Preoperative Disinfection of the Conjunctival Sac in Cataract Surgery

Hara, J; Yasuda, Fuyuko; Higashitsutsumi, Minoru

doi:10.1159/000310888

Cited by 46 publications

(28 citation statements)

References 14 publications

(22 reference statements)

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“…These commensal bacteria are generally regarded as beneficial microflora for the host because they can suppress pathogens by displacing them from a microbial niche or by secreting antimicrobial substances (36). Normal bacterial flora residing in the conjunctival sac or along the eyelid edge making contact with the corneal surface include coagulase negative staphylococci, P. acnes, and others (4,5). Commensal flora are also key to creating a symbiotic host-parasite interaction for the intestinal mucosa, especially in the large intestine.…”

Section: Discussionmentioning

confidence: 99%

“…However, physiological destruction of the ocular surface by trauma, immunodeficiencies, or routine contact lens wear increases the incidence of sightthreatening corneal infection caused by Pseudomonas aeruginosa and Staphylococcus aureus, the common causative pathogens (2,3). Residing in the conjunctival sac or eyelid edge of the ocular surface are normal bacterial flora, including coagulase negative staphylococci, Propionibacterium acnes, and other Gram-positive and -negative bacteria (4,5), but the corneal epithelium does not generally respond to such flora. In fact, in many cases, patients suffering from bacterial conjunctivitis show no signs of inflammation in their corneas.…”

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confidence: 99%

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Intracellularly Expressed TLR2s and TLR4s Contribution to an Immunosilent Environment at the Ocular Mucosal Epithelium

Ueta

Nochi

Jang

et al. 2004

The Journal of Immunology

140

129

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Epithelial cells are key players in the first line of defense offered by the mucosal immune system against invading pathogens. In the present study we sought to determine whether human corneal epithelial cells expressing Toll-like receptors (TLRs) function as pattern-recognition receptors in the innate immune system and, if so, whether these TLRs act as a first line of defense in ocular mucosal immunity. Incubation of human primary corneal epithelial cells and the human corneal epithelial cell line (HCE-T) with peptidoglycan or LPS did not lead to activation, at the level of DNA transcription, of NF-κB or the secretion of inflammation-associated molecules such as IL-6, IL-8, and human β-defensin-2. However, when incubated with IL-1α to activate NF-κB, the production by these cells of such inflammatory mediators was enhanced. Human corneal epithelial cells were observed to express both TLR2- and TLR4-specific mRNA as well as their corresponding proteins intracellularly, but not at the cell surface. However, even when LPS was artificially introduced into the cytoplasm, it did not lead to the activation of epithelial cells. Taken together, our results demonstrate that the intracellular expression of TLR2 and TLR4 in human corneal epithelial cells fails to elicit innate immune responses and therefore, perhaps purposely, contributes to an immunosilent environment at the ocular mucosal epithelium.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Intracellularly Expressed TLR2s and TLR4s Contribution to an Immunosilent Environment at the Ocular Mucosal Epithelium

Ueta

Nochi

Jang

et al. 2004

The Journal of Immunology

140

129

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“…Corynebacteria, along with Staphylococcus epidermidis and Propionibacterium acnes, constitute the major colonizers of the conjunctival sac, eyelids, and meibomian glands (8). Corynebacteria other than C. diphtheriae seem to have low virulence against the cornea (18).…”

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confidence: 99%

Suture-Related Keratitis Caused by Corynebacterium macginleyi

Suzuki¹,

Iihara

Uno³

et al. 2007

J Clin Microbiol

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We report two cases of suture-related keratitis following penetrating keratoplasty. In both cases, Corynebacterium macginleyi was isolated from corneal specimens. Scanning electron microscopy revealed that corynebacteria could aggregate and form a biofilm. The MICs of sulbenicillin and fluoroquinolones were high for both isolates. Our findings show that C. macginleyi can cause keratitis with biofilm formation. CASE REPORT Case 1. A 74-year-old woman underwent penetrating keratoplasty for a corneal opacity. Postoperatively, she was treated with topical corticosteroids (0.1% dexamethasone) and 0.3% gatifloxacin four times daily, and her recovery was uneventful. Four months later, she visited us with a complaint of blurred vision in her right eye. Slit-lamp biomicroscopy revealed an epithelial defect and a moderate degree of stromal infiltration, along with a loose corneal suture thread. We scraped over the surface of the suppurative area of the cornea and removed the loose corneal suture thread. Direct microscopy and bacterial culture of the corneal scraping were performed. The direct microscopy of the corneal scraping demonstrated the presence of gram-positive rods, and confluent growth of corynebacteria occurred after 48 h of incubation at 37°C in a 5% CO 2 -enriched atmosphere on Columbia agar plates supplemented with 5% sheep blood (SBA). Colonies were grayish translucent and less than 0.5 mm in diameter. We considered corynebacteria to be the causative agent of the keratitis. We stopped the topical corticosteroids and 0.3% gatifloxacin and started treatment with topical 0.3% tobramycin and 0.5% cefmenoxime every hour. The corneal lesion responded to these agents promptly, and the corneal infiltration healed within 1 week.Case 2. A 49-year-old man underwent penetrating keratoplasty for bullous keratopathy caused by a birth injury. Postoperatively, he was treated with topical corticosteroids (0.1% dexamethasone) and 0.5% levofloxacin four times daily, and his recovery was uneventful. The antibiotic eye drops were stopped 1 year after surgery. When he visited us 3 years after the surgery, slit-lamp biomicroscopy revealed an epithelial defect and a corneal plaque with a loose corneal suture thread (Fig. 1A). We removed the loose corneal suture thread and performed direct microscopy and bacterial culture of the removed corneal plaque. Direct microscopy demonstrated the presence of numerous gram-positive rods (Fig. 1B), and a large number of small colonies (Ͻ0.5 mm in diameter after 48 h of incubation) were observed on SBA. We diagnosed keratitis caused by corynebacteria, stopped the topical corticosteroids, and initiated treatment with topical 0.3% tobramycin and 0.3% gatifloxacin every hour. The epithelial defect and corneal plaque disappeared within 1 week.Bacteriological findings. The isolates (EC009 in case 1 and EC010 in case 2) were suspected of being lipophilic corynebacteria because small colonies (Ͻ0.5 mm in diameter) were found after 48 h of incubation on SBA. In order to identify corynebacteria, biochem...

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“…Approximately two thirds of these strains are Gram-negative bacterial strains, most notably Pseudomonas aeruginosa but also some Serratia species, while one third comprises Gram-positive cocci, including Staphylococcus aureus and Staphylococcus epidermidis (Catalonotti P et al, 2005;Leitch EC et al, 1998;Seal et al, 1999). S epidermidis is one of the microorganisms most frequently isolated from the normal microbiota of the human eye surface (Ayoub M et al, 1994;Doyle A et al, 1995;Hara J et al, 1997). Despite this, this bacterium has been held responsible for infections such as chronic blepharitis, conjunctivitis and keratitis, especially in immunocompromised hosts (Pinna A et al, 1999), and may account for 45 per cent of all cases of bacterial keratitis (Nayak et al, 2007;Nayak and Satpathy, 2000).…”

Section: Microbial Keratitis On Contact Lens Wearmentioning

confidence: 99%