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Year : 2019  |  Volume : 67  |  Issue : 10  |  Page : 1708-1709

Intraocular lens biofilm formation supported by scanning electron microscopy imaging

1 Department of Uvea, Ocular Pathology and Neuro-Ophthalmology Sri Sankaradeva Nethralaya, Guwahati, Assam, India
2 Vitreo-Retina, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
3 Microbiology, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
4 Ophthalmology, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
5 Ocular Pathology, Sri Sankaradeva Nethralaya, Guwahati, Assam, India

Date of Submission08-Mar-2019
Date of Acceptance15-Jun-2019
Date of Web Publication23-Sep-2019

Correspondence Address:
Dr. Dipankar Das
Department of Ocular Pathology, Uveitis and Neuro-Ophthalmology Services, Sri Sankaradeva Nethralaya, Guwahati - 781 028, Assam
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_467_19

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Keywords: Biofilms, cocci, explantation, intraocular lens

How to cite this article:
Das D, Bhattacharjee H, Gogoi K, Das JK, Misra P, Dhir P, Deka A. Intraocular lens biofilm formation supported by scanning electron microscopy imaging. Indian J Ophthalmol 2019;67:1708-9

How to cite this URL:
Das D, Bhattacharjee H, Gogoi K, Das JK, Misra P, Dhir P, Deka A. Intraocular lens biofilm formation supported by scanning electron microscopy imaging. Indian J Ophthalmol [serial online] 2019 [cited 2019 Oct 19];67:1708-9. Available from:

Endophthalmitis is a dreaded intraocular infection which is caused by various organisms.[1],[2] Biofilms are important in all the prostheses including intraocular lens (IOL).[3],[4],[5] We present a case of bacterial endophthalmitis nonresponding to conventional treatment and had IOL explanation which revealed Staphylococcus epidermidis infection and part of the IOL showed similar morphological organism in scanning electron microscopy (SEM).

A 55-year-old male who had uneventful cataract surgery with IOL implantation in the left eye (OS) presented with recurrent uveitis. Intraocular inflammation was treated on local steroid and cycloplegics by ophthalmologist for the last 8 months. On examination, his vision was 20/200 in the OS with minimal hypopyon and pan uveitis. A thick plaque on posterior surface of IOL was seen. B-scan ultrasound showed vitreous echoes without any retinal detachment. Provisional diagnosis of sequestrated endophthalmitis was made. Anterior chamber tap showed Eubacterium genome positivity in polymerase chain reaction and later IOL was explanted after proper consent. One half of the explanted IOL was studied in house ocular pathology and microbiology laboratory under compound microscope (Gram stain and bacterial culture revealed Staphylococcus epidermidis) and subsequently other half was submitted for SEM. Compound microscopy of the IOL showed pigmented melanocytic migration in a whorl-like pattern on the anterior surface of the IOL [Figure 1]. SEM revealed a layer of biofilm of cocci in clusters [Figure 2] and [Figure 3]. Energy-dispersive X-ray spectroscopy (EDX) showed biological component of carbon and oxygen as elements.
Figure 1: Surface of the optic of explanted intraocular lens (IOL) without any staining with pigment cells' proliferations (×400)

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Figure 2: Scanning electron microscopy image showing grape-like cocci in clusters forming a biofilms on the surface of IOL (×1000)

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Figure 3: Magnified view of the cocci in group on IOL surface (×5000)

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Bacteria often attach to surfaces and form dense aggregations called biofilm or bacterial mats.[1],[3],[4],[5] These films can be of few micrometers in thickness and in depth and may contain multiple species of bacteria, protists, and archaea.[2],[3],[4],[5] Bacteria living in biofilms display a complex arrangement of cells and extracellular components, forming secondary structures such as microcolonies through which there are networks of channels forms enabling better diffusion of nutrients.[3],[4],[5]

Biofilms are important in endophthalmitis as the structures are seen in chronic bacterial infections in implanted IOL devices and bacteria present within biofilms are much harder to kill than individual isolated bacteria.[3],[4],[5] Normal conjunctival and adnexal flora may be the cause of nidus in those biofilms on IOL in sequestrated endophthalmitis.


The authors would like to thank Dr. Kula Kamal Senapati, Department of CIF, IIT, Guwahati, India, for SEM photographs and EDX analysis and Sri Kanchi Sankara Health and Educational Foundation, Guwahati, India.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has/have given his consent for his images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Das T, Hussain A, Naduvilath T, Sharma S, Jalali S, Majji AB, et al. Case control analyses of acute endophthalmitis after cataract surgery in South India associated with technique, patient care, and socioeconomic status. J Ophthalmol 2012;2012:298459.  Back to cited text no. 1
Bhattacharjee H, Bhattacharjee K, Das D, Singh M, Sukumar P, Misra DK. Pathology and immunohistochemistry of capsular bag in spontaneously late dislocated capsular bag-intraocular lens complex. Indian J Ophthalmol 2017;65:949-54.  Back to cited text no. 2
[PUBMED]  [Full text]  
Costerton JW, Stewart PS, Greenberg EP. Bacterial biofilms: A common cause of persistent infections. Science 1999;284:1318-22.  Back to cited text no. 3
Griffiths PG, Elliot TS, McTaggart L. Adherence of Staphylococcus epidermidis to intraocular lenses. Br J Ophthalmol 1989;73:402-406.  Back to cited text no. 4
Cerca N, Pier GB, Vilanova M, Oliveira R, Azeredo J. Quantitative analysis of adhesion and biofilm formation on hydrophilic and hydrophobic surfaces of clinical isolates of Staphylococcus epidermidis. Res Microbiol 2005;156:506-14.  Back to cited text no. 5


  [Figure 1], [Figure 2], [Figure 3]


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