Biocompatibility of poly(ethylene glycol) and poly(acrylic acid) interpenetrating network hydrogel by intrastromal implantation in rabbit cornea.

We evaluated the biocompatibility of a poly(ethylene glycol) and poly(acrylic acid) (PEG/PAA) interpenetrating network hydrogel designed for artificial cornea in a rabbit model. PEG/PAA hydrogel measuring 6 mm in diameter was implanted in the corneal stroma of twelve rabbits. Stromal flaps were created with a microkeratome. Randomly, six rabbits were assigned to bear the implant for 2 months, two rabbits for 6 months, two rabbits for 9 months, one rabbit for 12 months, and one rabbit for 16 months. Rabbits were evaluated monthly. After the assigned period, eyes were enucleated, and corneas were processed for histology and immunohistochemistry. There were clear corneas in three of six rabbits that had implantation of hydrogel for 2 months. In the six rabbits with implant for 6 months or longer, the corneas remained clear in four. There was a high rate of epithelial defect and corneal thinning in these six rabbits. One planned 9-month rabbit developed extrusion of implant at 4 months. The cornea remained clear in the 16-month rabbit but histology revealed epithelial in-growth. Intrastromal implantation of PEG/PAA resulted in a high rate of long-term complications.

Successful DMEK after intraoperative graft inversion.

PURPOSE: Hardiness of a Descemet membrane endothelial keratoplasty (DMEK) graft is not well established. The aim of this study was to report a case of graft survival after intraoperative inversion. METHODS: We describe a case of a 76-year-old man with Fuchs corneal dystrophy who underwent DMEK in the left eye. After deployment of the graft and a 15-minute sulfur hexafluoride gas fill, the graft was noted to be inverted. The graft was then reoriented and properly positioned. RESULTS: Because of progressive graft detachment, rebubble was required at 2 weeks after surgery. At 2 months after surgery, the graft was clear and fully adherent. Specular microscopy revealed 27.9% endothelial cell loss of the donor cornea. CONCLUSIONS: Despite intraoperative inversion, this DMEK graft remained viable without excessive endothelial cell loss.

Incidence of postoperative endophthalmitis from 1990 to 2009 using povidone-iodine but no intracameral antibiotics at a single academic institution.

PURPOSE: To correlate the incidence of postoperative endophthalmitis with changes in the preoperative prophylaxis over a 20-year period. SETTING: Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany. DESIGN: Retrospective chart review. METHODS: Patients diagnosed with postoperative endophthalmitis from 1990 to 2009 after intraocular surgery performed at the same institution were included. Because of changes in the preoperative prophylaxis during the study period, 3 groups were formed for data analysis: Period 1 (1990 to 1992), no standardized prophylaxis regimen; period 2 (1993 to 1998), preoperative topical medication, povidone-iodine 10.0% periorbitally, and 1 drop of povidone-iodine 1.0% in the conjunctiva sac; and period 3 (1999 to 2009), similar to period 2 except with irrigation of the conjunctival sac with 10 mL of povidone-iodine 1.0%. RESULTS: The overall rate of postoperative endophthalmitis was 0.113% (77/68,323) for all intraocular surgeries. It decreased significantly from 0.291% (16/5505) in period 1 to 0.170% (33/19,413) in period 2 to 0.065% (28/43,405) in period 3 (P < .001). In cataract surgery, the overall rate of postoperative endophthalmitis was 0.125% (30/24,034). It decreased in each subsequent period, from 0.338% (9/2662) in period 1 to 0.224% (15/6696) in period 2 to 0.041% (6/14,676) in period 3 (P < .001). Coagulase-negative Staphylococcus was the most commonly isolated organism (47.4%). CONCLUSIONS: The rate of postoperative endophthalmitis decreased over a 20-year period at a single academic institution. Although multiple factors might have contributed to this decline, implementation of a preoperative prophylaxis protocol using copious povidone-iodine might have been the most important contributor. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Prevention and treatment of injection-related endophthalmitis.

