Effects of Long Term Use of Prostaglandin Analogues with and Without Preservative on Normal Conjunctival Flora of Glaucoma Patients

 

Abstract

Purpose: The effects of long term use of Benzalkonium chloride-preserved prostaglandin analogue eye drop on conjunctival bacterial flora was investigated and compared with preservative-free prostaglandin analogue eye drop

Methods: Conjunctival swabs were collected from 48 patients of glaucoma who had instilled either BAK-preserved latanoprost or preservative-free travoprost eye drops for 1 year. The bacterial characteristics and sensitivity patterns of the bacterial isolates from the conjunctival swabs of the two groups were compared between each other and also with conjunctival bacterial flora from normal healthy controls.

Results: There was no significant difference in culture positivity among the three groups (p = 0.99). 100% (13/13) isolates from Latanoprost group were Gram positive organisms. In the Travoprost group, 12 out of 14 isolates (85.7%) from 13 eyes were gram positive while the rest 2 bacteria (14.3%) were gram negative. In Controls, 14 out of 16 (87.5%) isolates were gram positive and the rest were gram negative. Methicillin-resistance was seen in 72.7% (8/11) of the CONS isolated from Latanoprost group, while 45.5% (5/11) of the CONS isolated from preservative free travoprost group were Methicillin resistant. While in the controls 45.4% (5/11) of the isolated CONS were Methicillin resistant. The occurrence of Methicillin resistant CONS (MR CONS) was higher in latanoprost group than the other two groups, though not statistically significant. Resistance to commonly used antibiotics was comparatively higher in BAK-preserved latanoprost group. Not a single gram positive bacteria was resistant to Vancomycin

Conclusion: Long-term use of prostaglandin analogues for glaucoma may adversely affect the antibiotic-resistance of indigenous bacterial flora of the eye by increasing the resistance against common antibiotics including Methicillin resistance.

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