Conjunctival Cultures Research Articles

Postoperative Lomefloxacin 0.3% Prophylaxis in Strabismus Surgery

Purpose: To evaluate the efficacy of topical lomefloxacin 0.3% versus chloramphenicol 0.2% with polymyxin B 2500 U/ml in the treatment of patients after strabismus surgery. Methods: Seventy-nine consecutive patients who underwent strabismus surgery from April through October 2006 were randomized to receive topical lomefloxacin 0.3% (n = 45, 58 eyes) or chloramphenicol 0.2% with polymyxin B 2500 U/ml (n = 34, 40 eyes) postoperatively, in addition to topical dexamethasone 0.1% and diclophenac 0.1%. The groups were compared for clinical signs of local cellulitis and findings on conjunctival cultures. Results: From postoperative day 1 to day 28, rates of chemosis decreased from 96% to 9.5% in the lomefloxacin group and from 94% to zero in the chloramphenicol group; rates of hyperemia decreased from 100% to zero in both groups. Accordingly, rates of a cumulative clinical sign score (CCSS) decreased from 60% to zero in the lomefloxacin group and 50% to zero in the chloramphenicol group. Rates of positive bacterial cultures dropped from 59.6% preoperatively to 48.3% on day 14 in the lomefloxacin group and from 63% to 47% in the chloramphenicol group. Conclusions: Topical lomefloxacin is a potent alternative to topical chloramphenicol eye drops after strabismus surgery for the control of pain, infection and discharge, chemosis, hyperemia, and conjunctival hemorrhage.

Antimicrobial Efficacy of Prophylactic Gatifloxacin 0.3% and Moxifloxacin 0.5% in Patients Undergoing Phacoemulsification Surgery

To evaluate the ocular surface and aqueous antimicrobial effects of gatifloxacin and moxifloxacin administered in two dosing regimens to patients undergoing phacoemulsification. Patients were divided between two treatment groups and randomized to receive gatifloxacin 0.3% or moxifloxacin 0.5% within each group. Group 1 patients received antibiotics four times per day for 2 days before surgery with one additional drop the morning of surgery (n=50, each drug). Group 2 patients were treated as in group 1, plus four drops (one drop every 10 minutes) during the hour before surgery (n=60, each drug). Conjunctival and eyelid swabs were taken before surgery, and aqueous humor cultures were obtained immediately after surgery. Pathogens were identified and colony-forming units (CFUs) were counted. No differences were observed between the antibiotics in mean CFUs in conjunctival cultures from group 1 (gatifloxacin, 59.9+/-165.6 CFUs; moxifloxacin, 57.0+/-214.7 CFUs; P=0.939) or group 2 (gatifloxacin, 76.7+/-327.7 CFUs; moxifloxacin, 92.0+/-486.1 CFUs; P=0.830). No differences were observed between antibiotics in mean CFUs in eyelid cultures from group 1 (gatifloxacin, 198.1+/-330.1 CFUs; moxifloxacin, 168.3+/-379.0; P=0.840) or group 2 (gatifloxacin, 556.8+/-1,029.3 CFUs; moxifloxacin, 596.5+/-1,013.5 CFUs; P=0.832). The overall rate of positive aqueous cultures in the 220 patients from groups 1 and 2 combined was less than 1% (i.e., no difference between antibiotics in either group). Preoperative topical ophthalmic gatifloxacin and moxifloxacin produced similar preoperative eyelid and conjunctival bacterial counts and identically low postsurgical aqueous contamination rates.