BACKGROUND: Intravitreal injections are the fastest growing cause of endophthalmitis and can result in severe vision loss. The prevention, diagnosis and management of such infections remain unclear and at times controversial. METHODS: We searched Pubmed for keywords "prophylaxis," "endophthalmitis," "intravitreal injection." We focused on studies published in the last 2 years as well as other recent studies with particular attention to data on the incidence, microbiology, prevention, and treatment of injection-related endophthalmitis. RESULTS: Over 20 relevant studies were found. With povidone-iodine preparation, the per-injection endophthalmitis rate is low at about 0.03%. Antibiotics do not appear to be beneficial for prevention of post-injection endophthalmitis. The best timing of vitrectomy is unclear. CONCLUSIONS: Antibiotic prophylaxis is probably not needed when giving intravitreal injections. More data is needed to help determine the proper treatment for post-injection endophthalmitis.

Application of 10% povidone iodine reduces conjunctival bacterial contamination rate in patients undergoing cataract surgery.

PURPOSE: To determine the efficacy of 10% povidone iodine (PVI) drops given before cataract extraction in addition to routine irrigation of the conjunctival sac with 1% PVI. METHODS: This prospective, randomized, single-center study at the Department of Ophthalmology, Ludwig-Maximilians-University, Munich, includes 263 eyes of 242 patients undergoing cataract surgery. Patients were randomized to receive 3 drops of 10% PVI into the conjunctival sac (study group) or no PVI drops (control group). All patients underwent periorbital disinfection with 10% PVI followed by irrigation of the conjunctiva with 10 mL of 1% PVI. Specimens were obtained prior to the application of PVI, after antibiotic administration (T1), after irrigation with PVI but before surgery (T2), and at the conclusion of surgery (T3). RESULTS: After PVI disinfection, the number of positive cultures was significantly reduced in all groups (p<0.0001) from 69%-93% at T1 to 1%-16% at T3. In outpatients, the study group showed significantly fewer positive cultures at the conclusion of surgery compared to the control group (4% vs 16%; p=0.03). Also in inpatients significant fewer positive cultures were found in the study group compared to the control group at T2 (12% vs 28%; p=0.03) and at T3 (1% vs 10%; p=0.03). CONCLUSIONS: Three additional drops of 10% PVI prior to surgery provided additional benefit by reducing the conjunctival bacterial contamination rate even in the setting of preoperative irrigation of the conjunctiva with 1% PVI.

Prevention of postcataract endophthalmitis: evidence-based medicine.

PURPOSE OF REVIEW: To provide a summary of current peer-reviewed publications on the methods of prophylaxis against postcataract endophthalmitis. RECENT FINDINGS: Preoperative application of povidone-iodine remains the standard protocol for the prevention of postoperative endophthalmitis. More recent evidence suggests that intracameral cefuroxime administered at the conclusion of surgery significantly reduces the risk of endophthalmitis. However, its clinical use has been limited because of a lack of commercially available antibiotic indicated for intraocular injection. Although topical antibiotic application continues to be a controversial topic with respect to the types of antibiotic prescribed and dosage, most ophthalmologists do prescribe an antibiotic for the perioperative period. Resistance against antibiotics, including the very popular classes of fluoroquinolones, is rising. Most notably, methicillin resistance continues to increase over time. SUMMARY: Prevention of postcataract endophthalmitis remains a difficult topic to study given the low incidence. In addition to appropriate wound construction, a combination of povidone-iodine and antibiotics provide a reasonable approach in reducing the risk of this rare but serious infection.

Long-term clinical course of dry eye in patients with chronic graft-versus-host disease referred for eye examination.

