Skip to main content
SpringerLink
Log in

Heparin and heparin-surface-modification reduce Staphylococcus epidermidis adhesion to intraocular lenses

  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

Bacterial adherence to intraocular lenses (IOLs) could be the cause of endophthalmitis following cataract surgery and lens implantation. The majority of cases of postoperative endophthalmitis are caused by microflora that reside on or near the eye of the patient. Staphylococcus epidermidis commonly colonizes the eyelid margin and conjunctiva and is the most common organism causing postoperative endophthalmitis. In this study, the in vitro adherence of S. epidermidis to regular poly-methyl methacrylate (PMMA) IOLs and to heparin-surface-modified (HSM) PMMA IOLs was investigated. The effects of heparin and antibiotics in solution on the adherence of bacteria to regular PMMA IOLs were evaluated. Adhesion of bacterial cells to IOLs was determined by counting the viable cells attached to the lenses. Significantly, fewer S. epidermidis attached to HSM-PMMA IOLs and to regular PMMA IOLs treated with heparin than to PMMA IOLs (p < 0.001). Furthermore, bacteria attached in significantly lower numbers to regular PMMA IOLs treated with heparin than to HSM-PMMA IOLs (p = 0.0031). Antibiotics in solution had no significant effect on bacterial adherence to PMMA IOLs. These data indicate that the use of HSM-PMMA IOLs and treatment of PMMA IOLs with heparin could diminish the incidence of postoperative endophthalmitis and intraocular inflammation associated with IOL implantation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kattan HM, Flynn HW, Pflugfelder SC, Robertson C, Forster RK. Nosocomial endophthalmitis survey: current incidence of infection after intraocular surgery. Ophthalmology 1991; 98: 227–38.

    PubMed  CAS  Google Scholar 

  2. Javitt JC, Vitale S, Canner JK, Street DA, Krakauer H, McBean AM et al. National outcomes of cataract extraction. Arch Ophthalmol 1991; 109: 1085–9.

    PubMed  CAS  Google Scholar 

  3. Weber DJ, Hoffman KL, Thoft RA, Baker AS. Endophthalmitis following intraocular lens implantation: Report of 30 cases and review of the literature. Rev Infect Dis 1986; 12–20.

  4. Speaker MG, Milch FA, Shah MK, Eisner W, Kreiswirth BN. The role of external bacterial flora in the pathogenesis of acute postoperative endophthalmitis. Ophthalmology 1991; 98: 639–49.

    PubMed  CAS  Google Scholar 

  5. Perkins RE, Kundsin RB, Pratt MV. Bacteriology of normal and infected conjunctiva. J Clin Microbiol 1975; 1: 147–9.

    PubMed  CAS  Google Scholar 

  6. Puliafito CA, Baker AS, Haaf J, Foster CS. Infectious endophthalmitis: Review of 36 cases. Ophthalmology 1982; 93: 921–9.

    Google Scholar 

  7. Driebe WT, Mandelbaum S, Forster RK, Schwartz LK, Culbertson WW. Pseudophakic endophthalmitis. Ophthalmology 1986; 93: 442–8.

    PubMed  Google Scholar 

  8. Han DP. Wisniewski SR, Wilson LA, Barza M, Vine AK, Doft BH et al. Endophthalmitis vitrectomy study group: Spectrum and susceptibilities of microbiologic isolates in the endophthalmitis vitrectomy study. Am J Ophthalmol 1996; 122: 1–17.

    PubMed  CAS  Google Scholar 

  9. Griffiths PG, Elliot TS, McTaggart L. Adherence of Staphylococcus epidermidis to intraocular lenses. Br J Ophthalmol 1989; 73: 402–5.

    PubMed  CAS  Google Scholar 

  10. Vafidis GC, Marsh RJ, Stacey AR. Bacterial contamination of intraocular lens surgery. Br J Ophthalmol 1984; 68: 520–3.

    PubMed  CAS  Google Scholar 

  11. Spencer SR, Dealler SF, Hassett PDA, Tott NJ, Hawkey PM, Noble BA. Bacterial contamination of intraocular lenses: The source of the bacteria. Eye 1989; 3: 685–9.

    PubMed  Google Scholar 

  12. Doyle A, Beigi B, EarlyA, Blake A, Eustace P, Hone R: Adherence of bacteria to intraocular lenses: A prospective study. Br J Ophthalmol 1995; 79: 347–9.

    PubMed  CAS  Google Scholar 

  13. Larsson R, Selen G, Formgren B, Holst A. Long-term stability of heparin-surface-modified intraocular lenses in vivo. J Cataract Refract Surg 1992; 18: 247–51.

    PubMed  CAS  Google Scholar 

  14. Lundgren B, Selen G, Spangberg M, Harfstrand A. Fibrinous reaction on implanted intraocular lenses. A comparison of conventional PMMA and heparin surface modified lenses. J Cataract Refract Surg 1992; 18: 236–9.

    PubMed  CAS  Google Scholar 

  15. Philipson B, Fagerholm P, Calel B, Grunge A. Heparin surface modified intraocular lenses. Three-month follow-up of a randomized, double-masked clinical trial. J Cataract Refract Surg 1992; 18: 71–8.