Ocular anti‐allergic compounds selectively inhibit human mast cell cytokines in vitro and conjunctival cell infiltration in vivo

Conjunctival mast cells (MCs) are important effector cells in seasonal allergic conjunctivitis, via histamine and cytokine secretion. Several new anti-allergic eye drops stabilize MCs and block histamine receptors, but their anti-inflammatory effects are unclear. Anti-allergic drugs were compared for their anti-inflammatory effects in an in vitro model of human MC activation and in an experimental murine model of allergic conjunctivitis. Human cord blood stem cell-derived (CBMC) and conjunctival biopsy-derived MCs were stimulated via FcepsilonRI, degranulation and histamine release were assayed at 1 h and cytokine secretion at 24 h using multiplex arrays. Mice sensitized to short ragweed pollen were given anti-allergics topically before allergen challenge, and conjunctival immuno-staining was performed at 24 h. After a 1 h stimulation, 80% of the CBMC had degranulated and secreted histamine (27.9+/-4.7 ng/10(6) cells; P<0.05). Pre-treatment by all drugs significantly reduced histamine and TNF-alpha, whereas IL-5, IL-8, IL-10 and TNF-beta profiles were differentially decreased. For conjunctival biopsy-derived cultures (n=11), FcepsilonR1 stimulation increased histamine, TNF-alpha, TNF-beta, IL-5 and IL-8 levels and the production of IL-5, IL-6 (P<0.05), histamine and IL-8 (P<0.01) was inhibited by epinastine. In vivo, epinastine and olopatadine pre-treatment significantly reduced the clinical scores and eosinophil numbers (n=6; P<0.05) while epinastine also reduced neutrophils (P<0.02). Differential effects on MC cytokine inhibition were observed, with epinastine inhibiting MC secretion of IL-5, IL-8, IL-10 and conjunctival neutrophil infiltration. The anti-allergic drugs have anti-histamine and mast-cell stabilizing properties but might differ in clinical improvement depending on the individual and the cytokines involved.

Conjonctivite à gonocoque compliquée d’abcès cornéen perforant chez un adulte

We present a case of bilateral purulent conjunctivitis complicated by ocular perforation of the right eye secondary to fulminant corneal melt in a 29-year-old man. He developed urethritis after a sexual contact with a prostitute 3 weeks previously. Microbiological analyses of conjunctival and urinary cultures were positive for Neisseria gonorrhoeae resistant to penicillins, tetracyclines, and fluoroquinolones. Progression was favorable with a 15-day course of high doses of parenterally administered antibiotics associating imipenem and fosfomycin. Keratoplasty was done after 3 months. This observation is a good example of the problems raised by gonococcal conjunctivitis in adults. Extremely rare in developed countries, it remains widely unrecognized by ophthalmologists. It is a sexually transmitted disease usually resulting from autoinoculation from an infected genital site. The risk of marginal purulent corneal melt, which can lead to fulminant perforation, warrants prompt microbiological analysis and early parenteral antibiotic treatment.

Phase 3 Safety Comparisons for 1.0% Azithromycin in Polymeric Mucoadhesive Eye Drops versus 0.3% Tobramycin Eye Drops for Bacterial Conjunctivitis

To compare the safety and tolerability of 1.0% azithromycin in a polymeric mucoadhesive delivery system with 0.3% tobramycin ophthalmic solution for the treatment of bacterial conjunctivitis. This study was a prospective, randomized, active-controlled, double-masked, phase 3 trial conducted from August 6, 2004, to October 6, 2005, at 47 sites. Subjects with a clinical diagnosis of bacterial conjunctivitis were randomly assigned to receive either 1% azithromycin in DuraSite (AzaSite; InSite Vision, Alameda, CA) (n = 365) or 0.3% tobramycin (n = 378). Both groups received masked medication four times daily for 5 days, but participants received an active dose of 1% azithromycin in DuraSite only twice a day on days 1 and 2 and daily on days 3 to 5. Conjunctival cultures were taken, and ocular signs and symptoms were evaluated at baseline and at two follow-up visits. A total of 743 patients were randomized, and 710 (96%) completed the trial. Both study medications were well tolerated. The most frequently observed ocular adverse events in the azithromycin group were eye irritation (1.9%), conjunctival hyperemia (1.1%), and worsening bacterial conjunctivitis (1.1%). These rates compared favorably with those obtained with tobramycin. Rates of microbial eradication (an efficacy parameter) and bacterial infection recurrence (a safety parameter) were the same in both groups. This is the first report of the safety and tolerability of a commercially manufactured preparation of azithromycin for ophthalmic use. Azithromycin 1% in DuraSite is safe and can be administered in a regimen of less frequent doses than can tobramycin, while producing an equivalent clinical outcome. The formulation is well tolerated in patients over the age of 1 year for the eradication of bacteria commonly associated with conjunctivitis. (ClinicalTrials.gov number, NCT00105469.).

