Contact Lens Disinfection Solutions Research Articles

Cell death of Acanthamoeba castellanii following exposure to antimicrobial agents commonly included in contact lens disinfecting solutions.

Several antimicrobial agents are commonly included in contact lens disinfectant solutions including chlorhexidine diacetate (CHX), polyhexamethylene biguanide (PHMB) or myristamidopropyl dimethylamine (MAPD); however, their mode of action, i.e. necrosis versus apoptosis is incompletely understood. Here, we determined whether a mechanism of cell death resembling that of apoptosis was present in Acanthamoeba castellanii of the T4 genotype (NEFF) following exposure to the aforementioned antimicrobials using the anticoagulant annexin V that undergoes rapid high affinity binding to phosphatidylserine in the presence of calcium, making it a sensitive probe for phosphatidylserine exposure. The results revealed that under the conditions employed in this study, an apoptotic pathway of cell death in this organism at the tested conditions does not occur. Our findings suggest that necrosis is the likely mode of action; however, future mechanistic studies should be accomplished in additional experimental conditions to further comprehend the molecular mechanisms of cell death in Acanthamoeba.

Hydrogen Peroxide-based Contact Lens Disinfection Systems Effective against SARS-CoV-2

While SARS-CoV-2 is a largely respiratory pathogen, it has been reported that the ocular surface may present a significant opportunity for infection either via airborne droplets or by self-contamination via touching an infected surface to the eye. In particular, contaminated contact lenses present a potential vector for microorganism transmission. It is then crucial to demonstrate that contact lens disinfection solutions are effective against the SARS-CoV-2 virus. Here, we applied the International Standards Organization protocol 14729 to assess the antiviral activity of CLEAR CARE® and CLEAR CARE® PLUS, hydrogen peroxide-based contact lens disinfection systems for use with soft contact lenses. Test samples were inoculated with 5.75 log10 TCID50/mL of SARS-CoV-2 and sampled at time zero and then again after the stated disinfection time of 6 hours. Both CLEAR CARE® and CLEAR CARE® PLUS demonstrated a 4.75 log reduction of the SARS-CoV-2 virus after 6 hours. No viable virus was recovered following disinfection with CLEAR CARE® and CLEAR CARE® PLUS. This data indicates the hydrogen peroxide-based contact lens disinfection systems are extremely effective at eliminating SARS-CoV-2, and these systems may provide patients with an effective option for contact lens disinfection in the face of this pandemic.

Efficacy of two contact lens disinfecting solutions in reducing growth rate of bacteria and eradication of biofilms

Efficacy of two types of contact lens disinfecting (CLD) solutions, most frequently purchased from Jordanian pharmacies by contact lens wearers, was investigated for reducing growth rate of methicillin resistant and methicillin sensitive Staphylococcus aureus, Serratia marcesence, S. liquefacience and Acinetobacter spp., previously isolated from In-use disinfecting solutions in CL cases. Each species was cultured in a clean and dirty conditions (to mimic real situation) of two fresh CLD solutions separately: A and B whose active agents are: Polyhexamethylene biguanide hydrochloride and Polyaminopropyl biguanide respectively. Log reduction of these bacteria have exceeded ISO 14729 acceptable criteria (3 log) and reached up to 5 log reduction. Dirty conditions have marked effect in reducing efficacy of CLD solution (A) to kill bacterial species under test. Biofilms produced by S. marcescens and S. liquefaciens were reduced by more than 50% after 24 hrs. using either CLD solutions, though it was less than that reduced after 4 hrs. Biofilm of methicillin resistant Staphylococcus aureus (MRSA) was the most affected by either CLD solutions after 4 hours. This study concluded that CL wearers should pay great consideration to cleaning and disinfection practices to decrease bacterial growth, reduce chances of biofilm formation.

