In Vitro Study of the Effect of 1.0% Sodium Hyaluronate on Bacterial Strains and Antibiotics

Öz

During anterior segment eye surgeries, ophthalmic viscosurgical devices (OVDs), primarily containing hyaluronic acid, protect the corneal endothelium and help maintain the anterior chamber with reduced trauma. We aimed to investigate the interaction of sodium hyaluronate 1.0% with Gram-positive and Gram-negative bacteria, and its interactions with prophylactic intracameral antibiotics moxifloxacin and cefuroxime. Four quality control bacterial strains were used in vitro to conduct five experiments using either cefuroxime or moxifloxacin. Our experiment included five stages: 1. Testing the ability of OVD to retain bacteria before antibiotic exposure. 2. Examining antibiotic-bacteria interactions in the presence of OVD. 3. Simulating aqueous humor circulation. 4. Evaluating the effect of OVD residuals on antibiotic retention. 5. Analyzing the interaction of bacteria and antibiotics within the OVD. Results showed a significant decrease in bacterial counts (p<0.001) between the initial stage and subsequent groups, with moxifloxacin consistently demonstrating lower bacterial counts and greater effectiveness compared to cefuroxime (p<0.001). Further in vivo studies are recommended to validate these results.

Anahtar Kelimeler

• Sodium hyaluronate 1.0%
• cefuroxime
• moxifloxacin
• ophthalmic viscosurgical devices

%1.0 Sodyum Hyaluronatın Bakteriler ve Antibiyotikler Üzerindeki Etkisinin İn Vitro Çalışması

Öz

Ön segment göz ameliyatları sırasında, öncelikli olarak hyaluronik asit içeren oftalmik viskocerrahi cihazlar (OVD'ler), kornea endotelini korur ve ön bölmenin daha az travma ile korunmasına yardımcı olur. Çalışmamızda %1.0 Sodyum hyaluronat içeren OVD’nin Gram pozitif ve Gram negatif bakterilerle etkileşimini ve profilaktik olarak kullanılan intrakamaral moksifloksasin ve sefuroksim ile etkileşimlerini araştırmayı amaçladık. Sefuroksim veya moksifloksasin kullanılarak beş deney yürütmek için dört kalite kontrol bakteri suşu in vitro kullanıldı. Deneyimiz beş aşamadan oluşmaktadır; 1. Antibiyotik maruziyetinden önce OVD'nin bakterileri tutma yeteneğini test etme, 2. OVD varlığında antibiyotik-bakteri etkileşimlerini inceleme, 3. Humor aköz dolaşımını simüle etme, 4. OVD kalıntılarının antibiyotik tutması üzerindeki etkisini değerlendirme, 5. OVD içindeki bakteri ve antibiyotik etkileşimini analiz etme. İlk deney grubundaki bakteri sayısı ve sonraki aşamalar arasındaki bakteri sayılarında önemli bir azalma olduğu (p<0,001) saptandı. Moksifloksasin, sefuroksim ile karşılaştırıldığında daha fazla etkinlik gösterdi (p<0,001). Çalışmamız invitro bir çalışma olup, sonuçları doğrulamak için daha fazla in vivo çalışma önerilmektedir.

Anahtar Kelimeler

• sefuroksim
• moksifloksasin
• oftalmik viskocerrahi cihaz
• %1 Sodyum hyaluronat

Kaynakça

1. 1.Huerta Ángeles G, Nešporová K. Hyaluronan and itsderivatives for ophthalmology: Recent advances and futureperspectives. Carbohydr Polym. 2021;259:117697. doi:10.1016/j.carbpol.2021.117697.
2. 2.Zhang X, Wei D, Xu Y, Zhu Q. Hyaluronic acid in ocular drugdelivery. Carbohydr Polym. 2021;264:118006. doi:10.1016/j.carbpol.2021.118006.
3. 3.Borkenstein AF, Borkenstein EM, Malyugin B. OphthalmicViscosurgical Devices (OVDs) in Challenging Cases: aReview. Ophthalmol Ther. 2021;10(4):831-843. doi:10.1007/s40123-021-00403-9.
4. 4.Park J, Popovic MM, Balas M, El-Defrawy SR, Alaei R, KertesPJ. Clinical features of endophthalmitis clusters after cataractsurgery and practical recommendations to mitigate risk:systematic review. J Cataract Refract Surg. 2022;48(1):100-112. doi:10.1097/j.jcrs.0000000000000756.
5. 5.Kato A, Horita N, Namkoong H, et al. Prophylactic antibioticsfor postcataract surgery endophthalmitis: a systematic reviewand network meta-analysis of 6.8 million eyes. Sci Rep.2022;12(1):17416. doi:10.1038/s41598-022-21423-w.
6. 6.Clinical and Laboratory Standards Institute (CLSI)Guidelines—Performance Standards for AntimicrobialSusceptibility Testing (2023) CLSI Document M100 ED33.
7. 7.Hsiao CW, Cheng H, Ghafouri R, Ferko NC, Ayres BD.Corneal Outcomes Following Cataract Surgery UsingOphthalmic Viscosurgical Devices Composed of ChondroitinSulfate-Hyaluronic Acid: A Systematic Review and Meta-Analysis. Clin Ophthalmol. 2023;17:2083-2096. doi:10.2147/OPTH.S419863.
8. 8.Matsuo T, Iguchi M, Morisato N, Murasako T, Hagiya H. AreProphylactic Systemic Antibiotics Required in Patients withCataract Surgery at Local Anesthesia?. Int J Environ Res Public Health. 2022;19(23):15796. doi:10.3390/ijerph192315796.