    PubMed  CAS  Google Scholar 

  16. Percival P. Use of heparin-modified lenses in high-risk cases for uveitis. Dev Ophthalmol 1991; 22: 80–3.

    PubMed  CAS  Google Scholar 

  17. Borgioli M, Coster DJ, Fan RFT, Henderson J, Jacobi KW, Kirkby GR et al. Effect of heparin surface modification of polymethylmethacrylate intraocular lenses on signs of postoperative inflammation after extracapsular cataract extraction. One-year results of a double-masked multicenter study. Ophthalmology 1992; 99: 1248–54.

    PubMed  CAS  Google Scholar 

  18. Cappuccino JG, Sherman N (eds) Microbiology: A Laboratory Manual. Benjamin/Cummings Publishing Company, Inc., New York, pp 75–81, 1987.

    Google Scholar 

  19. Portoles M, Refojo MF, Leong FL. Reduced bacterial adhesion to heparin-surface-modified intraocular lenses. J Cataract Refract Surg 1993; 19: 755–9.

    PubMed  CAS  Google Scholar 

  20. Arciola CR, Caramazza R, Pizzoferrato A. In vitro adhesion of Staphylococcus epidermidis on heparin-surface-modified intraocular lenses. J Cataract Refract Surg 1994; 20: 158–61.

    PubMed  CAS  Google Scholar 

  21. Davis AJ. Coagulase negative staphylococci infections. BrMed J (editorial) 1985; 290: 1230–1.

    Google Scholar 

  22. Lowy FD, Hammer SM. Staphylococcus epidermidis infections. Ann Intern Med 1983; 99: 834–9.

    PubMed  CAS  Google Scholar 

  23. Christensen GD, Simpson WA, Bisno AL, Beachey EH. Experimental foreign body infection in mice challenged with slimeproducing Staphylococcus epidermidis. Infect Immunol 1983; 40: 407–10.

    CAS  Google Scholar 

  24. Peters G, Pulverer G. Pathogenesis and management of Staphylococcus epidermidis ‘plastic’ foreign body infections. J Antimicrob Chemother 1984; 14 (Suppl D): 67–71.

    PubMed  Google Scholar 

  25. Dilly PN, Sellors PJ. Bacterial adhesion to intraocular lenses. J Cataract Refract Surg 1989; 15: 317–20.

    PubMed  CAS  Google Scholar 

  26. Jansen B, Hartmann C, Schumacher-Pedreau F, Peters G. Late onset endophthalmitis associated with intraocular lens: A case of molecularly proved S. epidermidis aetiology. Br J Ophthalmol 1991; 75: 440–1.

    PubMed  CAS  Google Scholar 

  27. Duran JA, Malvar A, Rodriquez-Ares MT, Garcia-Riestra C. Heparin inhibits Pseudomonas adherence to soft contact lenses. Eye 1993; 7: 152–4.

    PubMed  Google Scholar 

  28. Ruggieri MR, Hanno PM, Levin RM. Reduction of bacterial adherence to catheter surface with heparin. J Urol 1987; 138: 423–6.

    PubMed  CAS  Google Scholar 

  29. Ruggieri MR, Hanno PM, Levin RM. The effects of heparin on the adherence of five species of urinary tract pathogens to urinary bladder mucosa. Urol Res 1984; 12: 199–203.

    Article  PubMed  CAS  Google Scholar 

  30. Chin JL, Sharpe JR. The anti-adherence effect of heparin: A visual analysis. Urol Res 1983; 11: 173–9.

    Article  PubMed  CAS  Google Scholar 

  31. Vacca-Smith AM, Jones CA, Levine MJ, Stinson MW. Glucosyltransferase mediates adhesion of Streptococcus gordanii to human endothelial cells in vitro. Infect Immun 1994; 62: 2187–94.

    PubMed  CAS  Google Scholar 

  32. Noel GJ, Love DC, Mosser DM. High-molecular-weight proteins of nontypeable Haemophilus influenzae mediate bacterial adhesion to cellular proteoglycans. Infect Immun 1994; 62: 4028–33.

    PubMed  CAS  Google Scholar 

  33. Hanno PM, Fritz RW, Mulholland SG, Wein AJ. Heparin — an examination of its antibacterial adsorption properties. Eur Urol 1981; 7: 359–62.

    PubMed  CAS  Google Scholar 

  34. Pringle JH, Fletcher M. Influence of substratum hydration and absorbed macromolecules on bacterial attachment to surfaces. Appl Environ Microbiol 1986; 51: 1321–5.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia

    Ahmed M. Abu El-Asrar, Khalid F. Tabbara & Soliman A. Al-Kharashi

  2. Department of Microbiology, Faculty of Pharmacy, King Saud University, Riyadh, Saudi Arabia

    Atef M. Shibl

Authors
  1. Ahmed M. Abu El-Asrar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Atef M. Shibl
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Khalid F. Tabbara
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Soliman A. Al-Kharashi
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Abu El-Asrar, A.M., Shibl, A.M., Tabbara, K.F. et al. Heparin and heparin-surface-modification reduce Staphylococcus epidermidis adhesion to intraocular lenses. Int Ophthalmol 21, 71–74 (1997). https://doi.org/10.1023/A:1005835013581

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1005835013581

Search

Navigation