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Klin Monbl Augenheilkd 2003; 220(7): 453-458
DOI: 10.1055/s-2003-40940
Übersicht
© Georg Thieme Verlag Stuttgart · New York

Infektionsimmunologie bei Silikonhydrogelkontaktlinsen mit verlängerter Tragezeit - eine Übersicht

Infection Immunology in Silicone Hydrogel Contact Lenses for Continuous Wear - A ReviewAlexander  A.  Bialasiewicz1
  • 1Dept. of Ophthalmology & School of Ophthalmic Technicians, Sultan Qaboos University Hospital, University of Oman
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Publication History

Eingegangen: 19. Mai 2003

Angenommen: 30. Juni 2003

Publication Date:
29 July 2003 (online)

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Zusammenfassung

Hintergrund: Dem Wunsch nach dauerhafter refraktiver Lösung und optimalem Tragekomfort des Kontaktlinsenträgers steht die Vermeidung von Komplikationen, insbesondere Infektionen, gegenüber. Hypersauerstoffdurchlässige Silikonhydrogele wurden entwickelt, um diesem Patientenwunsch und der augenärztlichen Forderung nach Risikominimierung zu entsprechen. Methoden: Zur Charakterisierung von hypersauerstoffdurchlässigen Silikonhydrogellinsen (HOTL) wurden Kolonisierungsverhalten und Antibiotikasensitivität von Bakterien (in vitro), Expression von bakteriellen Liganden des Hornhautepithels (Kaninchenmodell) und Morphologie von Komplikationen (Patienten) beschrieben. Ergebnisse: Die Adhärenz von Bakterien an hydrophilen Silikonhydrogelen ist geringer als an hydrophobe Silikonelastomere. Die Reduktion der Antibiotikasensitivität ist für PMMA-adhärente Bakterien höher als für silikonelastomeradhärente Bakterien. Kolonisierende Bakterien sind bei asymptomatischen vs. symptomatischen KL-Trägern bei allen Linsentypen nicht signifikant unterschiedlich: koagulasenegative Staphylokokken (CNS) (54 vs. 47 %), Propioni- (43 vs. 48 %), Koryne- (6 vs. 10 %), gramnegative Bakterien (2 vs. 3 %), S. aureus (2 vs. 1 %). Bei Patienten mit Keratitis sind die Bakterienarten gegenüber asymptomatischen Trägern nicht unterschiedlich: kontaktlinsenassoziiertes rotes Auge (CLARE): H. influenzae, S. pneumoniae, kontaktlinsenassoziierte periphere Ulzeration (CLPU): S. aureus, S. pneumoniae, infiltrative Keratitis (IK): P. aeruginosa; aber gramnegative und S. pneumoniae werden häufiger isoliert: 23,7 vs. 3,8 % (asymptomatisch) und S. pneumoniae: 7,6 vs. 0,6 % (asymptomatisch). Im Kaninchenmodell ist die epitheliale Expression von bakteriellen Liganden wie WGA bei HOTL-Tragen mit 3230 p/750 μ niedriger als für weniger sauerstoffdurchlässige Kontaktlinsen mit 4611 p/750 μ. Das entspricht der Beobachtung einer verminderten Pseudomonasadhärenz von 5,31 - 5,98 gegenüber 5,9 - 7,81 Bakterien/Zelle an der menschlichen Hornhaut. Asymptomatische morphologische Anomalien sind bei HOTL geringer. Die apoptoseinduzierte Desquamation ist bei HOTL verringert und die zentrale Epitheldicke ist höher. In einer 1-Jahres-Studie mit 504 Patienten wurden bei HOTL 30-Tage Dauertragelinsen gegenüber 7-Tage-Kontaktlinsen korneale Anfärbbarkeit bei 10,6 vs. 10,5 % Infiltrate 2,3 vs. 4,6 %, Epithelödem 3,6 vs. 2,0 % und tarsale konjunktivale Anomalien 3,0 vs. 1,6 % beobachtet. Einzelberichte zu infektiösen Keratitiden bei HOTL liegen vor. Schlussfolgerungen: Die höhere Sauerstoffdurchlässigkeit von Silikonhydrogelkontaktlinsen ist mit geringerer Infektionsinzidenz (pro Tragezeit) verbunden. Die Kolonisierung mit gleichen Bakterienarten wie bei anderen Biomaterialien und der verlängerten Tragezeit fordert aber aus klinischer Sicht die Patientenberatung und aufmerksame Kontrollen durch den Augenarzt.

