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2020 OMIG Abstract

Autologous Serum Eye Drops Alter the Stability of the Ocular Surface Microbiome

Katherine D. Leviste, MS, Darlene Miller, DHSc, MPH
Bascom Palmer Eye Institute, Miami, FL

Purpose: Autologous serum eye drops (ASED) promote stability and epitheliotropic remodeling of the ocular surface epithelium in patients with dry eye and persistent epithelial defects. ASED composition of nutrients and inert antimicrobial substances also help to stabilize the ocular surface microbiome and guard against microbial invasion in these patients. Our purpose was to characterize the demographic of patients who used ASED while treating a concurrent infection and to assess the impact of various ASED tear concentrations on the prevalence, diversity and phylogenetic profiles of isolates recovered from ocular surface samples (OSS) that were previously exposed or naive to ASED. Additionally, the antibiotic susceptibility of the pre and post ASED isolates were examined.

Methods: A comprehensive retrospective chart and microbiology database review was performed to evaluate patient demographics, ASED concentrations and culture-dependent comparison of phylogenetic profiles of patients treated with ASED 90 days before or after microbial isolate recovery (Not exposed) versus those with isolates recovered within 90 days of ASED treatment (Exposed). The impact of antibiotics on culture dependent phylogenetic profiles was also determined.

Results: Of the 930 patients screened, ocular surface infections were documented in 87 or 9.35%. Females were significantly more likely (58.6% vs 41.4%), P = 0.0173 to be culture-positive than males. Age groups ranged from 0-19 (2.3%) to 80-99 (35.6%) with the majority in age group 60-79 (41.4%). A total of 181 isolates were recovered from 7 different geographic sites sampled from the ocular surface. Cornea scrapings (n=150, 82%) were the most common ocular surface source. Sixty percent of patients were also on antibiotics. Gram-positive organisms (Firmicutes n=99, 97.1%, Actinobacteria n=3, 2.9%) constituted 56.4% of the isolates recovered followed by Gram-negatives (Proteobacteria n=55, 30.4%, Ascomycota n=23, 12.7%) and Simplex virus (n=1, 0.6%). Staphylococcus aureus was the most frequent isolate (n=41, 22.6%) and significantly more likely to be recovered from patients on ASED concentrations <30% (n= 30, 73.2%) and from patients on antibiotics (n=35, 85.4%). Phylogenic diversity and abundance for Firmicutes and Ascomycota were higher in OSS with ASED exposure greater than 90 days (n=145, 80.1%) than patients treated with ASED within 90 days (n=36, 19.9%), but not significantly so. Proteobacteria were more often recovered from patients on antibiotics and with ASED exposure greater than 90 days (n=34.5%).

Conclusion: Culture dependent phylogenic profiles of microbiota recovered from patients prescribed ASED were distinct from those reported for the healthy ocular surface or those with dry eye. ASED in combination with antibiotic use could contribute to a persistent dysbiotic ocular surface and increased risk of infection.

Disclosure: N



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