Effect of povidone iodine contact lens disinfecting solution on orthokeratology lens and lens case contamination and organisms in the microbiome of the conjunctiva

PurposeTo compare lens cleaning routines using a povidone iodine-based rigid lens disinfecting solution and its effect on conjunctival colonisation, and lens and lens case contamination. MethodsParticipants, aged 6–10 years, receiving orthokeratology treatment were randomised to four lens cleaning routines: with and without the use of daily and/or weekly cleaners, which were performed by their parents. Conjunctival colonisation was compared before lens wear and at 1-, 3-, and 6-month after commencement of lens wear. Contamination of lenses and lens cases was investigated at these times. Organisms were identified using MALDI-TOF mass spectrometry. ResultsOf the 76 participants who completed the study, conjunctival colonization was present in 24 (32 %) at baseline. Of the remaining 52 participants, 34 consistently yielded no growth. Participants positive at baseline were statistically more likely to be colonized after commencement of lens wear (p = 0.020). Overall, colonization rate was reduced to 15 % (11/72) after 6-month lens wear, which reached significance for initially colonized participants (p < 0.001). Few cultures yielded potential ocular pathogens, with notably no Pseudomonas aeruginosa. Contamination rates of both lenses and lens cases were also low, with few isolations of ocular pathogens. No significant differences were observed between cleaning regimes for conjunctival colonization or contamination of lenses or cases. ConclusionsDisinfection for rigid and ortho-k lens wearers may be effectively achieved with the use of povidone iodine-based solution, apparently regardless of cleaning routine adopted in the current study. The absence of pathogens in the conjunctiva, lenses, and lens cases in the great majority of samples indicates that it can improve the safety of overnight lens wear.

In vitro effects of multi-purpose contact lens disinfecting solutions towards survivability of Acanthamoeba genotype T4 in Malaysia.

The incidence of Acanthamoeba keratitis has been increasing since the previous decades, especially among contact lens users. This infection is majorly caused by the use of ineffective contact lens disinfecting solution. Thus, this study was conducted to evaluate the in vitro effects of multi-purpose disinfecting solutions (MPDS) against Acanthamoeba trophozoites and cysts. Acanthamoeba genotype T4 isolated from contact lens paraphernalia and an environmental strains were propagated for trophozoite or cyst-containing culture and adjusted in final concentration of 1 × 105 cells/ml. Amoebicidal and cysticidal assays were conducted by incubating trophozoites and cysts with OPTI-FREE® Express®, ReNu® Fresh™, Complete® Multi-Purpose Solution and AVIZOR Unica® Sensitive according to the manufacturer’s minimum recommended disinfectant time (MMRDT) for up to 12 h at 30 ⁰C. Trypan blue hemocytometer-based microscopic counts determined amoebicidal and cysticidal effects. The viability of Acanthamoeba trophozoites and cysts was confirmed by re-inoculated them in the 1.5% non-nutrient agar plates. It was found that none of the MPDS showed amoebicidal and cysticidal effects during the MMRDT. However, OPTI-FREE® Express® demonstrated a significant differences in average cell reduction for both stages within MMRDT. When subjected to 12 h exposure, both OPTI-FREE® Express® and ReNu® Fresh™ led to significant reduction in the number of trophozoite and cyst cells. Notably, Complete® Multi-Purpose Solution and AVIZOR Unica® Sensitive did appreciably improve the solution effectiveness towards trophozoite cells when incubated for 12 h. All MPDS were largely ineffective, with 100% survival of all isolates at MMRDT, while OPTI-FREE® Express® showed limited amoebicidal activity against the contact lens paraphernalia isolate, however, it was more against the environmental strains after 12 h incubation time. The commercially available MPDS employed in this research offered minimal effectiveness against the protozoa despite the contact time. Improvement or development of new solution should consider the adjustment of the appropriate disinfectant concentration, adequate exposure time or the incorporation of novel chemical elements, which are effective against Acanthamoeba for accelerated disinfecting and more reduction of potential exposure of contact lens users to Acanthamoeba keratitis.

Enhancement of Contact Lens Disinfection by Combining Disinfectant with Visible Light Irradiation.

Multiple use contact lenses have to be disinfected overnight to reduce the risk of infections. However, several studies demonstrated that not only microorganisms are affected by the disinfectants, but also ocular epithelial cells, which come into contact via residuals at reinsertion of the lens. Visible light has been demonstrated to achieve an inactivation effect on several bacterial and fungal species. Combinations with other disinfection methods often showed better results compared to separately applied methods. We therefore investigated contact lens disinfection solutions combined with 405 nm irradiation, with the intention to reduce the disinfectant concentration of ReNu Multiplus, OptiFree Express or AOSept while maintaining adequate disinfection results due to combination benefits. Pseudomonads, staphylococci and E. coli were studied with disk diffusion assay, colony forming unit (cfu) determination and growth delay. A log reduction of 4.49 was achieved for P. fluorescens in 2 h for 40% ReNu Multiplus combined with an irradiation intensity of 20 mW/cm2 at 405 nm. For AOSept the combination effect was so strong that 5% of AOSept in combination with light exhibited the same result as 100% AOSept alone. Combination of disinfectants with visible violet light is therefore considered a promising approach, as a reduction of potentially toxic ingredients can be achieved.