Abstract

Background: The patient's wish for permanent refractive solution and optimal comfort must be weighed against the risk of infections. In order to meet these wishes and the demand for minimising associated risks, hyperoxygen-transmissible silicone hydrogel contact lenses have been developed. Methods: Colonisation and sensitivity to antibiotics of bacteria in vitro, expression of bacterial ligands of the corneal epithelium (rabbit model), and the morphology of complications in patients have been reported to characterise HOTL. Results: Bacterial adherence to hydrophobic silicone elastomers is low. The reduction of sensitivity towards antibiotics is higher for PMMA-adherent bacteria with respect to the conventional antibiotics compared to the silicone-elastomer adherent bacteria. Colonising bacteria are not significantly different in asymptomatic CL wearers concerning CFU and species: asymptomatic: CNS (54 vs. 47 %), propioni- (43 vs. 48 %), coryne- (6 vs. 10 %) and gram-negative bacteria (2 vs. 3 %), S. aureus (2 vs. 1 %), and in patients with keratitis are not significantly different concerning species: CLARE (H. influenzae, S. pneumoniae), CLPU (S. aureus, S. pneumoniae), IK (P. aeruginosa), however, concerning the CFU (gram-negative) 23.7 % (keratitis) vs. 3.8 %, (asymptomatic), S. pneumoniae 7.6 % vs. 0.6 %. The epithelial expression of bacterial ligands like WGA is lower for HOTL (3230 p/750 μ) than for low oxygen-transmissible (4611 p/750 μ) consistent with a decreased adherence of pseudomonas of 5.31 - 5.98 vs. 5.9 - 7.81 bacteria/cell. Asymptomatic morphological anomalies and keratitis are less frequent in HOTL. Apoptosis-induced desquamation and the central epithelial thickness decreased. In a one-year study of 504 patients wearing continuous wear HOTL for 30 days, corneal staining was seen in 10.6 vs. 10.5 % 30-day 7 day extended wear, infiltrates in 2.3 vs. 4.6 %, epithelial oedema in 3.6 vs. 2.0 % und tarsal conjunctival anomalies in 3.0 vs. 1.6 %. Individual reports on infectious keratitis in HOTL wearers have been published. Conclusions: Fewer morphological anomalies and a decreased incidence of infections (on the basis of duration of wear) can be associated with the higher oxygen transmission of HOTL. From the clinical point of view, colonisation of HOTL with the same bacterial species as in conventional biomaterials, and the extended wear demand clear patient counseling and vigilant follow-up by an ophthalmologist.