Eficácia de um regime de administração de antibióticos tópicos na redução da microbiota conjuntival de pacientes sadios com catarata senil

PURPOSE: To evaluate the conjunctival bacterial flora of healthy patients and its antibiotic resistance pattern and determine the effective of a regime of topical antibiotics on reduction of endogenous microbiota. METHODS: Its a prospective non randomized study. Fourty eyes of 40 patients, divided in 4 groups of 10 eyes each, used four differents topical antibiotics (ciprofloxacin, tobramycin and gatifloxacin). One group served as a control group. Were performed conjunctival cultures before instillation of the antibiotics drops and after 15, 30 [...]

Prospective Randomized Comparison of 1-Day versus 3-Day Application of Topical Levofloxacin in Eliminating Conjunctival Flora

To compare efficacy of a 1-day versus 3-day application of topical levofloxacin in reducing ocular surface bacteria. In this prospective randomized controlled trial, 100 volunteer patients (50 per group) were assigned to receive topical 0.5% levofloxacin four times daily for 1 day or 3 days. Conjunctival cultures were obtained prior to (T0) and after the application of antibiotics (T1). Additionally, all patients received topical levofloxacin at 5-minute intervals for three applications (T2), followed by two drops of topical 5% povidone-iodine (T3). Conjunctival cultures were obtained at timepoints T2 and T3. A 1-day application of topical levofloxacin significantly reduced (p = 0.0004) the number of eyes with positive conjunctival cultures from 41 eyes (82%) to 23 eyes (46%). Similarly, a 3-day application significantly reduced (p = 0.0001) the positive culture rate from 37 eyes (74%) to 17 eyes (34%). Two drops of povidone-iodine further reduced the positive culture rate for both groups to 20% (10 eyes for each group). There was no significant difference in positive culture rate between the 1-day and 3-day groups at T0 (p = 0.4689), T1 (p = 0.3074), T2 (p = 0.6706), or T3 (p = 1.000). The application of topical 0.5% levofloxacin for 1 or 3 days significantly reduced the number of eyes with positive conjunctival cultures. The addition of 5% povidone-iodine further eliminated bacteria from the conjunctiva. The application of levofloxacin for 1 day appears to be as effective as a 3-day application.

The effect of povidone iodine flush versus drops on conjunctival colonization before intravitreal injections

To determine the most effective method of applying povidone iodine 5% to decrease conjunctival colonization before intravitreal injections. Twenty-eight patients from two tertiary care centers undergoing intravitreal injection for diffuse diabetic macular edema, exudative age-related macular degeneration, venous occlusive disease, or refractory pseudophakic cystoid macular edema were prospectively randomized to two study arms. One arm received 2-3 drops of 5% povidone iodine (drops group) and the second received a 10 ml flush of the same solution (flush group). The inferior conjunctival fornix was cultured before and after antiseptic technique was performed in all patients. Three culture media, thioglycollate broth, chocolate agar and blood agar, were used for each sample. Each study group had 14 patients. Prior to antisepsis, 22 of the 28 (78.6%) subjects had positive conjunctival cultures. 16 and 14 bacterial organisms were isolated in the first and second groups, respectively. After using 2-3 drops of 5% povidone iodine in the first study arm of patients, three of 16 (18.7% reduction) bacterial organisms were no longer isolated in thioglycollate broth media. With flush irrigation of 10 ml of 5% povidone iodine, seven of 14 (50% reduction) bacterial organisms were no longer isolated (P-value 0.07) in broth media. No difference in reduction of bacterial colonization was found on plated media (chocolate agar and blood agar). Irrigating the conjunctival fornix with 5% povidone iodine results in greater reduction of bacterial colonization compared with drop application of the same solution. Flush irrigation may provide better protection against the risk of endophthalmitis with intravitreal injections.

