transplantation that had previously undergone cataract surgery with posterior chamber IOL implantation and that had no recorded clinical history of postoperative inflammation. We assessed the intraocular environment (DNA traces and biofilm formation) by microbiological evaluation of intraocular fluids using conventional microbiology and molecular techniques, including assessment for the presence of microbes (biofilm formation) on the IOL surface by scanning electron microscopy and ultrastructural capsular remnants by transmission electron microscopy. RESULTS Isolated or aggregated cocci were probable in 18.8% of IOL optic surfaces (n = 13) studied by scanning electron microscopy, suggesting the presence of bacterial biofilm. In 3 intraocular fluid samples for IOLs with biofilm, we identified 16S rDNA by polymerase chain reaction and sequencing. No microbial contamination was found in intraocular fluids by conventional microbiological methods. CONCLUSIONS Our data suggest the possibility of bacterial biofilm formation on the optic surface of IOLs in normal eyes after long-term uncomplicated cataract surgery even in the absence of clinical or subclinical symptoms.
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Fuest M, Plum W, Salla S, Walter P, Hermel M. Conjunctival and intraocular swabs for the microbiological assessment of donor corneas. Acta Ophthalmol 2016; 94:70-5. [PMID: 26146765 DOI: 10.1111/aos.12796] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 05/31/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE In this study, we investigated the associations between conjunctival (co) and intraocular (io) swabs and their implications for the contamination rates of organ-cultured corneas. METHODS A total of 4177 swabs from 1054 corneas of 527 donors were acquired from the conjunctiva, after disinfection with 5% polyvinylpyrrolidone-iodine solution, and also from the anterior chamber after corneoscleral trepanation (io). Samples were incubated at 22.5 ± 2.5°C and 32.5 ± 2.5°C in thioglycollate broth for 14 days. Donor corneas were cultured in a closed system at 31°C. Microbial differentiation was performed for positive cultures. RESULTS A higher temperature (32.5°C) and the intraocular swab retrieving localization led to significantly higher swab positive rates (32.5°C versus 22.5°C, odds 1.65, p < 0.0001; io versus co, odds 1,53, p < 0.0001). Death-to-collection time and laterality (left or right eye) had no significant influence on swab positivity. The cause of death significantly influenced the positive rates (p < 0.0001). Detection at 32.5°C occurred significantly earlier than at 22.5°C (p < 0.0001). The overall comparison of detected species showed no significant differences in the variety between intraocular and conjunctival swabs. During the study period, six contaminations of organ-cultured corneas occurred: four times Pseudomonas aeruginosa and once each Candida albicans and Staphylococcus hominis were found. Swap results and cornea contaminations were not significantly correlated. CONCLUSIONS Co and io swabs show high microbial colonization rates, even after standard disinfection. Io swabs generally reproduce the co microbial range, most likely due to a mobilization and diversion of microorganisms during the trepanation procedure. Swab results do not yield a valuable tool to predict contaminations of organ-cultured corneas.
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Affiliation(s)
- Matthias Fuest
- Department of Ophthalmology; RWTH Aachen University; Aachen Germany
| | - Wolfgang Plum
- Department of Ophthalmology; RWTH Aachen University; Aachen Germany
| | - Sabine Salla
- Department of Ophthalmology; RWTH Aachen University; Aachen Germany
| | - Peter Walter
- Department of Ophthalmology; RWTH Aachen University; Aachen Germany
| | - Martin Hermel
- Department of Ophthalmology; RWTH Aachen University; Aachen Germany
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Laubichler* P, Arend* N, Vounotrypidis E, Wertheimer C, Mayer WJ, Yu AL, Remy M, de Kaspar HM, Kampik A, Kook D. Comparing Different Decontamination Procedures in Harvesting Human Donor Cornea. Curr Eye Res 2016; 41:1173-7. [DOI: 10.3109/02713683.2015.1101773] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Peter Laubichler*
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
| | - Nicole Arend*
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
| | | | | | - Wolfgang J. Mayer
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
- Bayerische Gewebebank GmbH, Sektion Hornhautbank, Munich, Germany
| | - Alice L. Yu
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
- Bayerische Gewebebank GmbH, Sektion Hornhautbank, Munich, Germany
| | - Matthias Remy
- Department of Ophthalmology, Goethe-Universität-Frankfurt, Frankfurt am Main, Germany
| | | | - Anselm Kampik
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
- Bayerische Gewebebank GmbH, Sektion Hornhautbank, Munich, Germany
| | - Daniel Kook
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
- Bayerische Gewebebank GmbH, Sektion Hornhautbank, Munich, Germany
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Reddy SC, Paul G. Bacterial flora of conjunctiva after death. Int J Ophthalmol 2013; 6:632-6. [PMID: 24195038 DOI: 10.3980/j.issn.2222-3959.2013.05.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 08/22/2013] [Indexed: 11/02/2022] Open
Abstract
AIM To evaluate the frequency of bacterial flora of conjunctiva after death (cadaver eyes) which will give information about the bacterial contamination of donor eyes, and the in-vitro sensitivity of isolated bacteria to the commonly used antibiotics in ophthalmic practice. METHODS Conjunctival swabs were taken from the cadavers (motor vehicle accident deaths and patients who died in the hospital), within 6h after death, and sent for culture and sensitivity test. Conjunctival swabs, taken from the healthy conjunctiva of patients admitted for cataract surgery, were sent for culture and sensitivity as controls (eyes in those of living status). The bacterial isolates were tested against the commonly used antibiotics (chloramphenicol, gentamicin, ciprofloxacin) in ophthalmology practice. RESULTS Bacteria were isolated in 41 out of 100 conjunctival swabs (41%), taken from 50 cadavers (study group). Coagulase negative staphylococcus was the most common bacteria isolated (15%), followed by pseudomonas aeruginosa (5%). Gentamicin was effective against majority of the bacterial isolates (82%). Bacteria were isolated from 7 out of 100 conjunctival swabs taken as control group (eyes in living state). Coagulase negative staphylococcus was the most common organism (5%) isolated in control group; the others were staphylococcus aureus (1%) and beta hemolyticus streptococci (1%). CONCLUSION Bacteria were isolated from 41% of the cadaver eyes. High percentage sensitivity of the bacterial isolates to gentamicin (82%) supports the practice of thorough irrigation of the eyes with gentamicin solution before starting the procedure of enucleation followed by immersion of the enucleated eyeballs in gentamycin solution, to prevent the bacterial contamination.
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Effectiveness of 1.25 % povidone–iodine combined with topical levofloxacin against conjunctival flora in intravitreal injection. Jpn J Ophthalmol 2012; 56:497-501. [DOI: 10.1007/s10384-012-0160-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Accepted: 05/08/2012] [Indexed: 10/28/2022]
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