In Vitro Amoebicidal Activity of Imidazolium Salts Against Trophozoites.

Several strains of the free-living genus Acanthamoeba can cause granulomatous amoebic encephalitis (GAE), a rare chronic and slowly progressive infection of the central nervous system (CNS), and Acanthamoeba keratitis (AK), a sight-threatening eye infectious disease. AK incidence has increased with the popularization of the contact lens wear and its treatment is currently limited and frequently unsuccessful. As imidazolium salts (IS), cationic imidazole derivatives, have promising antimicrobial potential. The present study evaluated the amoebicidal activity of four IS; 1-n-hexadecyl-3-methylimidazolium methanesulfonate (C16MImMeS), chloride (C16MImCl) and bis (triluoromethylsulfonyl) imide (C16MImNTf2 ), and 1-methyl-3-n-octadecylimidazolium chloride (C18MImCl), against the Acanthamoeba castellanii (ATCC30010) environmental strain and a clinical isolate (genotype T4). Three IS showed being lethal to 100% of the Acanthamoeba trophozoites at the minimum inhibitory concentrations of 125 and 62.5 μg/mL (C16MImMeS), 31.25 and 62.5 μg/mL (C16MImCl), and 125 and 125 μg/mL (C18MImCl) for ATCC30010 and isolate T4, respectively. C16MImNTf2 did not demonstrate amoebicidal activity. All active IS caused the hemolysis of erythrocytes. The cytotoxic effect of the IS was tested in RAW macrophages and human brain microvascular endothelial cells, which demonstrated cytotoxicity in all concentrations tested against both cell lines. As a consequence, these IS with amoebicidal activity presented low selectivity index values (SI) (SI < 1.0), demonstrating lack of parasite selectivity. Thus, C16MImMeS, C16MImCl, and C18MImCl seem to hold greater promise as components for contact lens cleaning and disinfection solutions, instead of direct human application.

Pseudomonas aeruginosa and microbial keratitis.

Pseudomonas aeruginosa, a versatile Gram-negative pathogen that can cause a wide range of infections, is the most common causative agent in cases of bacterial keratitis associated with contact-lens use. Corneal infections with P. aeruginosa often have poor clinical outcomes and can result in long and costly treatments. During the infection process, the pathogen exploits its large genome, encoding complex regulatory networks and a wide range of virulence factors, including motility and the secretion of various proteases and toxins. Although antibiotic resistance levels in the UK are low, higher levels have been seen in some other countries. In the face of increasing antibiotic resistance, alternative therapeutic approaches such as antivirulence strategies and phage therapy are being developed. There is increasing evidence to suggest that keratitis infections are associated with a phylogenetic subgroup of P. aeruginosa isolates carrying the gene encoding the potent cytotoxin exotoxin U, one of two mutually exclusive exotoxins secreted via the type III secretion system. The mechanisms behind this association are unclear, but understanding the genetic differences that predispose P. aeruginosa to cause corneal infections may allow for the development of targeted and more effective future treatments to reduce the morbidity of P. aeruginosa keratitis. In order to minimize the risk of severe P. aeruginosa eye infections, a wide range of contact-lens disinfection solutions are available. Constant exposure to biocides at a range of concentrations, from sub-inhibitory to inhibitory, could contribute to the development of resistance to both antibiotics and disinfectants.

Study of Disinfectant Resistance Genes in Ocular Isolates of Pseudomonas aeruginosa.

