Publication: Influencia del tratamiento farmacológico hipotensor ocular en la flora bacteriana conjuntival
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2016-07-13
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Universidad Complutense de Madrid
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Abstract
La flora bacteriana conjuntival desempeña un papel muy relevante en la patogenia de la endoftalmitis postoperatoria. Esta complicación, aunque es infrecuente, tiene una gran importancia dadas sus graves consecuencias sobre la función visual. El conocimiento de las características de la población bacteriana puede permitir establecer tanto valoraciones de riesgo individualizado como terapias profilácticas adaptadas al perfil específico de cada caso. En la situación particular del ojo con glaucoma este hecho adquiere una significación especial por varios factores, a menudo coexistentes: la alteración del complejo película lagrimal-superficie ocular, la habitual necesidad de instilación tópica de fármacos hipotensores de manera crónica, la posible existencia de una conjuntiva alterada por procedimientos quirúrgicos previos incluida la existencia de una ampolla de filtración y, finalmente, la grave repercusión de una contaminación bacteriana sobre un ojo operado de glaucoma. La alteración crónica de la superficie ocular es frecuente en pacientes con glaucoma. La instilación repetida y mantenida de colirios hipotensores, cuyos principios activos y conservantes pueden alterar la película lagrimal y dar lugar a modificaciones histológicas de la conjuntiva, puede reducir la capacidad de defensa del ojo frente a la agresión bacteriana...
Conjunctival bacterial flora plays a very important role in the pathogenesis of postoperative endophthalmitis. This complication, although unusual, is very important because of its serious consequences on visual function. The knowledge of bacterial population characteristics may be used to establish both individual risk assessment and prophylactic therapies for each specific case. In the particular case of the eye with glaucoma, this fact acquires a special significance due to several factors which often coexist: the alteration of the ocular surface and tear film complex; the frequent need of hypotensive drop instillation in a chronic manner; the existence of a conjunctival alteration due to prior surgical procedures, including a bleb; and finally, the serious impact of bacterial contamination on an eye having undergone glaucoma surgery. Chronic ocular surface disorder is common in patients with glaucoma. Repeated and sustained hypotensive eye drop instillation, whose active ingredients and preservatives can alter the tear film and can lead to histological changes of the conjunctiva, may reduce the ability of the eye to protect itself against bacterial aggression. The drop instillation process may pose a contamination risk in itself since many patients are limited during instillation and lack the adequate hygiene measures. Hence, repeated drop application may become such risk by inoculating germs from the containers themselves or from periocular tissues...
Conjunctival bacterial flora plays a very important role in the pathogenesis of postoperative endophthalmitis. This complication, although unusual, is very important because of its serious consequences on visual function. The knowledge of bacterial population characteristics may be used to establish both individual risk assessment and prophylactic therapies for each specific case. In the particular case of the eye with glaucoma, this fact acquires a special significance due to several factors which often coexist: the alteration of the ocular surface and tear film complex; the frequent need of hypotensive drop instillation in a chronic manner; the existence of a conjunctival alteration due to prior surgical procedures, including a bleb; and finally, the serious impact of bacterial contamination on an eye having undergone glaucoma surgery. Chronic ocular surface disorder is common in patients with glaucoma. Repeated and sustained hypotensive eye drop instillation, whose active ingredients and preservatives can alter the tear film and can lead to histological changes of the conjunctiva, may reduce the ability of the eye to protect itself against bacterial aggression. The drop instillation process may pose a contamination risk in itself since many patients are limited during instillation and lack the adequate hygiene measures. Hence, repeated drop application may become such risk by inoculating germs from the containers themselves or from periocular tissues...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Oftalmología y Otorrinolaringología, leída el 10/09/2015