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Mariya Moosajee, Dhani Tracey-White, Richard P. Harbottle, Veronica Ferguson; Safety Profile of Stromal Hydration of Clear Corneal Incisions with Cefuroxime. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1983.
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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. This study aims to investigate the safety profile 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.
MF-1 mice had clear corneal incisions placed in each eye. Stromal hydration was performed with either 5 µl of 10 mg/ml cefuroxime, cefuroxime-texas red conjugate, or BSS (each group n=30). Corneas were harvested at 1 hour, day 1, and weeks 1, 2 and 6 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.
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 6 weeks post-operatively. Confocal microscopy detects cefuroxime-texas red up to 48 hours surrounding the corneal wound.
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 corneal incisions.
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