PURPOSE: To assess the long-term clinical course of dry eye in patients with chronic graft-versus-host disease (cGVHD). METHODS: A prospective case series of 49 patients with cGVHD was conducted. Complete history and ophthalmic examination were performed at baseline and at 36 months (range, 26-53). All patients received treatment for dry eye. RESULTS: Of the 49 participants, 18 (37%) had expired at the time of the 3-year eye examination, 11 were lost to follow-up, 11 declined or were unable to attend the final examination, and 9 (18%) completed the study. There was a statistically insignificant improvement in symptoms of dry eye assessed by the ocular surface disease index [start vs. endpoint: 36 ± 22 (range, 4-72) vs. 30 ± 27 (range, 4-86); P = 0.51]. Visual acuity remained stable at approximately 20/20. Lissamine green staining improved and Schirmer test (with anesthetic) worsened, but neither trend was statistically or clinically significant. CONCLUSIONS: Stable visual acuity, tear production, and lissamine green staining and a statistically insignificant improvement in dry eye symptoms were observed in the 9 participants who completed this 3-year prospective case series of 49 patients with cGVHD. Insofar as these patients represent a minority (18%) of the original cohort, their clinical course may not be generalizable to all patients with cGVHD but may still suggest that this patient population's prognosis could be characterized by stability and excellent vision. Sufficiently powered prospective studies are required to validate these postulates.

Antibiotic susceptibility patterns of ocular bacterial flora in patients undergoing intravitreal injections.

PURPOSE: To determine the antibiotic susceptibility patterns of conjunctival flora in patients undergoing intravitreal (IVT) injection. DESIGN: Prospective, observational study. PARTICIPANTS: Patients (n = 85) scheduled to undergo 136 IVT injections at California Vitreoretinal Center at Stanford University. METHODS: Conjunctival cultures were obtained on the day of the IVT injection from the injection site bulbar conjunctiva before the application of povidone-iodine or antibiotics. MAIN OUTCOME MEASURES: Bacterial isolates were identified and tested for antibiotic susceptibility using either the Kirby-Bauer disc-diffusion technique or MicroScan-WalkAway system. RESULTS: Our analysis included 136 samples collected from 90 eyes of 85 patients. Of those with positive cultures (n = 65), the most common bacterial isolates were coagulase-negative staphylococci (CNS), comprising 59 (83%) of the 71 bacterial strains. Among the CNS, all were susceptible to vancomycin and >80% were susceptible to gentamicin, chloramphenicol, tetracycline, and imipenem. Between 60% and 80% of the CNS were susceptible to the cephalosporins and newer generation fluoroquinolones. Fewer than 60% were susceptible to the penicillin analogs, erythromycin, and the earlier generation fluoroquinolones. Nearly half of the CNS (47%) were resistant to oxacillin/methicillin. CONCLUSIONS: Bacteria isolated from the injection site of patients undergoing IVT injections were mostly CNS. Most are sensitive to vancomycin, gentamicin, and chloramphenicol. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Morphology of Photopolymerized End-linked Poly(ethylene glycol) Hydrogels by Small Angle X-ray Scattering.

Due to the biocompatibility of poly(ethylene glycol) (PEG), PEG-based hydrogels have attracted considerable interest for use as biomaterials in tissue engineering applications. In this work, we show that PEG-based hydrogels prepared by photopolymerization of PEG macromonomers functionalized with either acrylate or acrylamide end-groups generate networks with crosslink junctions of high functionality. Although the crosslink functionality is not well controlled, the resultant networks are sufficiently well ordered to generate a distinct correlation peak in the small angle x-ray scattering (SAXS) related to the distance between crosslink junctions within the PEG network. The crosslink spacing is a useful probe of the PEG chain conformation within the hydrogel and ranges from approximately 6 to 16 nm, dependent upon both the volume fraction of polymer and the molecular weight of the PEG macromonomers. The presence of a peak in the scattering of photopolymerized PEG networks is also correlated with an enhanced compressive modulus in comparison to PEG networks reported in the literature with much lower crosslink functionality that exhibit no scattering peak. This comparison demonstrates that the method used to link together PEG macromonomers has a critical impact on both the nanoscale structure and the macroscopic properties of the resultant hydrogel network.

One-day application of topical moxifloxacin 0.5% to select for fluoroquinolone-resistant coagulase-negative Staphylococcus.

