Study of conjunctival flora in anophthalmic patients: influence on the comfort of the socket

• Published in: Graefe's archive for clinical and experimental ophthalmology 2017-08, Vol.255 (8), p.1669-1679
• Main Authors: Toribio, Alvaro, Marrodán, Teresa, Fernández-Natal, Isabel, Martínez-Blanco, Honorina, Rodríguez-Aparicio, Leandro, Ferrero, Miguel Á.
• Format: Article
• Language: English
• Subjects: Anophthalmia; Anophthalmos - surgery; Coagulase; Conjunctiva - microbiology; Cross-Sectional Studies; Eye; Eye Enucleation; Eye Infections, Bacterial - microbiology; Eye, Artificial; Female; Gram-negative bacteria; Gram-Negative Bacteria - isolation & purification; Humans; Male; Medicine; Medicine & Public Health; Microflora; Middle Aged; Oculoplastics and Orbit; Ophthalmology; Patient Satisfaction; Patients; Prostheses; Prosthesis-Related Infections - microbiology; Spectrophotometry
• ISSN: 0721-832X; 1435-702X
• DOI: 10.1007/s00417-017-3708-8

Purpose To investigate the relationship between conjunctival flora and comfort of the socket in anophthalmic patients. Methods A cross-sectional clinical study including 60 patients with unilateral anophthalmia who wear a prosthetic eye. From each patient three microbiological samples were taken from the lower conjunctival sac (healthy eye, pre-prosthesis, and retro-prosthesis space of socket). The 180 samples obtained were cultured. Samples from a randomized subgroup of 29 patients were measured by spectrophotometry at 540 nm after 48 h of growth, to determine their microbial density (MD). The grade of comfort of the socket (GCS) of each patient was established by a questionnaire. Epidemiological and clinical data of the anophthalmic socket and artificial eye care of each patient were also collected. Results MD decreased in healthy eyes (0.213 ± 0.201, P  = 0.004) compared with the pre-prosthesis (0.402 ± 0.323) and retro-prosthesis (0.438 ± 0.268) samples. Pre-prosthesis MD correlated with retro-prosthesis MD ( R  = 0.401, P  = 0.031) and healthy eye MD ( R  = 0.482, P  = 0.008), and it was also related to poor GCS ( P  = 0.017). Aerobic Gram-negative bacteria in retro-prosthesis samples of patients with poor GCS was higher than in patients with good or fair GCS ( P  = 0.008). In the same samples, coagulase-negative staphylococci proportion (excluding S. epidermidis ) increased in patients with good GCS ( P  = 0.030). Conclusions Socket microflora is related to GCS. Increased pathogenic flora, especially Gram-negative bacteria, and high MD are related to discomfort, while coagulase-negative staphylococci (other than S. epidermidis ) are associated with comfort.