Ozkan Jerome, Zhu Hua, Gabriel Manal, Holden Brien A, Willcox Mark D P
Brien Holden Vision Institute, Sydney, New South Wales, Australia.
Optom Vis Sci. 2012 Mar;89(3):326-35. doi: 10.1097/OPX.0b013e318243280e.
Bacterial contamination of the contact lens surface has been demonstrated to cause corneal infiltrative events. A reduction in the rate of bacterially driven corneal infiltrative events associated with lens wear is one of the major goals of the contact lens industry. There is a concern over the potential of any antimicrobial strategy that there will be unwanted changes to the ocular microbiota or the development of resistance to the antimicrobial. The aim of this study was to investigate the effect of prophylactic topical antibiotic instillation during continuous wear of silicone hydrogel lenses on the normal ocular microbiota, the throat microbiota, and the ocular physiology.
Forty-two male subjects were dispensed with lotrafilcon A silicone hydrogel contact lenses for a 3-month, 30 night continuous wear, monthly replacement trial. Subjects were randomized into either tobramycin 0.3% (test) or saline (control) drop group. Two drops were instilled into each eye on waking and before sleep. At monthly visits, lenses were collected aseptically, and ocular and throat swabs were performed, followed by standard microbial recovery and identifications. Any corneal infiltrative event at scheduled or unscheduled visits was recorded.
Numbers of microbes recovered from eye swabs from the tobramycin (test) group were significantly lower than the control (p = 0.01). Gram-positive cocci were recovered less frequently from the test group (p = 0.001). There were no significant differences in the numbers and types of microbes recovered from lens samples, or the contamination rate of the lenses between the two groups. There were no changes in the numbers of fungi or bacteria from throat swabs. There was no evidence of changes to resistance profile of microbes in the throat. More eye swabs from the test group (68.5%) were culture-negative than swabs from control (46.5%; p = 0.002). The test group had less corneal staining superiorly (0.0 ± 0.0 vs. 0.3 ± 0.4; p = 0.025) but increased bulbar redness (2.2 ± 0.5 vs. 1.5 ± 0.4; p < 0.001) at the 3-month visit only, compared with control group.
Overall, there appeared to be a minimal safety risk with 3-month's prophylactic antibiotic drop use during continuous wear of silicone hydrogel lenses. Clinically, antibiotic drop use induced a mild to moderate increase in bulbar redness by the 3-month time-point. Antibiotic use reduced microbiota on lids but did not affect the microbiota of the throat or change resistance to tobramycin.
已证实隐形眼镜表面的细菌污染会导致角膜浸润事件。降低与隐形眼镜佩戴相关的由细菌驱动的角膜浸润事件发生率是隐形眼镜行业的主要目标之一。人们担心任何抗菌策略都可能对眼部微生物群产生不良变化或导致对抗菌药物产生耐药性。本研究的目的是调查在连续佩戴硅水凝胶隐形眼镜期间预防性局部滴注抗生素对正常眼部微生物群、咽喉部微生物群和眼部生理的影响。
42名男性受试者佩戴lotrafilcon A硅水凝胶隐形眼镜进行为期3个月、30晚连续佩戴、每月更换的试验。受试者被随机分为0.3%妥布霉素（试验组）或生理盐水（对照组）滴眼组。每天醒来和睡前每只眼睛滴入两滴。每月随访时，无菌收集隐形眼镜，并进行眼部和咽喉部拭子采样，随后进行标准的微生物回收和鉴定。记录计划内或计划外随访时的任何角膜浸润事件。
从妥布霉素（试验组）组眼部拭子中回收的微生物数量显著低于对照组（p = 0.01）。试验组中革兰氏阳性球菌的回收频率较低（p = 0.001）。从隐形眼镜样本中回收的微生物数量和类型，或两组之间隐形眼镜的污染率没有显著差异。咽喉部拭子中的真菌或细菌数量没有变化。没有证据表明咽喉部微生物的耐药性发生改变。试验组的眼部拭子培养阴性的比例（68.5%）高于对照组（46.5%；p = 0.002）。与对照组相比，仅在3个月随访时，试验组上方角膜染色较少（0.0±0.0对0.3±0.4；p = 0.025），但球结膜充血增加（2.2±0.5对1.5±0.4；p < 0.001）。
总体而言，在连续佩戴硅水凝胶隐形眼镜期间使用3个月预防性抗生素滴眼液似乎存在最小的安全风险。临床上，到3个月时间点时，使用抗生素滴眼液会导致球结膜轻度至中度充血增加。使用抗生素可减少眼睑上的微生物群，但不影响咽喉部微生物群或改变对妥布霉素的耐药性。