Schlüsselwörter

HOTL - Silikon-Hydrogellinsen - Kontaktlinsen - Infektionen

Key words

HOTL - silicone hydrogel - contact lenses - infections

Literatur

  • 1 Ahearn D G, Grace D T, Jennings M J, Borazjani R N, Rose L J, Simmons R B, Ahanotu E N. Effects of hydrogel/silver coatings on in vitro adhesion to catheters of bacteria associated with urinary tract infections.  Curr Microbiol. 2000;  41 (2) 120-125
    CrossrefPubMedGoogle Scholar
  • 2 Arciola C R, Campoccia D, Montanaro L. Effects on antibiotic resistance of Staphylococcus epidermidis following adhesion to polymethylmethacrylate and to silicone surfaces.  Biomaterial. 2002;  23 (6) 1495-1502
    PubMedGoogle Scholar
  • 3 Bialasiewicz A A. Pathophysiologie von Infektionen am Auge als Grundlage der antibiotischen Therapie. In: Kampik A, Grehn F (Hrsg) Augenärztliche Therapie. Stuttgart; Thieme Verlag 2001: 258-267 ISBN 3-1313-8411-0
    Google Scholar
  • 4 Bialasiewicz A A. Mikrobiologische Aspekte der Kontaktlinsenpraxis.  Contactologia. 1996;  18 201-204
    PubMedGoogle Scholar
  • 5 Bialasiewicz A A, Bischoff G, Engelmann K, Richard G. Korrelation von 55 Kontaktlinsenflüssigkeiten mit Direktabstrichen von der Augenoberfläche bei symptomatischen Kontaktlinsenträgern.  Ophthalmologe. 2001;  98 747-760
    CrossrefPubMedGoogle Scholar
  • 6 Brooun A, Liu S, Lewis K. A dose-response study of antibiotic resistance in P. aeruginosa biofilms.  Antimicrob Ag Chemother. 2000;  44 640-646
    PubMedGoogle Scholar
  • 7 Cavanagh H D, Ladage P M, Li S L, Yamamoto K, Molai M, Ren D H, Petroll M, Jester J V. Effects of daily and overnight wear of a novel hyper oxygen-transmissible soft contact lens on bacterial binding and corneal epithelium.  Ophthalmology. 2002;  109 1957-1969
    CrossrefPubMedGoogle Scholar
  • 8 Chang K H, Spanjaard L, Rutten H, Dankert J, Polak B CP, Kijlstra A. Immunoglobulin A antibodies against P. aeruginosa in the tears fluid of contact lens wearers.  Invest Ophthalmol Vis Sci. 1996;  37 2081-2088
    PubMedGoogle Scholar
  • 9 Dart J. Extended-wear contact lenses, microbial keratitis, and public health.  Lancet. 1999;  354 174-175
    CrossrefPubMedGoogle Scholar
  • 10 Ditizio V, Ferguson G W, Mittelman M W, Khoury A E, Bruce A W, DiCosmo F. A liposomal hydrogel for the prevention of bacterial adhesion to catheters.  Biomaterials. 1998;  19 1877-1884
    CrossrefPubMedGoogle Scholar
  • 11 Donshik P. Invited editorial comment. New safer extended contact lenses.  Ophthalmology. 2002;  109 39-40
    CrossrefPubMedGoogle Scholar
  • 12 Elder M J, Stapleton F, Evans E, Dart J KG. Biofilm-related infections in ophthalmology.  Eye. 1995;  9 102-109
    PubMedGoogle Scholar
  • 13 Farber B F, Kaplan M H, Clogston A G. S. epidermidis extracted slime inhibits the antimicrobial action of glycopeptide antibiotics.  J Infect Dis. 1990;  161 37-40
    PubMedGoogle Scholar
  • 14 Gallardo-Morno A M, Mei H C van der, Busscher H J, Gonzalez-Martin M L, Bruque J M, Perez-Giraldo C. Adhesion of Enterococcus faecalis 1131 grown under subinhibitory concentrations of ampicillin and vancomycin to a hydrophilic and a hydrophobic substratum.  FEMS Microbiol Lett. 2001;  203 (1) 75-79
    CrossrefPubMedGoogle Scholar
  • 15 Geerlings S E, Hoepelman A IM. Immune dysfunction in patients with diabetes mellitus.  FEMS Immunol Med Microbiol. 1999;  26 259-265
    CrossrefPubMedGoogle Scholar
  • 16 Gupta S K, Masinick S, Garrett M, Hazlett L D. P. aeruginosa LPS binds galectin-3 and other human corneal epithelial proteins.  Infect Immun. 1997;  65 2747-2753
    PubMedGoogle Scholar
  • 17 Hahn H P. The type 4 pilus is the major virulence-associated adhesin of P. aeruginosa - a review.  Gene. 1997;  192 99-108
    CrossrefPubMedGoogle Scholar
