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Microbiology and biofilm of corneal sutures
  1. Eldad Adler1,2,
  2. Darlene Miller1,
  3. Oded Rock3,
  4. Oriel Spierer1,3,
  5. Richard Forster1
  1. 1 Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
  2. 2 Department of Ophthalmology, Emek Medical Center, Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
  3. 3 Department of Ophthalmology, Wolfson Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
  1. Correspondence to Dr Eldad Adler, Department of Ophthalmology, Emek Medical Center, Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; eldad1111{at}


Aim To investigate the relationships between corneal suture bacteriology, biofilm and the clinical setting using culture studies and scanning electron microscopy (SEM).

Methods This is a prospective, observational study of patients with a history of penetrating keratoplasty presenting to a tertiary cornea clinic for routine or symptoms-related corneal suture removal. We documented for each patient the suture clinical setting (quiescent, exposed and keratitis-related), retention time, antimicrobial therapy, bacterial growth on culture studies, and bacterial presence and biofilm coverage on SEM.

Results There were significantly different culture positivity rates between the quiescent (8%), exposed (12%) and keratitis-related (60%) suture groups (p=0.039). As expected, keratitis-related sutures had the longest retention time compared with quiescent and exposed ones (p=0.02). The biofilm coverage score was higher for sutures from the keratitis-related and exposed groups, although this trend was not statistically significant (p=0.90). Higher biofilm scores were seen in samples that also yielded a positive culture result (p=0.36) and in samples with bacterial presence on SEM images (p=0.16 and p=0.73). Both of these were important trends but not statistically significant.

Conclusions Evidence for active bacterial and biofilm presence on corneal sutures was found. Corneal sutures should be considered for removal sooner, before becoming exposed and/or keratitis-related. Traditional culture studies and SEM imaging are helpful in investigating biofilm and its clinical importance. More studies of the spectrum of bacterial growth on embedded biomedical devices such as corneal sutures are needed.

  • infection
  • cornea
  • microbiology

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  • OS and RF contributed equally.

  • Contributors Conception or design of the work: EA, OS, RF. Acquisition, analysis or interpretation of data: EA, DM, OR, OS, RF. Drafting the work: EA. Revising it critically: EA, DM, OR, OS, RF. Final approval of the version published: EA, DM, OR, OS, RF. Accountable for all aspects of the work: EA, DM, OR, OS, RF.

  • Funding This study was funded by the NIH Center Core Grant (grant number: P30EY014801), Research to Prevent Blindness, unrestricted grant.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The study was approved by the Internal Review Board of the University of Miami Miller School of Medicine and complied with the principles outlined in the Declaration of Helsinki and with the Health Insurance Portability and Accountability Act.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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