PURPOSE: To compare selection for fluoroquinolone-resistant bacteria between 1-day and 3-day application of topical moxifloxacin 0.5%. SETTING: Department of Ophthalmology, Stanford University, Stanford, California, USA. METHODS: After investigative review board approval, patients scheduled for ocular surgery were randomized to receive topical moxifloxacin 0.5% drops 4 times a day for 1 day or 3 days preoperatively. Conjunctival cultures were obtained at baseline and after antibiotic application. Bacteria were identified and tested for resistance to a battery of antibiotic agents using the Kirby-Bauer disk-diffusion method. The differences in resistance distributions for the most commonly isolated bacteria between baseline (T0) and after antibiotic administration (T1) were compared between the 2 treatment groups. RESULTS: Coagulase-negative Staphylococcus (CNS) were the most common bacteria isolated at T0 and T1. At T0, the proportion of CNS isolated in the 1-day group (n = 63) that was resistant to fluoroquinolones ranged from 4% to 22% depending on the antibiotic agent tested. After 1-day treatment with moxifloxacin, the percentage of resistant bacteria increased significantly (range 13% to 67%) for all fluoroquinolones except gatifloxacin (P<.05). Resistance to gentamicin and tobramycin also increased significantly. However, patients treated for 3 days (n = 57) showed no differences in bacterial resistance rates to any antibiotic agent tested. CONCLUSION: Prophylactic topical moxifloxacin 0.5% treatment starting 1 day before ocular surgery resulted in a significant increase in fluoroquinolone-resistant bacteria, while a 3-day antibiotic regimen did not select for resistant organisms.

Prospective study of risk factors for conjunctival bacterial contamination in patients undergoing intraocular surgery.

PURPOSE: To determine whether a patient's age, gender, local or systemic risk factors affect the rate of preoperative bacterial contamination. METHODS: Consecutive 1,474 patients undergoing intraocular surgery were enrolled in this prospective masked study. Past medical history was noted and examinations were performed. The patients were divided into four groups: a control group (without local or systemic risk factors), those with local risk factors (chronic use of topical medications, contact lens wear, blepharitis, chronic eyelid or conjunctival inflammation), those with systemic risk factors (immunosuppression, diabetes, autoimmune conditions, and asthma), and those with both. Conjunctival cultures were obtained before surgery. RESULTS: Among the 1,474 patients, 914 bacteria were isolated from 214 (14.9%) patients. Advanced age was associated with a higher rate of positive conjunctival cultures (p<0.005). No statistical difference was found with regard to gender (p=0.7173). Among the 282 patients in the control group, 14 (5%) had a positive conjunctival culture. Compared to the control group, positive conjunctival cultures were found in 118 out of 503 patients (23.5%) with local risk factors (p<0.0001), 65 out of 545 patients (11.9%) with systemic risk factors (p=0.0019), and 22 out of 144 (15.3%) with both (p=0.0006). Two patients developed postoperative endophthalmitis (0.14%), one with both local risk and systemic factors and the other with a systemic risk factor. CONCLUSIONS: Patients with local or systemic risk factors or advanced age were found to have a higher rate of bacterial conjunctival contamination before intraocular surgery.

Prospective randomized comparison of 1-day and 3-day application of topical 0.5% moxifloxacin in eliminating preoperative conjunctival bacteria.

PURPOSE: Compare the efficacy of a 1-day versus 3-day application of topical 0.5% moxifloxacin in reducing preoperative conjunctival bacteria. METHODS: Following IRB approval, patients (n = 144) scheduled for ocular surgery between 2004 and 2005 were recruited and randomized to receive topical 0.5% moxifloxacin drops four times a day for either 1 day (n = 63) or 3 days (n = 57) prior to surgery. Conjunctival cultures were obtained at baseline (T0), after application of antibiotic (T1), following povidone-iodine and additional antibiotic applications immediately before surgery (T2), and after surgery (T3). Cultures were inoculated onto blood and chocolate agar plates and in thioglycolate broth, and then incubated at 37 degrees C for 10 days. Bacterial growth were isolated, identified, quantified, and compared. RESULTS: There were similar (P = 0.8435) rates of patients with positive thioglycolate cultures between the 1-day (79.37%) and 3-day groups (82.46%) at T0. At T1, T2, and T3, the number of eyes with positive cultures were again similar (1 day, 3 days, P value [T1: 34.9%, 35.1%, P = 0.8631; T2: 14.3%, 7%, P = 0.3245; T3: 7.9%, 3.5%, P = 0.5199]). No significant differences were found between the colony-forming units (CFU) of bacteria on solid agar media in 1-day and 3-day groups at any of the time points studied (P values: 0.1-0.8). Coagulase-negative Staphylococcus was the most commonly isolated (73.3% at baseline). CONCLUSIONS: In patients undergoing intraocular anterior segment surgery, 1-day and 3-day applications of topical 0.5% moxifloxacin appear to have similar efficacy in reducing perioperative conjunctival bacteria.

