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Another barrier against infection: stromal hydration of clear corneal incisions with cefuroxime

Session Details

Session Title: Cystoid Macular Oedema and Infection

Session Date/Time: Sunday 06/10/2013 | 16:30-18:00

Paper Time: 17:38

Venue: Forum (Ground Floor)

First Author: : M.Moosajee UK

Co Author(s): :    D. Tracey-White   R. Harbottle   V. Ferguson        

Abstract Details

Purpose:

Sutureless clear corneal incisions for phacoemulsification are widely used, but it has been suggested that an increase in post-operative endophthalmitis may be due to the ingression of ocular surface fluid including bacteria through the wound. To improve the self-sealing status of corneal incisions, stromal hydration of the wound can be performed with balanced salt solution (BSS) with variable persistence. Stromal hydration together with intracameral cefuroxime (1mg/0.1ml) has reduced endophthalmitis rates following cataract surgery. The purpose of this study is to investigate the safety of stromal hydration of clear corneal incisions with cefuroxime. Therapeutic levels of antibiotic sequestered at the wound may further reduce rates of post-operative endophthalmitis.

Setting:

UCL Institute of Ophthalmology and Imperial College London

Methods:

MF-1 albino mice had clear corneal incisions placed in each eye. Stromal hydration was performed with either 5 ?l of 10 mg/ml cefuroxime (CEF), cefuroxime-texas red conjugate (CEF-TR), texas red only (TR) or BSS (each group n=30). Corneas were harvested at 1 hour, day 1, and weeks 1, 6 and 12 post-operatively. Confocal microscopy was used to monitor presence of cefuroxime-texas red conjugate. Corneal morphology and histology was examined by light microscopy, and apoptosis was detected by TUNEL assay to evaluate the safety profile of this technique. To confirm efficacy of cefuroxime, varying concentrations (1, 10 and 100 mg/ml) of CEF, CEF-TR, and TR only was added to gram-negative bacteria Escherichia coli DH5? cells incubated with in Luria-Bertani (LB) medium overnight at 37ḞC. This was then plated onto agar plates for further incubation overnight at 37ḞC to assess levels of bactericidal activity.

Results:

Cefuroxime stromal hydration did not alter corneal morphology; there was no evidence of corneal scarring or vascularisation. Corneal histology and levels of apoptosis were minimal and comparable in the BSS and cefuroxime stromal hydration groups up to 12 weeks post-operatively. Confocal microscopy detected cefuroxime-texas red up to 1 week surrounding the corneal wound. Conjugation of cefuroxime with texas red did not affect bactericidal properties and doses of 10 mg/ml or more successfully inhibited the growth of the aerobe gram-negative bacteria tested.

Conclusions:

Stromal hydration of clear corneal incisions with cefuroxime is safe in mouse corneas. A reservoir of cefuroxime at the wound can act as a barrier of defence against infection. This technique has the potential to reduce rates of post-operative endophthalmitis if applied to phacoemulsification or other ocular surgery involving similar sutureless corneal incisions.

Financial Interest:

NONE