Intraocular lenses, bacterial adhesion and endophthalmitis prevention: A review

Issue title: 2nd International Conference on New Biomedical Materials, 5–8 April 2003, Cardiff, Wales, UK

Article type: Research Article

Authors: Kodjikian, Laurent^{; ; ;} | Burillon, C.^; | Roques, C. | Pellon, G. | Renaud, F.N.R.^; | Hartmann, D. | Freney, J.^;

Affiliations: Department of Ophthalmology, Croix‐Rousse Hospital, Lyon, France | Department of Ophthalmology, Edouard Herriot Hospital, Lyon, France | Laboratory “Biomaterials and Matrix Remodeling”, EA 3090, Claude Bernard University, Lyon, France | Department of Microbiology, EA 819, Cinétique des xénobiotiques, Faculté de pharmacie, Université Paul Sabatier, Toulouse, France | Department of Biochemistry University Lyon1, France | Department of Microbiology, Institut des Sciences Pharmaceutiques et Biologiques, Lyon, France

Note: [] Corresponding author: Dr Laurent Kodjikian, Croix‐Rousse Hospital, Department of Ophthalmology, 103, grande rue de la Croix‐Rousse, Lyon 69004, France. Tel.: +33 472 071 718; Fax: +33 472 071 708; E‐mail: [email protected].

Abstract: Postoperative endophthalmitis following intraocular lens (IOL) implantation is still one of the most feared complications of cataract surgery. Bacterial adhesion to IOLs during their insertion is a prominent etiological factor. Polypropylene was the first biomaterial that allowed this relation of cause and effect to be proven. Following adhesion, bacteria replicate, congregate and form multiple layers of microcolonies which actually represent the basic structural unit of the biofilm. The bacteria are embedded in a slime layer. Personal photographs illustrate the different steps of biofilm formation. This slime matrix is not only an adhesive medium; it also affects virulence. Adhesion to IOLs has been studied by several in vitro studies and discrepancies can be found between them which are due to variations of experimental conditions. The strains, the incubation times and the methods all varied. Adhesion is affected by the nature of the IOLs, the isolates and the surrounding medium. Since this medium is very difficult to model because of its complexity, in vivo studies seemed essential. We have recently determined in vivo evolution of the amount of attached bacteria to five types of IOLs. Crystalline lenses from 90 domestic pigs were removed aseptically and replaced with previously infected IOLs. There have been few epidemiological studies published to determine the relationship between endophthalmitis and the IOL type. However, the perfect biomaterial that could prevent postoperative endophthalmitis does not yet exist. Globally, hydrophilic materials and hydrophobic acrylic seem to be less sticky than silicone or PMMA, but this remains to be proven clinically.

Keywords: Bacterial adhesion, biofilm, Staphylococcus epidermidis, intraocular lenses, endophthalmitis, in vitro & in vivo studies

Journal: Bio-Medical Materials and Engineering, vol. 14, no. 4, pp. 395-409, 2004