9. 9.Althiabi S, Aljbreen AJ, Alshutily A, Althwiny FA. Post-operative Endophthalmitis After Cataract Surgery: An Update.Cureus. 2022;14(2):e22003. doi:10.7759/cureus.22003.
10. 10.Chiquet C, Bron AM, Lundström M, Maurin M. Acute post-operative endophthalmitis: Microbiology from the laboratory tothe bedside. Surv Ophthalmol. 2022;67(6):1698-1710. doi:10.1016/j.survophthal.2022.07.001.
11. 11.Chiquet C, Cornut PL, Benito Y, et al. Eubacterial PCR forbacterial detection and identification in 100 acute postcataractsurgery endophthalmitis. Invest Ophthalmol Vis Sci.2008;49(5):1971-1978. doi:10.1167/iovs.07-1377.
12. 12.Endophthalmitis Vitrectomy Study Group. Results of theEndophthalmitis Vitrectomy Study. A randomized trial ofimmediate vitrectomy and of intravenous antibiotics for thetreatment of post-operative bacterial endophthalmitis. ArchOphthalmol.1995;113(12):1479-96.
13. 13.Simina DS, Larisa I, Otilia C, Ana Cristina G, Liliana MV,Aurelian MG. The ocular surface bacterial contamination andits management in the prophylaxis of post cataract surgeryendophthalmitis. Rom J Ophthalmol. 2021; 65(1):2-9. doi:10.22336/rjo.2021.2.
14. 14.George NK, Stewart MW. The Routine Use of Intracameral Antibiotics to Prevent Endophthalmitis After Cataract Surgery:How Good is the Evidence? Ophthalmol Ther. 2018;7(2):233-245. doi: 10.1007/s40123-018-0138-6.
15. 15.Chang DF, Braga-Mele R, Henderson BA, Mamalis N,Vasavada A. ASCRS Cataract Clinical Committee Antibiotic prophylaxis of post-operative endophthalmitis after cataractsurgery: Results of the 2014 ASCRS member survey. J Cataract Refract Surg. 2015;41(6):1300-5. doi:10.1016/j.jcrs.2015.01.014.
16. 16.Endophthalmitis Study Group, European Society of Cataract &Refractive Surgeons. Prophylaxis of post-operative endophthalmitis following cataract surgery: results of theESCRS multicenter study and identification of risk factors. JCataract Refract Surg. 2007;33(6):978-88. doi:10.1016/j.jcrs.2007.02.032.
17. 17.Sunderland DK, Sapra A. Physiology, Aqueous HumorCirculation. In: StatPearls [Internet]. Treasure Island (FL):StatPearls Publishing. (2023 Mar 12) 2024 Jan–. PMID:31985990.
18. 18.Astafurov K, Elhawy E, Ren L, Dong CQ, Igboin C, Hyman L,Griffen A, Mittag T, Danias J. Oral microbiome link toneurodegeneration in glaucoma. PLoS One. 2014;9(9):e104416. doi: 10.1371/journal.pone.0104416.
19. 19.Bowen RC, Zhou AX, Bondalapati S, Lawyer TW, Snow KB,Evans PR, Bardsley T, McFarland M, Kliethermes M, Shi D,Mamalis CA, Greene T, Rudnisky CJ, Ambati BK.Comparative analysis of the safety and efficacy of intracameralcefuroxime, moxifloxacin and vancomycin at the end ofcataract surgery: a meta-analysis. Br J Ophthalmol.2018;102(9):1268-1276. doi: 10.1136/bjophthalmol-2017-311051.