Comparison of one-day versus one-hour application of topical gatifloxacin in eliminating conjunctival bacterial flora.

PURPOSE: To compare efficacies of 1-day, 1-hour, and combined 1-day/1-hour preoperative topical gatifloxacin in eliminating conjunctival bacterial flora. DESIGN: Prospective, comparative case series. PARTICIPANTS: Sixty patients (120 eyes) scheduled to undergo anterior segment intraocular surgery at Stanford University Medical Center. METHODS: Cultures were collected from the palpebral conjunctival sac at baseline and after 1 day (4 doses), 1 hour (3 doses), and 1 day/1 hour (7 doses) of gatifloxacin use. MAIN OUTCOME MEASURES: Incidence of positive bacterial samples collected pre- and post-antibiotic treatment and number of colony forming units (CFUs). RESULTS: SeptiChek (Becton Dickinson, Franklin Lakes, NJ) positive cultures significantly decreased from 67% growth at baseline to 28% (P<0.0001) after 1 day and from 60% at baseline to 37% (P = 0.018) after 1 hour of gatifloxacin use. Reductions of 44% growth at baseline to 12% (P = 0.0001) after 1 day and 32% at baseline to 13% (P = 0.029) after 1 hour of gatifloxacin use were observed on blood agar. Surgical eyes that received both 1-day and 1-hour preoperative gatifloxacin had reductions from 67% growth at baseline to 18% posttreatment (P<0.0001) and 45% at baseline to 7% posttreatment (P<0.0001) on SeptiChek and blood agar media, respectively. In addition to a lower frequency of positive cultures, a significantly lower CFU count was found after 1-day (P = 0.004) and 1-hour (P = 0.049) gatifloxacin use compared with pretreatment levels. Combined 1-day/1-hour doses of gatifloxacin were associated with a greater reduction in CFUs (P = 0.001) when compared with 1-hour treatment alone. CONCLUSIONS: Both 1-hour and 1-day topical gatifloxacin use are effective in reducing the frequency of conjunctival bacterial growth and the overall bacterial load as measured by CFUs, relative to baseline. Although a 1-hour pretreatment is associated with a reduction in bacterial growth, the combination of 1-day and 1-hour preoperative gatifloxacin dosing results in an even lower overall bacterial load, suggesting that the latter might be the preferred preoperative regimen for eyes undergoing anterior segment surgery.

Prospective comparison of topical moxifloxacin in eliminating conjunctival bacterial flora following a one-day or one-hour application.

PURPOSE: The aim of this study was to compare the efficacy of a 1-hour(h) versus 1-day application of topical moxifloxacin in eliminating conjunctival bacterial flora. METHODS: In this prospective, nonrandomized, controlled trial, the surgical eyes of 60 patients scheduled for intraocular surgery received topical moxifloxacin four times a day, starting 1 day prior to surgery and three additional applications at 5-minute intervals 1 h before surgery. The nonsurgical eye of each patient only received three applications of the same antibiotic at 5-minute intervals 1 h before surgery. Conjunctival cultures were obtained at baseline and after antibiotic application. RESULTS: Prior to antibiotic application, 80% of surgical eyes and 70% of nonsurgical eyes had positive cultures. Following the 1-day application, significantly fewer eyes (40%) had positive cultures (P < 0.0001), with a further reduction to 32% with three additional doses 1 h prior to surgery. In the nonsurgical eye, the decrease in the percentage of positive cultures, from 55% to 53% following the three applications 1 h prior to surgery, was not significant (P > 0.9999). The 1-day application was associated with significantly fewer positive cultures, compared to the 1-h group (P = 0.0267). CONCLUSIONS: The one-day application of moxifloxacin resulted in significantly fewer positive conjunctival cultures, compared with a 1-h application.

