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2018 Agenda and Abstracts | < Previous Next >

2018 OMIG Abstract

The Search For Antifungal Prophylaxis Following Artificial Cornea Surgery

Sarah Kim1,2, Paulo Bispo2,3, Michael Gilmore2,3, Irmgard Behlau4, Eleftherios Paschalis1,2, James Chodosh1,2, and Claes Dohlman1,2
1The Boston Keratoprosthesis Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, 2Harvard Medical School, Boston, MA, 3Department of Ophthalmology, Microbiology and Immunology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, 4Molecular Biology and Microbiology and Ophthalmology, Tufts-Sackler Graduate School of Biomedical Sciences, Tufts University School of Medicine, Boston, MA

 

Purpose: Prophylactic low dose antibiotics drops postoperatively after keratoprosthesis surgery have greatly reduced bacterial infections, with polymyxin B (PMB)/trimethoprim (TMP), fluoroquinolones (FQ), vancomycin (VAN), or chloramphenicol (CHL) as the leading choices. However, there is still an unmet need for prophylaxis against fungi. We have earlier found that on Polytrim®, one drop daily over years, no fungal infections occurred (Behlau et al, 2014). Our aim is to explore the antifungal properties of antibiotics that are already being used to prevent bacterial endophthalmitis.

Methods: Candida albicans, Candida parapsilosis, Fusariumsolani, and Aspergillusfumigatus were tested. Time kill tests and MIC’s were determined for the antibiotics and the preservative benzalkonium chloride (BAK). Adhesion and tissue invasion experiments were carried out by cultures, with or without ?-irradiation, and by analysis with confocal microscopy and fluorescent microscopy.

Results: Polytrim®, PMB, Zymaxid® (gatifloxacin with BAK), and same-concentration BAK alone, exhibited antifungal activity in vitro. A log unit dilution markedly reduced efficacy. Moxifloxacin or gatifloxacin without BAK, as well as TMP, VAN, and CHL, had no effect. Polytrim® also reduced adhesion of Candida albicans to Kontur™ contact lenses. γ-irradiated corneas showed resistance to fungal invasion.

Conclusion: Of antibiotics already in use for preventing bacterial infections after KPro surgery.Polytrim® has wide spectrum antibacterial effect and is very inexpensive. The antifungal killing effect of Polytrim® is mainly conferred by its BAK content. Fluoroquinolones without BAK have no effect. Polytrim®’s effect on fungi is somewhat weak but may be consistent with our observations in patients, suggesting that it may suffice to prevent both bacterial and fungal infections.

Disclosure: E

Support: The B-KPro Research Fund

 

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