title: Demonstration of bacterial biofilms in culture-negative silicone stent and jones tube.
abstract: OBJECTIVE
  To demonstrate the presence of bacterial biofilms on a dacryocystorhinostomy silicone stent and a Jones tube.
  
  
  METHODS
  One dacryocystorhinostomy silicone stent and one Jones tube were removed from 2 patients who presented with an infection of their respective nasolacrimal system. Cultures were obtained, and the implants were processed for scanning electron microscopy and confocal laser scanning microscopy, advanced microscopic methods that are applicable for detection of uncultivable biofilm organisms.
  
  
  RESULTS
  Routine bacterial cultures revealed no growth, but bacterial biofilms on outer and inner surfaces of both implants were confirmed by advanced microscopic techniques.
  
  
  CONCLUSIONS
  To the authors' knowledge, this is the first article that documents the presence of biofilms on a Crawford stent or a Jones tube on patients who presented with infections involving the nasolacrimal system. Although initial cultures revealed absence of any bacterial growth, confocal laser scanning microscopy and scanning electron microscopy documented bacterial colonization. Clinicians should consider the role of biofilms and the limitation of our standard culturing techniques while treating patients with device- or implant-related infections.
authors.affiliation: Oculoplastic and Orbital Reconstructive Surgery, Beverly Hills, California 90210, USA. kamiparsa@gmail.com
authors.forename: Kami
authors.initials: K
authors.lastname: Parsa
authors.forename: Christoph
authors.initials: C
authors.lastname: Schaudinn
authors.forename: Amita
authors.initials: A
authors.lastname: Gorur
authors.forename: Parish P
authors.initials: PP
authors.lastname: Sedghizadeh
authors.forename: Thomas
authors.initials: T
authors.lastname: Johnson
authors.forename: David T
authors.initials: DT
authors.lastname: Tse
authors.forename: John W
authors.initials: JW
authors.lastname: Costerton
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000648:ultrastructure*; D018441:Biofilms; D003608:Dacryocystorhinostomy / Q000295:instrumentation*; D020878:Device Removal; D004359:Drug Therapy, Combination; D015818:Eye Infections, Bacterial / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D006801:Humans; D007440:Intubation; D008297:Male; D018613:Microscopy, Confocal; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000382:microbiology*; D012826:Silicone Elastomers; D015607:Stents / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D012826:Silicone Elastomers