Isolation, purification and cultivation of conjunctival melanocytes

The purpose of the present study was to develop methods for isolation, purification and cultivation of human conjunctival melanocytes. Conjunctiva excised from donor eyes or corneal rims was subjected with various enzyme digestion methods or by the enzyme-microdissection method. Cells were cultured with F12 medium supplemented by fetal bovine serum, basic fibroblast growth factor, isobutylmethylxanthine and cholera toxin. Contaminant cells were eliminated by a selective cytotoxic agent, geneticin. Both trypsin digestion and dispase-microdissection methods provided pure conjunctival melanocyte cultures with high cell yields, good viability and rapid growth rate. Melanocytes isolated with dispase-microdissection method showed better viability and growth capacity. Cells grew well, could be passaged for 5–10 generations and divided 20 times in vitro. They maintained a constant melanin content per cell and produced measurable amounts of melanin in vitro. Melanogenesis correlated with the degree of pigmentation of the eyes (iris color). This method provides a valuable source of large numbers of human conjunctival melanocytes, which can be used to study their biological behavior, to compare with the epidermal and uveal melanocytes; and to compare them to their malignant counterparts in the exploration of the pathogenesis of conjunctival melanoma.

Mycobacterium tuberculosis Presenting as Chronic Red Eye

To report a case of tuberculosis of the conjunctiva. Case report with pathologic correlation. A 17-year-old man who had relocated to Australia from Liberia presented with chronic unilateral conjunctivitis. The diagnosis was not initially evident, despite 2 separate biopsy specimens, conjunctival cultures, and polymerase chain reaction testing. Definitive diagnosis was made after repeated histologic examination. Antituberculous treatment resulted in prompt resolution of all ocular signs. Tuberculous conjunctivitis is now a very rare condition in the developed world. Definitive diagnosis requires the identification of Mycobacterium tuberculosis organisms in conjunctival biopsy specimens-either through microscopic detection of acid-fast bacilli or more sensitive culture techniques.

Effects of Fourth-Generation Fluoroquinolones on the Ocular Surface, Epithelium, and Wound Healing

Purpose: To compare the cellular effects of gatifloxacin and moxifloxacin on multidimensional aspects of corneal wound healing. Methods: Several animal models were used to evaluate the effect of commercial preparations of gatifloxacin ophthalmic solution 0.3% (Zymar) and moxifloxacin ophthalmic solution 0.5% (Vigamox) on the rate and quality of corneal wound healing. These included an in vivo rabbit anterior keratectomy model, a central corneal full-thickness incision model, and a model of the inflammation associated with experimental dry eye in mice. An in vitro normal human conjunctival epithelial cell culture model was also evaluated. Results: Despite the presence of benzalkonium chloride (BAK) in its formulation, gatifloxacin caused less degradation of corneal epithelial barrier function than moxifloxacin did. Moxifloxacin inhibited collagen IV synthesis to a greater extent than did gatifloxacin, and transmission electron microscopy revealed loss of normal structure in the basal lamina of moxifloxacin-treated eyes. Incisional healing in eyes treated with moxifloxacin was slower and more disorganized than in eyes treated with gatifloxacin or vehicle. In the gatifloxacin-treated cultures, the normal human conjunctival cells continued to grow and appeared most like the vehicle-treated cultures. Conversely, moxifloxacin inhibited cell proliferation. Conclusion: Taken together, the studies presented here provide evidence that moxifloxacin has a deleterious effect on both the speed and quality of corneal wound healing, whereas gatifloxacin does not. The clinical relevance of these data needs to be evaluated further.