Background: The prevalence of disinfectant resistance in Pseudomonas aeruginosa is on the rise. P. aeruginosa is the most common bacteria isolated from cases of microbial keratitis. Many multi-purpose contact lens disinfectant solutions are available to decontaminate contact lenses before use and to help reduce the incidence of infections. However, with increasing disinfectant resistance, the effect of multi-purpose disinfectant solutions may diminish. The goal of this study was to examine genes associated with disinfectant resistance in ocular isolates of P. aeruginosa and understand the strain’s susceptibility to different multipurpose disinfectant solutions. Methods: Seven potential disinfectant resistance genes were used in BLASTn searches against the whole genomes of 13 eye isolates of P. aeruginosa. A microdilution broth method was used to examine susceptibility to four different multipurpose disinfectant solutions. Results: All strains possessed the sugE2, sugE3 and emrE (qacE) genes. The sugE1 and qacEdelta1 genes were present in 6/13 isolates. No strains contained the qacF or qacG genes. All tested disinfectant solutions had the ability to kill all test strains at 100% concentration, with some strains being susceptible at 1:8 dilutions of the disinfecting solutions. However, the presence of disinfectant resistance genes was not associated with susceptibility to multi-purpose disinfectants. Conclusion: All four tested contact lens disinfectant preparations are effective against P. aeruginosa isolates regardless of the presence of disinfectant resistance genes.

Effect of 2, 6-Dichlorobenzonitrile on Amoebicidal Activity of Multipurpose Contact Lens Disinfecting Solutions.

Multipurpose contact lens disinfecting solutions (MPDS) are widely used to cleanse and disinfect microorganisms. However, disinfection efficacy of these MPDS against Acanthamoeba cyst remain insufficient. 2, 6-dichlorobenzonitrile (DCB), a cellulose synthesis inhibitor, is capable of increasing the amoebical effect against Acanthamoeba by inhibiting its encystation. In this study, we investigated the possibility of DCB as a disinfecting agent to improve the amoebicidal activity of MPDS against Acanthamoeba cyst. Eight commercial MPDS (from a to h) were assessed, all of which displayed insufficient amoebicidal activity against the mature cysts. Solution e, f, and h showed strong amoebicidal effect on the immature cysts. Amoebicidal efficacy against mature cysts remained inadequate even when the 8 MPDS were combined with 100 μM DCB. However, 4 kinds of MPDS (solution d, e, f, and h) including 100 μM DCB demonstrated strong amoebicidal activity against the immature cysts. The amoebicidal activity of solution d was increased by addition of DCB. Cytotoxicity was absent in human corneal epithelial cells treated with either DCB or mixture of DCB with MPDS. These results suggested that DCB can enhance the amoebicical activity of MPDS against Acanthamoeba immature cyst in vitro.

Microbiocidal characterization of a novel povidone-iodine based rigid contact lens disinfecting solution.

This study investigated the efficacy of a novel povidone-iodine based disinfection solution for rigid gas permeable (RGP) lenses compared to three other currently available multipurpose and hydrogen peroxide solutions. Bactericidal and fungicidal activities were assessed using ISO 14729 reference methods, whilst amoebicidal properties were evaluated using an automated viability counter. All solutions were also assessed for long term storage stability over a 3-month period. The FDA guidelines were adequately achieved by all solutions tested and 3-month storage did not affect their activity against bacterial and fungal agents. Activity against Acanthamoeba castellani trophozoites reached 1-log reduction for the povidone-iodine solution and approached this level for the remaining solutions. Activity against cysts was somewhat reduced and ranged from 78 to 86% reduction in viability. A povidone-iodine based solution, which may offer advantages as resistance to this agent has not been demonstrated and it lacks toxicity, provided equivalent antimicrobial activity to other RGP solutions.

Butan-1-ol as an extractant solvent in dispersive liquid-liquid microextraction in the spectrophotometric determination of aluminium

Determining aluminium ions at μg L−1 scale currently requires either costly analytical techniques such as inductively coupled plasma, and/or graphite furnace atomic absorption spectrometry. Dispersive liquid-liquid microextraction (DLLME) is designed to promote separation and preconcentration, thus making it possible to determine the analyte of interest without significant matrix influence. This study was aimed at the development of a spectrophotometric method to determine Al3+ after microextraction of its complex with quercetin. Butan-1-ol was used as a novel extractant solvent in the DLLME process. The parameters influencing complexation and microextraction, such as the amount of quercetin and volume of extractant were evaluated by univariate analysis. In optimised conditions were estimated for the proposed method: linear range from 7.5 to 165.0 μg L−1, LOD of 2.0 μg L−1, and LOQ of 7.0 μg L−1. The accuracy was checked by applying the proposed method to water (NIST SRM-1643e) and rice flour (NIST SRM-1568c) certified reference materials and spike-and-recovery trials with distinct samples (mineral water, green tea, thermal spring water, contact lens disinfecting solution, saline concentrate for hemodialysis and urine).

