Please use this identifier to cite or link to this item: https://doi.org/10.1371/journal.pone.0139653
Title: Prophylactic vancomycin drops reduce the severity of early bacterial keratitis in keratoprosthesis
Authors: Konstantopoulos A.
Tan X.W.
Goh G.T.W.
Saraswathi P.
Chen L.
Nyein C.L.
Zhou L. 
Beuerman R.
Tan D.T.H. 
Mehta J. 
Keywords: eye drops
vancomycin
eye drops
vancomycin
animal experiment
animal model
animal tissue
Article
bacterial count
bacterial keratitis
bacterial viability
controlled study
cornea thickness
disease severity
drug efficacy
infection prevention
keratoprosthesis
minimum inhibitory concentration
New Zealand White (rabbit)
nonhuman
prospective study
Staphylococcus aureus
animal
anterior eye segment
cornea
drug effects
Eye Infections, Bacterial
immunohistochemistry
keratitis
microbial sensitivity test
microbiology
optical coherence tomography
pathology
rabbit
slit lamp
visual prosthesis
Animals
Anterior Eye Segment
Cornea
Eye Infections, Bacterial
Eye, Artificial
Immunohistochemistry
Keratitis
Microbial Sensitivity Tests
Ophthalmic Solutions
Rabbits
Slit Lamp
Tomography, Optical Coherence
Vancomycin
Issue Date: 2015
Citation: Konstantopoulos A., Tan X.W., Goh G.T.W., Saraswathi P., Chen L., Nyein C.L., Zhou L., Beuerman R., Tan D.T.H., Mehta J. (2015). Prophylactic vancomycin drops reduce the severity of early bacterial keratitis in keratoprosthesis. PLoS ONE 10 (10) : e0139653. ScholarBank@NUS Repository. https://doi.org/10.1371/journal.pone.0139653
Abstract: Background: Artificial cornea transplantation, keratoprosthesis, improves vision for patients at high risk of failure with human cadaveric cornea. However, post-operative infection can cause visual loss and implant extrusion in 3.2-17% of eyes. Long-term vancomycin drops are recommended following keratoprosthesis to prevent bacterial keratitis. Evidence, though, in support of this practice is poor. We investigated whether prophylactic vancomycin drops prevented bacterial keratitis in an animal keratoprosthesis model. Methodology: Twenty-three rabbits were assigned either to a prophylactic group (n = 13) that received vancomycin 1.4% drops 5 times/day from keratoprosthesis implantation to sacrifice, or a non-prophylactic group (n = 10) that received no drops. All rabbits had Staphylococcus aureus inoculation into the cornea at 7-12 days post-implantation and were sacrificed at predetermined time-points. Prophylactic and non-prophylactic groups were compared with slit-lamp photography (SLP), anterior segment optical coherence tomography (AS-OCT), and histology, immunohistochemistry and bacterial quantification of excised corneas. Corneal vancomycin pharmacokinetics were studied in 8 additional rabbits. Results: On day 1 post-inoculation, the median SLP score and mean±SEM AS-OCT corneal thickness (CT) were greater in the non-prophylactic than the prophylactic group (11 vs. 1, p = 0.049 and 486.9±61.2 vs. 327.4±37.1 ?m, p = 0.029 respectively). On days 2 and 4, SLP scores and CT were not significantly different. Immunohistochemistry showed a greater CD11b+ve/non-CD11b+ve cell ratio in the non-prophylactic group (1.45 vs. 0.71) on day 2. Bacterial counts were not significantly different between the two groups. Corneal vancomycin concentration (2.835±0.383 ?g/ml) exceeded minimum inhibitory concentration (MIC) for Staphylococcus aureus only after 16 days of vancomycin drops. Two of 3 rabbits still developed infection despite bacterial inoculation after 16 days of prophylactic drops. Conclusions: Prophylactic vancomycin drops provided short-term benefit, but did not prevent infection. Achieving MIC in the cornea was not sufficient to prevent Staphylococcus aureus keratitis. Patients should continue to be counselled regarding the risk of infection following keratoprosthesis. © 2015 Konstantopoulos et al.This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Source Title: PLoS ONE
URI: https://scholarbank.nus.edu.sg/handle/10635/161486
ISSN: 19326203
DOI: 10.1371/journal.pone.0139653
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