A Community Outbreak of Conjunctivitis Caused by Nontypeable Streptococcus pneumoniae in Minnesota

The Minnesota Department of Health (MDH) was notified of an outbreak of conjunctivitis in city A with cultures positive for Streptococcus pneumoniae. MDH staff contacted clinics and schools in city A and city B regarding conjunctivitis cases, reviewed clinical findings of conjunctivitis cases in city A and collected isolates for subtyping. Between September 1 and December 12, 2003, cities A and B reported 735 conjunctivitis cases. Fifty-one percent of the cases were reported from schools, childcare centers and colleges. Adults were more likely to report itching, burning or swelling of the eye(s); children were more likely to report crusty eyes (P < 0.05). Forty-nine percent of conjunctival cultures (71 of 144) were positive for S. pneumoniae. All isolates were nontypeable by serotyping. Pulsed field gel electrophoresis identified 3 clonal groups with 84% of isolates belonging to one clonal group. Multilocus sequence typing revealed that isolates had the same multilocus sequence type as isolates from a 2002 outbreak at a New England college. This outbreak was widespread in the community and conjunctivitis clinical presentation varied by age. The predominant strains in this outbreak were related to a pneumococcal strain implicated in prior conjunctivitis outbreaks, suggesting these strains have a predilection for causing conjunctivitis.

Bacterial Culture Isolates from Hospitalized Pediatric Patients With Conjunctivitis

To determine the spectrum of organisms causing acute bacterial conjunctivitis in hospitalized children at a tertiary care referral center. Retrospective chart review. Charts of hospitalized children with positive conjunctival cultures were reviewed, and patients with clinical description of conjunctivitis were studied. One hundred and seven isolates from 59 patients were included in the study. The most common organisms cultured were coagulase-negative Staphylococcus (59.3% of patients), viridans Streptococcus (47.5%), and Staphylococcus aureus (20.3%). The type of organisms differed based on age, with S. aureus and Haemophilus influenzae being more common in nonneonates. Gram-negative bacilli and methicillin-resistant Staphylococcus species were more common in patients hospitalized longer than two days. The distribution of bacterial organisms causing acute bacterial conjunctivitis in our hospitalized children differs from that of previous reports in the outpatient setting. Conjunctival swabbing for culture and sensitivities before instituting empiric broad-spectrum antibiotic therapy may be useful.

Index of Suspicion in the Nursery

A 10-day old male infant in the neonatal intensive care unit (NICU) has a small amount of purulent drainage from his right eye, but no other signs of infection. His respiratory rate is 40 to 64 breaths/min, with oxygen saturations of more than 90% in room air and no significant episodes of apnea. His pulse is 140 to 164 beats/min, with no significant episodes of bradycardia, and his temperatures are recorded at 97.7° to 98.1°F (36.5° to 36.7°C) in a heated bed. He is tolerating feedings of expressed human milk through a feeding tube and has gained weight consistently since the sixth postnatal day, although he is still approximately 100 g below birthweight. His only medication is caffeine for apnea of prematurity, which was started on the second postnatal day. The patient was born at 29 4/7 weeks’ gestation to a 35-year-old, G2P1→2 woman who developed preterm labor that was resistant to tocolysis with magnesium and nifedipine. The infant was delivered vaginally and resuscitated in the delivery room with supplemental oxygen via facemask. Apgar scores were 7 at 1 minute and 8 at 5 minutes. His birthweight was 1,660 g. He was admitted to the NICU because of preterm birth and mild respiratory distress syndrome. Laboratory tests upon admission included a complete blood count (CBC) and blood cultures, and ampicillin and gentamicin administration was initiated. His initial CBC revealed a white blood cell count of 14.3×103/mcL (14.3×109/L), with 58% neutrophils, 3% bands, 25% monocytes, and 14% lymphocytes. He received a total of four doses of ampicillin and two doses of gentamicin over the first two postnatal days; antibiotics were discontinued when initial blood cultures showed no growth at 48 hours. He did not require intubation; he was maintained initially on continuous positive airway pressure and then …