Efficacy of Contact Lens Solutions Against Bacteria Isolated from Clinical Specimens

In this study, the efficacy of two recently marketed multipurpose contact lens disinfecting solutions against Staphylococcus aureus Rosenbach and Pseudomonas aeruginosa Gessard bacteria isolated from clinical specimens were investigated. The antibacterial activities of multipurpose contact lens disinfecting solutions were determined by microbiological culture method described in ISO 14729 guidelines. Bacterial counts were obtained for sampling intervals determined in addition to the manufacturer’s minimum recommended disinfection time and mean log reductions were calculated for each interval. Three different lots of each contact lens disinfecting solutions were used. The results showed that both contact lens disinfecting solutions provided at least 3 log reductions for all bacteria tested at the end of the manufacturer’s minimum recommended disinfection time. New formulations are being developed in contact lens disinfecting solution industry by new technologies and scientific researches. Further studies on strains isolated from different sources are needed in order to a complete understanding of these newly marketed contact lens solutions.

Efficacy of Korean Multipurpose Contact Lens Disinfecting Solutions against Acanthamoeba castellanii.

Acanthamoeba keratitis has been increasing in recent years. Main risk factors are contact lens wear and their cleaning solutions. Most contact lens wearers use multipurpose disinfecting solutions (MPDS) for cleansing and disinfecting microorganisms because of its convenience. We determined amoebicidal effects of MPDS made in Korea and their cytotoxicity on human corneal epithelium cells. Fifteen commercial MPDS (A to O) were tested for their amoebicidal effects on Acanthamoeba castellanii trophozoites and cysts by using a most probable number (MPN) technique. Among them, 7 kinds of MPDS showed little or no amoebicidal effects for 24 hr exposure. Solutions A, B, G, H, L, and O showed positive amoebicidal effects, and solutions M and N killed almost all trophozoites and cysts after 24 hr exposure. However, 50%-N solution showed 56% cytotoxicity on human corneal epithelial cells within 4 hr exposure, and 50%-O solution also showed 62% cytotoxicity on human cells within 4 hr exposure. Solution A did not show any cytotoxicity on human cells. These results revealed that most MPDS made in Korea were ineffective to kill Acanthamoeba. The solutions having amoebicidal activity also showed high levels of cytotoxicity on human corneal epithelial cells. New formulations for improved MPDS that are amoebicidal but safe for host cells are needed to prevent Acanthamoeba keratitis.

An unusual case of Mycobacterium chelonae in contact lens solution

Importance: Microbial keratitis is an increasing complication amongst contact lens wearers. In the absence of positive cultures, there should be a high index of suspicion for uncommon pathogens including acanthamoeba, herpes simplex, fungi and mycobacteria. Our unique case highlights mycobacteria as serious a pathogen which requires aggressive therapy. Successful treatment of mycobacteria could result in good visual potential. Observations: We describe an original case of presumed Mycobacterium chelonae infection and management in an elderly contact lens wearer with a protracted clinical course of bilateral non-healing epithelial defects. The patient initially did not reveal she was a contact lens wearer. She later confessed to washing contact lens with domestic tap water, but later changed this practice by using a contact lens disinfecting solution. Inspection of her contact lens solution revealed expiry 3 years earlier, from which Mycobacterium chelonae was eventually isolated. Resolution of her keratitis only occured after triple antibiotic therapy of topical amikacin, moxifloxacin and azithromycin supported by oral clarithromycin. She later underwent penetrating keratoplasty in both eyes, with good visual outcome. Conclusions and relevance: To the best of our knowledge, this is the first reported case of bilateral Mycobacterium chelonae keratitis arising from contaminated CL solution. This case illustrates the importance of considering Mycobacterium in the differential diagnoses when treating non healing keratitis. It is important to enquire about contact lens wear and hygiene in all keratitis cases, regardless of patient age. There is a need to create public awareness regarding the potential serious risk of CL wear and safe CL practice that includes monitoring by eye care professionals.

Status of the effectiveness of contact lens solutions against keratitis-causing pathogens.