  • 18 Hogt A H, Dankert J, Feijen J. Adhesion of CNS to methacrylate polymers and copolymers.  J Biomed Mater Res. 1986;  20 533-545
    PubMedGoogle Scholar
  • 19 Hussain M, Herrmann M, Eiff C von, Perdreau-Remington F, Peters G. A 140 kD extracellular protein is essential for the accumulation of S. epidermidis strains on surfaces.  Infect Immun. 1997;  65 519-524
    PubMedGoogle Scholar
  • 20 Jarlov J O. Phenotypic characteristics of coagulase-negative staphylococi: typing at antibiotic susceptibility.  APMIS. 1999;  91, Suppl 1-42
    PubMedGoogle Scholar
  • 21 Keay L, Willcox M D, Sweeney D F, Morris C A, Harmis N, Corrigan K, Holden B A. Bacterial populations on 30-night extended wear silicone hydrogel lenses.  CLAO J. 2001;  27 (1) 30-34
    PubMedGoogle Scholar
  • 22 Keay L, Sweeney D F, Jalbert I, Skotnitsky C, Holden B A. Microcyst response to high Dk/l silicone hydrogel contact lenses.  Optom Vis Sci. 2000;  77 (11) 582-585
    PubMedGoogle Scholar
  • 23 Kitano T, Yutani Y, Shimazu A, Ohhashi H, Yamano Y. The role of physicochemical properties of biomaterials and bacterial cell adhesion in vitro.  Int J Artif Organs. 1996;  19 353-358
    PubMedGoogle Scholar
  • 24 Ladage P M, Yamamoto K, Ren D H. Proliferation rate of rabbit corneal epithelium during overnight rigid contact lens wear.  Invest Ophthalmol Vis Sci. 2001;  42 2804-2812
    PubMedGoogle Scholar
  • 25 Latkovic S, Nilson S E. The effect of high and low Dk/L soft contact lenses on the glycocalyx layer of the corneal epithelium and on the membrane associated receptors for lectins.  CLAO J. 1997;  23 (3) 185-191
    PubMedGoogle Scholar
  • 26 Leriche V, Sibille P, Carpentier B. Use of an enzyme-linked lectinsorbent assay to monitor the shift in polysaccharide composition in bacterial biofilms.  Appl Environ Microbiol. 2000;  66 (5) 1851-1856
    CrossrefPubMedGoogle Scholar
  • 27 Lema I, Gomez-Torreiro M, Rodriguez-Ares M T. Comamonas acidovorans keratitis in a hydrogel contact lens wearer.  CLAO J. 2001;  27 (1) 55-56
    PubMedGoogle Scholar
  • 28 Lim L, Loughman M S, Sullivan L J. Microbial keratitis associated with extended wear of silicone hydrogel contact lenses.  Br J Ophthalmol. 2002;  86 (3) 355-357
    CrossrefPubMedGoogle Scholar
  • 29 Mack A, Haeder M, Siemssen N, Laufs R. Association of biofilm production of coagulase negative staphylococci with expression of a specific polysaccharide intercellular adhesin.  J Infect Dis. 1996;  174 881-884
    PubMedGoogle Scholar
  • 30 Meiller T F, Depaola L G, Kelley J L, Baqui A A, Turng B F, Falkler W A. Dental unit waterlines: biofilms and recurrence.  J Am Dent Assoc. 1999;  130 65-72
    PubMedGoogle Scholar
  • 31 Miyanaga Y. A new perspective in ocular infection and the role of antibiotics.  Ophthalmologica. 1997;  211, S1 9-14
    PubMedGoogle Scholar
  • 32 Muller F MC, Morschhauser J, Kohler G, Oelschläger T A, Ziebuhr W, Hacker J. Adhärenz und Invasion: zwei Pathogenitätsfaktoren bei pathogenen Bakterien und Pilzen.  Mycoses. 1999;  42/1, Suppl 39-42
    PubMedGoogle Scholar
  • 33 Nagaoka A, Kawakami H. Inhibition of bacterial adhesion and biofilm formation by a heparinized hydrophilic polymer.  ASAIO J. 1995;  41/3 M365-M368
    PubMedGoogle Scholar
  • 34 Nagino K, Kobayashi H. Influence of macrolides on mucoid alginate biosynthetic enzyme from P. aeruginosa.  Clin Microbiol Infect. 1997;  3/4 432-439
    PubMedGoogle Scholar
  • 35 Nilsson S E. Seven-day extended wear and 30 day continuous wear of high-oxygen transmissibility soft silicone hydrogel contact lenses: a randomized 1-year study of 504 patients.  CLAO J. 2001;  27 (3) 125-136
    PubMedGoogle Scholar