Multiple cytokines in human tear specimens in seasonal and chronic allergic eye disease and in conjunctival fibroblast cultures

Several cytokines are involved in the recruitment and activation of inflammatory cells in ocular allergic diseases. The purpose of the study was to assay multiple cytokines and chemokines in tears, to compare subgroups of allergic conjunctivitis (AC) with controls, and in culture supernatants to determine whether conjunctival fibroblasts produce some of these cytokines. Fifty to one hundred microlitre tears were obtained from patients with active seasonal allergic conjunctivitis (SAC; n=12), vernal keratoconjunctivitis (VKC; n=18), atopic keratoconjunctivitis (AKC; n=6) and non-atopic controls (n=14). Primary conjunctival fibroblasts grown in vitro were stimulated with IL-4, IL-13 or TNF-alpha for 24 h. Cell-free tear and culture supernatants were assayed for IL-1beta, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, IL-13, IFN-gamma, TNF-alpha, eotaxin, MCP-1 and RANTES using multiplex bead analysis. Induction of chemokine gene expression was determined by PCR. IL-1beta, IL-2, IL-5, IL-6, IL-12, IL-13, MCP-1 were increased in all tears groups compared with controls, with highly significant correlations between many of these molecules. In addition IL-4, IFN-gamma, and IL-10 were elevated in SAC and VKC, while eotaxin and TNF-alpha were only increased in VKC. IL-6, IL-8, MCP-1, RANTES and eotaxin were detected from fibroblasts cultures, and were all up-regulated by TNF-alpha. By PCR, fibroblasts expressed MCP-1 transcripts constitutively, whereas IP-10 and Mig were up-regulated by TNF-alpha. Differential cytokine levels support tears as a useful indicator of immune mechanisms occurring during AC. The striking similarities in chemokine profiles between tears and fibroblasts suggest these cells as likely sources of chemokines in tears.

Prospective Randomized Study Determining Whether a 3-Day Application of Ofloxacin Results in the Selection of Fluoroquinolone-Resistant Coagulase-Negative Staphylococcus

Purpose To determine whether a 3-day application of ofloxacin results in the selection of fluoroquinolone-resistant conjunctival coagulase-negative Staphylococcus. Design. Prospective randomized trial. Methods Patients scheduled for ocular surgery were randomized to a control (89 eyes) or study group (70 eyes). The study group received topical ofloxacin (0.3%) four times a day for 3 days. Conjunctival cultures were obtained at baseline (T0) and after 3 days of ofloxacin (T1). Cultures were also obtained at T0 and T1 for the control group, but these eyes did not receive an antibiotic. Bacteria isolated were identified and antibiotic susceptibility was determined. Results At T0, 53 out of 89 patients (60%) in the control and 48 out of 70 patients (69%) in the study group harbored coagulase-negative Staphylococcus. Among these coagulase-negative Staphylococcus, 12 out of 53 in the control and 11 out of 48 in the study group were resistant to ofloxacin (p&gt;0.9999). At T1, significantly fewer coagulase-negative Staphylococcus (p=0.0003) were isolated from the study group (18 coagulase-negative Staphylococcus), compared the control group (48 coagulase-negative Staphylococcus). Of these, 5 out of 17 coagulase-negative Staphylococcus in the study group and 9 out of 48 coagulase-negative Staphylococcus in the control group were resistant to ofloxacin (p=0.5649). There was no significant difference in the number of coagulase-negative Staphylococcus resistant to ciprofloxacin or norfloxacin in the study group compared to the control group at T1. Conclusions Ofloxacin given four times a day for 3 days does not select out for conjunctival fluoroquinolone-resistant coagulase-negative Staphylococcus.