The aim of this study was to assess the antimicrobial effects of marketed contact lens disinfecting solutions. Using ISO 14729 Stand-Alone Test for disinfecting solutions, bactericidal, fungicidal and amoebicidal assays of eight different contact lens solutions including: ReNu MultiPlus, DuraPlus, Ultimate Plus, OptiFree Express, Kontex Clean, Kontex Normal, Kontex Multisol extra(+), Kontex Soak were performed. The efficacy of contact lens solutions was determined against keratitis-causing microbes, namely: Pseudomonas aeruginosa, Serratia marcescens, Staphylococcus aureus, Methicillin-resistant Staphylococcus aureus, Fusarium solani and Acanthamoeba castellanii. The results revealed that ReNu MultiPlus, DuraPlus and OptiFree Express were effective in killing bacterial and fungal pathogens as per manufacturer's minimum recommended disinfection time. Ultimate Plus was effective against F. solani and MRSA but ineffective against P. aeruginosa, S. marcescens and S. aureus. Of concern however, is that none of the locally formulated contact lens disinfecting solutions from Pakistan, i.e., Kontex Clean, Kontex Normal, Kontex Multisol extra(+) and Kontex Soak were effective against any of the keratitis-causing organisms tested. All eight contact lens disinfecting solutions were unable to destroy Acanthamoeba cysts. Because such ineffective contact lens disinfection solutions present a major risk to public health, these findings are of great concern to the health officials and to the manufacturers of the contact lens disinfection solutions and effective solutions are needed, along with emphasis on proper hygiene for contact lens care and special guidelines for developing countries regarding the manufacture and storage of contact lens disinfecting solutions.

Amoebicidal efficacy of a novel multi-purpose disinfecting solution: First findings

Free-living amoebae of the genus Acanthamoeba can cause a sight-threatening corneal infection, Acanthamoeba keratitis, mostly in contact lens wearers. The use of ineffective contact lens disinfecting solutions is one of the most important risk factors for this infection. This study concerns a new multi-purpose contact lens disinfecting solution, OPTI-FREE® PureMoist®, tested for its efficacy against Acanthamoeba trophozoites and cysts by using the most probable number technique for amoebic enumeration. Acanthamoeba castellanii ATCC 50373 and an environmental strain of Acanthamoeba genotype T4 isolated from tap water in Istanbul were used during the experiments. OPTI-FREE® PureMoist® achieved total kill (more than a 3-log reduction) of trophozoites of both strains before the manufacturer-recommended disinfection time (6h). In contrast, this solution had limited cysticidal activity against the ATCC strain but more against the environmental strain, with log reductions of 0.75 and 2.20, respectively, after 6h of exposure.

Inefficacy of marketed contact lens disinfection solutions against keratitis-causing Acanthamoeba castellanii belonging to the T4 genotype

The aim of this study was to assess the anti-amoebic effects of marketed contact lens disinfecting solutions. Using amoebistatic, amoebicidal, and cysticidal assays, nine different contact lens solutions were tested including: ReNu MultiPlus, DuraPlus, Ultimate Plus, OptiFree Replenish, OptiFree Express, Kontex Clean, Kontex Normal, Kontex Multisol extra+, Kontex Soak. In vitro growth inhibition (amoebistatic) assays were performed by incubating Acanthamoeba castellanii with aforementioned contact lens disinfection solutions as per manufacturer’s instructions in the growth medium for up to 48h at 30°C. To determine amoebicidal and cysticidal effects, amoebae were incubated with contact lens solutions in phosphate buffered saline for 24h and viability was determined by haemocytometer counting as well as re-inoculating them in the growth medium. For controls, solutions were tested against bacterial corneal pathogen, Pseudomonas aeruginosa, as well as amoebae were incubated with the solvent alone. Of the nine contact lens solutions tested, none of them showed potent amoebicidal effects. Only DuraPlus and OptiFree Replenish exhibited trophozoite lysis of 85.3% and 73.7% respectively. In contrast, all contact lens disinfection solutions except Kontex Clean, Kontex Normal, Kontex Multisol extra+, tested showed amoebistatic effects. Importantly, none of the contact lens disinfection solutions exhibited cysticidal effects using qualitative assays, i.e., cysts treated with aforementioned solutions re-emerged as viable amoebae upon inoculation in the growth medium. However, more than 3-log reduction was observed when ReNu MultiPlus, DuraPlus and OptiFree Express were tested against P. aeruginosa which is in accordance with the ISO Stand-Alone Primary acceptance criteria. These findings are of great concern for contact lens users.