  • 36 Nilsson S E. Bacterial keratitis and inflammatory corneal reactions: possible relations to contact lens oxygen transmissibility. The Harold A Stein Lectureship 2001.  CLAO J. 2001;  28 (2) 62-65
    PubMedGoogle Scholar
  • 37 Nilsson S E. Bacterial keratitis and inflammatory corneal reactions: possible relations to contact lens oxygen transmissibility. The Harold A Stein Lectureship 2001.  CLAO J. 2002;  28 (2) 62-65
    PubMedGoogle Scholar
  • 38 Pier G B, Grout M, Zaidi T S. Cystic fibrosis transmembrane conductance regulator is an epithelial cell receptor for clearance of P. aeruginosa from the lung.  Proc Natl Acad Sci USA. 1997;  94 12088-12093
    CrossrefPubMedGoogle Scholar
  • 39 Polse K A, Graham A D, Fusaro R E, Gan C M, Rivera R K, Lin M C, Sanders T L, McNamara N A, Chan J S. The Berkeley Contact Lens Extended Wear Study. Part II: Clinical results.  Ophthalmology. 2001;  108 (8) 1389-1399
    CrossrefPubMedGoogle Scholar
  • 40 Potera C. Forging a link between biofilms and disease.  Science. 1999;  283 1837-1839
    CrossrefPubMedGoogle Scholar
  • 41 Ren D H, Yamamoto K, Ladage P M. et al . Adaptive effects of 30-night wear of hyper-O2 transmissible contact lenses on bacterial binding and corneal epithelium. A 1 year clinical trial.  Ophthalmology. 2002;  109 27-40
    CrossrefPubMedGoogle Scholar
  • 42 Sankaridurg P R, Sharma S, Willcox M, Naduvilath T J, Sweeney D F, Holden B A, Rao G N. Bacterial colonization of disposable contact lenses is greater during corneal infiltrative events than during asymptomatic extended lens wear.  J Clin Microbiol. 2000;  38 (12) 4420-4424
    PubMedGoogle Scholar
  • 43 Schwank S, Rajacic Z, Zimmerli W, Blaser J. Impact of bacterial biofilm formation on in vitro and in vivo activities of antibiotics.  Antimicrob Ag Chemother. 1998;  42 895-898
    PubMedGoogle Scholar
  • 44 Skotnitsky C, Jalbert I, O'Hare N, Sweeney D F, Holden B A. Case report of three atypical infiltrative keratitis events with high DK soft contact lens wear.  Cornea. 2002;  21 (3) 318-324
    CrossrefPubMedGoogle Scholar
  • 45 Stapleton F, Dart J KG, Davies S. Bacterial adherence and biofilm formation.  Invest Ophthalmol Vis Sci. 1991;  32S 366
    PubMedGoogle Scholar
  • 46 Strathmann M, Wingender J, Flemming H C. Application of fluorescent-labeled lectins for the visualization and biochemical characterization of polysaccharides in biofilms of Pseudomonas aeruginosa.  J Microbiol Methods. 2002;  503 237-248
    PubMedGoogle Scholar
  • 47 Tong H H, Liu X, Chen Y, James M, Demaria T. Effect of neuraminidase on receptor-mediated adherence of Streptococcus pneumoniae to chinchilla tracheal epithelium.  Acta Otolaryngol. 2002;  122 (4) 413-419
    CrossrefPubMedGoogle Scholar
  • 48 Willcox M D, Harmis N Y, Holden B A. Bacterial populations on high-Dk silicone hydrogel contact lenses: effect of length of wear in asymptomatic patients.  Clin Exp Optom. 2002;  85 (3) 172-175
    PubMedGoogle Scholar
  • 49 Yamamoto K, Ladage P M, Ren D H. Bcl-2 expression in the human cornea.  Exp Eye Res. 2001;  73 247-255
    CrossrefPubMedGoogle Scholar
  • 50 Yamamoto K, Ladage P M, Ren D H. The effects of low and hyper Dk rigid gas permeable contact lenses on Bcl-2 expression and apoptosis in the rabbit corneal epithelium.  CLAO J. 2001;  27 137-143
    PubMedGoogle Scholar
  • 51 Yamamoto K, Ladage P M, Ren D H. Epitope variability of Bcl-2 immunolocalization in the human corneal epithelium.  CLAO J. 2001;  27 221-224
    PubMedGoogle Scholar

Prof. Dr. Alexander A. Bialasiewicz

Dept. of Ophthalmology & School of Ophthalmic Technicians · Sultan Qaboos University Hospital · University of Oman

123 Al Khod, Muscat · Oman

Fax: (00968) 514100

Email: alexander@squ.edu.om; Bialasiew@aol.com

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