Reply : Perioperative antibiotics in phacoemulsification

We are pleased to hear of your low incidence of postoperative endophthalmitis. We favor the use of fourth-generation fluoroquinolones because they cover bacterial resistance to the second-generation and third-generation antibiotics, have broader coverage than the second-generation and third-generation fluoroquinolones for gram-positive bacteria, and are equally effective for gram-negative bacteria based on in vitro and in vivo studies.1,2 In addition, gatifloxacin and moxifloxacin are less prone to resistance development because of their resistance to single-step topoisomerase mutations and enhanced activity against gram-positive pathogens.3 Although Ness and Reinhard have seen a low incidence of endophthalmitis with a single use of ofloxacin preoperatively, Ta et al.4 performed a prospective randomized controlled trial comparing 3-day and 1-hour preoperative ofloxacin prophylaxis for cataract surgery. They found that 42% of eyes receiving 1-hour preoperative ofloxacin had positive conjunctival culture immediately before surgery, compared with 19% of eyes receiving 3 days of ofloxacin. Immediately after surgery, 34% of eyes with 1-hour prophylaxis compared with 14% of eyes receiving 3 days of prophylaxis had positive cultures. Furthermore, fewer bacteria were isolated from eyes receiving 3 days of prophylactic antibiotic. Likewise, Kowalski et al.5 found that commercially formulated moxifloxacin every 15 minutes preoperatively starting an hour before bacterial challenge and postoperatively with 4 drops separated by 4 hours prevented endophthalmitis in a rabbit model of endophthalmitis. Based on these results and our clinical experience, we believe that 3 days of prophylactic antibiotic use is superior to 1 antibiotic dose preoperatively. We agree with Ness and Reinhard that the efficacy of postoperative antibiotics after phacoemulsification is currently unknown. However, Mather et al.2 performed a prospective laboratory study in rabbit models that measured the effect of cataract surgery on the aqueous humor levels of topical moxifloxacin. They found no statistically significant difference in the penetration of topical moxifloxacin in eyes that had had cataract surgery compared with unoperated eyes. Furthermore, they discovered that a 3-drop schedule of moxifloxacin immediately after surgery produced aqueous concentrations that were well above the minimum inhibitory concentrations for resistant strains of the most common organisms implicated in endophthalmitis after cataract surgery. Until more studies have been performed, we are hopeful that the fourth-generation fluoroquinolones may be effective in eliminating bacteria that are introduced intraoperatively.

Superficial corneal foreign body: laboratory and epidemiologic aspects

To determine by bacterioscopy and culture the microorganisms carried by corneal foreign body and their sensitivity to antibiotics by antibiotic sensitivity test. A prospective study was carried out and information was collected on 101 patients who presented with corneal foreign body at the São Paulo Hospital Eye Emergency Service. Prior to any treatment, a sample of the ipsilateral inferior conjunctival fornix and the foreign body were collected and immersed in thioglycolate broth. Samples were sown on solid culture media including blood, chocolate and Sabouraud agar. Bacterioscopic examination using Gram and Giemsa staining and sensitivity test were performed. Positive foreign body culture results were compared to ipsilateral conjunctival fornix culture to exclude possible normal flora growth. Approximately 92% of patients were males with a mean age of 35 years and in 62.4% (95% confidence interval: 52.2-71.8%) had the right eye was affected. Foreign body positive cultures were achieved in 32.7% (95% confidence interval: 23.7-42.7%) of the cases. The microorganisms isolated from the foreign body culture were identified as: Streptococcus, alpha-hemolytic (n=4), Staphylococcus aureus (n=4), Staphylococcus, coagulase-negative (n=4), Corynebacterium xerosis (n=3), unidentified Gram-positive bacillus (n=2), Moraxella sp (n=1), Serratia sp (n=1), Acynetobacter sp (n=1). The microbial sensitivity test showed that 95% of the cases were sensitive to chloramphenicol and 90% were sensitive to ciprofloxacin, these being antibiotics used in our routine service. Superficial corneal foreign body acts as important contaminant vector and the great majority of isolated bacteria were sensitive to the antibiotic prophylaxis used in the treatment.