Human Corneal Epithelial Cell Shedding and Fluorescein Staining in Response to Silicone Hydrogel Lenses and Contact Lens Disinfecting Solutions

Purpose: A pilot study was conducted to evaluate human corneal epithelial cell shedding in response to wearing a silicone hydrogel contact lens/solution combination inducing corneal staining. The nature of ex vivo collected cells staining with fluorescein was also examined.Methods: A contralateral eye study was conducted in which up to eight participants were unilaterally exposed to a multipurpose contact lens solution/silicone hydrogel lens combination previously shown to induce corneal staining (renu® fresh™ and balafilcon A; test eye), with the other eye using a combination of balafilcon A soaked in a hydrogen peroxide care system (Clear Care®; control eye). Lenses were worn for 2, 4 or 6 hours. Corneal staining was graded after lens removal. The Ocular Surface Cell Collection Apparatus was used to collect cells from the cornea and the contact lens.Results: In the test eye, maximum solution-induced corneal staining (SICS) was observed after 2 hours of lens wear (reducing significantly by 4 hours; p < 0.001). There were significantly more cells collected from the test eye after 4 hours of lens wear when compared to the control eye and the collection from the test eye after 2 hours (for both; n = 5; p < 0.001). The total cell yield at 4 hours was 813 ± 333 and 455 ± 218 for the test and control eyes, respectively (N = 5, triplicate, p = 0.003). A number of cells were observed to have taken up the fluorescein dye from the initial fluorescein instillation. Confocal microscopy of fluorescein-stained cells revealed that fluorescein was present throughout the cell cytoplasm and was retained in the cells for many hours after recovery from the corneal surface.Conclusion: This pilot study indicates that increased epithelial cell shedding was associated with a lens-solution combination which induces SICS. Our data provides insight into the transient nature of the SICS reaction and the nature of fluorescein staining observed in SICS.

Resistance and Growth of Fusarium species in Contact Lens Disinfectant Solutions

To compare the biocidal efficacy of contact lens care solutions against clinical isolates and the American Type Culture Collection (ATCC) 36031 reference strain of Fusarium species and to determine the ability of the organism to survive and grow in such systems. The ISO 14729 reference method to assess biocidal efficacy was applied to the purified conidial form of 10 strains of Fusarium species. Six multipurpose disinfectant solutions (MPDSs), a one-step hydrogen peroxide (Per-1) system, a hydrogen peroxide-sodium chlorite (Per-2) system, and a one-step povidone iodine (PI) system were compared. Challenge organism viability was determined at various intervals, including the manufacturers' recommended disinfection time for the products (4 to 6 hours) and thereafter to 21 days. All MPDSs achieved a 3- to 4-log10 reduction in viability of ATCC 36031 within the recommended disinfection time of 6 hours. For the clinical strains, MPDS-1 (PQ-1 + alexidine) and MPDS-2 (PQ-1 + PHMB) produced 3 to 5 log₁₀ kill after 6 hours. Multipurpose disinfectant solution 3 (PQ-1 + Aldox 0.0006%), MPDS-4 (PQ-1 + Aldox 0.0005% + C-9 ED3A), and MPDS-5 (PQ-1 + Aldox 0.0005%) showed reduced efficacy for the same two strains, with 0.6 to 1.7 log₁₀ kill. Multipurpose disinfectant solution 6 (PHMB) gave 1.6 log₁₀ for one strain and 3 to 4 log₁₀ for the remainder. Growth in all the MPDS was not detected up to 21 days incubation. Per-1 showed less than 1 log₁₀ kill at 6 hours for six of 10 strains, including ATCC 36031, and growth (1.2 to 2.7 log₁₀) occurred with three of 10 strains by 7 days. Per-2 gave less than or equal to 0.5 log₁₀ kill after 6- or 24-hour exposure without growth. The PI system showed 4 to 5 log₁₀ kill for all strains tested by the first time point of 4 hours. However, with the exception of ATCC 36031, growth (1.7 to 4.0 log₁₀) occurred with all strains by 7 days in PI. All MPDSs were effective against the ATCC 36031 reference strain of Fusarium solani. However, reduced efficacy was found for some MPDSs against the clinical isolates. Unlike MPDSs, peroxide- and povidone iodine-based systems have no continued antimicrobial presence once neutralized, and this can allow growth of surviving Fusarium in the solution. Accordingly, lenses should be subject to fresh disinfection if stored in such solutions for extended periods.