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K. A. Truax, B. J. Osgood, J. De La Cruz, T. T. McMahon; Surveillance Cultures of Bandage Contact Lenses of Patients With Boston Type I Keratoprosthesis. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1494.
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To evaluate if surveillance cultures of contact lenses of type I Boston keratoprosthesis patients can detect organism growth and/or antibiotic resistance prior to clinical presentation of infection.
Cultures of contact lenses from Boston KPro type 1 patients were performed. All patients were maintained on a prophylactic antibiotic regimen including vancomycin. Either Kontur large diameter lenses or Focus Night and Day (CIBA Vision) lenses were used, with selection based on adequate fit and patient comfort. All contact lenses were removed 1 week to 1 month after insertion. Lenses were removed under sterile conditions and placed into sterile balanced saline solution. Using sterile instruments, the lenses were cut into pieces and cultured in Page's saline, Eugonic broth, blood agar, and chocolate agar.
The lenses of 15 Boston KPro Type I patients were analyzed in the above manner. Of 15 lenses analyzed, one patient had cultures positive for streptococcus pneumoniae. This patient presented with signs and symptoms of endophthalmitis after self-discontinuing vancomycin. Three patients had cultures positive for coagulase negative staphylococcus in the absence of signs or symptoms of infection. One of the patients had a coagulase negative staphylococcus species with inducible macrolide-lincosamide-streptogramin B resistance. The remainder of the patients had no culture growth. No patients had positive amoeba or fungal cultures.
To avoid complications related to drying of the corneal tissue surrounding the Boston type I keratoprosthesis, patients require the use of a bandage contact lens. Additionally, these patients require chronic use of topical antibiotics to reduce the ever-present risk of endophthalmitis due to the PMMA-corneal interface. This combination may promote growth of fungi and resistant bacteria. The detection of these organisms prior to the clinical presentation of infection could alert the clinician that a change in antibiotic regimen may be necessary. Surveillance cultures appear to be an effective way to monitor the contact lenses of Boston KPro patients for possible organism growth and antibiotic resistance.
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