OPHTHALMIC EXAMINATION OF THE CAPTIVE WESTERN LOWLAND GORILLA (GORILLA GORILLA GORILLA)

This study examined the captive western lowland gorilla (Gorilla gorilla gorilla) eye as compared and contrasted with the human eye. Bilateral ophthalmic examinations of western lowland gorillas (n = 5) while under general anesthesia were performed opportunistically, including slit-lamp biomicroscopy, dilated fundus examination, cycloplegic retinoscopy, Schiotz tonometry, corneal diameter and thickness measurements, A-scan and B-scan ultrasonography, keratometry, and cultures of the eyelid margins and bulbar conjunctiva. Mean spherical equivalent refractive error by cycloplegic retinoscopy was +1.20 +/- 0.59 diopters. Mean intraocular pressure by Schiotz tonometry was 12.0 +/- 4.3 mm Hg. Mean optic nerve head cup to disc ratio was 0.42 +/- 0.11. Mean horizontal corneal diameter was 13.4 +/- 0.8 mm, and mean vertical cornea diameter was 12.7 +/- 0.8 mm. Mean central corneal thickness by ultrasound pachymetry was 489 +/- 52 microm. Mean axial length of the eye by A-scan was 22.75 +/- 0.71 mm. Mean lens thickness by A-scan was 4.23 +/- 0.34 mm. Mean anterior chamber depth by A-scan was 4.00 +/- 0.26 mm. Mean keratometry reading was 44.38 +/- 1.64 diopters. Eyelid margin and bulbar conjunctival cultures isolated Candida sp. (n = 5), Staphylococcus aureus (n = 4), Staphylococcus epidermidis (n = 3), Staphylococcus saccharolyticus (n = 3), and Micrococcus sp. (n = 3). This study suggests important similarities between western lowland gorilla and human eyes. These similarities may allow diagnostics, techniques, and equipment for human eye surgery, such as those used for cataract extraction and intraocular lens implantation, to be successfully utilized for gorillas.

Keratoconjunctival effects of diabetes mellitus in dogs

To compare Schirmer tear test (STT) values, corneal sensitivity, tear film break up times (TFBUTs), and tear glucose concentrations in relation to conjunctival microflora, and conjunctival cytologic and histologic findings among diabetic cataractous, nondiabetic cataractous, and nondiabetic noncataractous dogs. Procedures Fifteen dogs in each category underwent neuro-ophthalmic examination; aerobic, anaerobic and fungal conjunctival cultures; assessment of corneal touch threshold (CTT), STT, tear glucose, TFBUT; and conjunctival cytology and histology (in certain cases only). Degree of cataract and uveitis were critically graded. Glycemic control was estimated using serum fructosamine and glycosylated hemoglobin. STT values were significantly lower in diabetic cataractous than nondiabetic noncataractous dogs. CTT of diabetic cataractous dogs was significantly lower than that of nondiabetic noncataractous dogs. Mean TFBUTs were significantly less in diabetic cataractous dogs than nondiabetic cataractous and nondiabetic noncataractous dogs. Tear glucose concentrations were significantly higher in diabetic cataractous dogs than nondiabetic cataractous and nondiabetic noncataractous dogs. Conjunctival microbial isolates did not differ among groups. There were no significant differences in degree of cataract or uveitis between diabetic cataractous and nondiabetic cataractous groups. There was mild submucosal inflammatory infiltrate in conjunctival specimens from diabetic dogs. Conjunctival epithelial dysplasia and/or squamous metaplasia was/were detected in conjunctival biopsies of 5/7 diabetic dogs. Reductions in conjunctival goblet cell (GC) densities were noted in 4/7 diabetic dogs; there were no significant differences in mean GC densities among the three groups. Diabetic cataractous dogs have significantly altered keratoconjunctival characteristics compared to nondiabetic cataractous and nondiabetic noncataractous dogs.