title: In vitro drug-induced spoliation of a keratoprosthetic hydrogel.
abstract: OBJECTIVE
  To investigate in vitro the effects of selected drugs on the spoliation of poly(2-hydroxyethyl methacrylate) (PHEMA), a synthetic acrylic hydrogel currently used for the manufacture of a keratoprosthesis, AlphaCor. The experiments were carried out both in the presence of simulated aqueous humor (SAH) and in its absence.
  
  
  METHODS
  Disks of PHEMA were incubated and shaken with 9 commonly prescribed drugs at 37 degrees C in sterile conditions for 1 week. Samples were incubated either in SAH only (controls), in each drug preparation, or in each drug for 1 week followed by 1 week in SAH. The drugs selected for this study were steroids (prednisolone, dexamethasone, fluorometholone, medroxyprogesterone), antiglaucoma drugs (timolol maleate and pilocarpine), and antibiotics (chloramphenicol, cephazolin, and ciprofloxacin), as commercially available formulations. Following incubation, the PHEMA specimens were examined visually and then histologically, after staining with alizarin red for the presence of calcium in the spoliating sediments/deposits.
  
  
  RESULTS
  Although only 5 of the drug formulations (dexamethasone as Maxidex, fluorometholone as FML, pilocarpine as Isopto Carpine, chloramphenicol as Chlorsig, and medroxyprogesterone as Depo-Ralovera) induced spoliation of the hydrogel in the absence of SAH, all drugs induced spoliation after postincubation in SAH, and calcium was detected in the majority of samples. The deposits on the hydrogel specimens incubated first in cephazolin (as Cefazolin-BC), pilocarpine (as Isopto Carpine), and chloramphenicol (as Chlorsig) and then in SAH did not contain calcium, despite its presence in SAH.
  
  
  CONCLUSIONS
  The study appears to confirm our earlier clinical observations that topical medication may play a role in the spoliation of the hydrogel ophthalmic devices. Presence of calcium in the deposits seems to be correlated to the nature of drug. Although the incidence of spoliation in real clinical situations is much lower than suggested by this extreme-case in vitro simulation, topical therapy after implantation of AlphaCor should be carefully considered, kept to the minimum required, and additive-free where possible.
authors.affiliation: Lions Eye Institute, Centre for Ophthalmology and Vision Science, Perth, Australia. tchirila@cyllene.uwa.edu.au
authors.forename: Traian V
authors.initials: TV
authors.lastname: Chirila
authors.forename: David A
authors.initials: DA
authors.lastname: Morrison
authors.forename: Celia R
authors.initials: CR
authors.lastname: Hicks
authors.forename: Zoya
authors.initials: Z
authors.lastname: Gridneva
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Barry
authors.forename: Sarojini
authors.initials: S
authors.lastname: Vijayasekaran
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D000893:Anti-Inflammatory Agents / Q000494:pharmacology*; D000959:Antihypertensive Agents / Q000494:pharmacology*; D001082:Aqueous Humor / Q000378:metabolism; D002118:Calcium / Q000378:metabolism; D066298:In Vitro Techniques; D007910:Lenses, Intraocular; D011102:Polyhydroxyethyl Methacrylate; D011475:Prosthesis Failure
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D000959:Antihypertensive Agents; D011102:Polyhydroxyethyl Methacrylate; D002118:Calcium