A prospective randomized study to determine the efficacy of preoperative topical levofloxacin in reducing conjunctival bacterial flora.

PURPOSE: To compare the efficacy of topical levofloxacin in combination with povidone-iodine irrigation vs povidone-iodine (PVI) alone in reducing conjunctival bacteria. DESIGN: Prospective, randomized, controlled trial. METHODS: One hundred and forty eyes of 140 patients scheduled to undergo intraocular surgery eyes were randomized to either group 1 or 2 (70 each). Whereas group 1 eyes had no prophylactic antibiotic, eyes in group 2 received topical treatment with one drop of 0.5% levofloxacin four times on the day before surgery. Both groups underwent irrigation of the fornices with 1% PVI. Conjunctival swabs were inoculated on solid and broth culture media to determine bacterial growth. RESULTS: Of 132 eyes evaluated, baseline culture analysis in thioglycolate demonstrated positive culture results in 55 (84.6%) of 65 eyes from group 1, similar to 55 (82.1%) of 67 eyes in group 2 (P = .697). Before surgery, 57 (87.7%) of 65 eyes in group 1 had positive culture results, compared with 50 (74.6%) of 67 eyes in group 2 (P = .055). After irrigation with PVI, 20 (30.8 %) of 65 eyes in group 1 had positive culture results, compared with only eight (11.9%) of 67 eyes in group 2 (P = .008). After surgery, 15 (23.1%) of 65 eyes in group 1 and six (9.0%) of 67 eyes in group 2 had positive culture results (P = .027). CONCLUSIONS: Our study shows an enhanced effect of using topical levofloxacin in combination with PVI irrigation to reduce conjunctival bacteria in patients undergoing intraocular surgery.

Prospective study demonstrating the efficacy of combined preoperative three-day application of antibiotics and povidone-iodine irrigation.

In 50 patients undergoing anterior segment intraocular surgery we determined that a three-day course of topical ofloxacin followed by preoperative povidone-iodine irrigation caused a marked decrease in the number of conjunctival bacterial flora and resulted in no contamination of the anterior chamber aqueous fluid at the beginning and conclusion of surgery.

Aspergillus fumigatus keratitis following laser in situ keratomileusis.

A 31-year-old woman developed pain, decreased vision, and a corneal flap infiltrate 4 days following laser in situ keratomileusis (LASIK). Treatment with topical antibiotic agents did not improve the symptoms. Approximately 2 weeks after surgery, the patient was referred to Stanford University, with 20/400 visual acuity in the left eye and a stromal infiltrate posterior to the flap. Cultures demonstrated Aspergillus fumigatus sensitive to voriconazole. The corneal ulcer progressed despite aggressive antifungal treatment, requiring amputation of the corneal flap and daily debridement. The infiltrate resolved in response to topical voriconazole, natamycin, and oral voriconazole. Aspergillus fumigatus keratitis is a rare but serious complication of LASIK surgery. The infection was successfully treated with flap amputation and daily debridement in addition to antifungal therapy.

Endophthalmitis prophylaxis.

The prevalence of postoperative endophthalmitis following cataract surgery appears to be increasing with the popularity of clear cornea incision. As a result, endophthalmitis prophylaxis will play and increasingly important role as the number of clear cornea cataract surgeries increases. In this article, the authors examine and critically evaluate techniques used to prevent endophthalmitis including proper preoperative patient preparation, application of povidone-iodine, and use of broad-spectrum antibiotics (topical, intracameral, and subconjunctival injection).

Normal ocular flora in newborns delivered in two hospital centers in Argentina and Paraguay.

PURPOSE: To determine the spectrum of normal conjunctival flora in newborns in two hospital centers in North Argentina and Paraguay. METHODS: In this prospective observational study, conjunctival specimens were obtained from the right eyes of newborns prior to the application of any topical medications. Culture samples were also obtained from the cervicovaginal secretions of the infants' mothers. All samples were directly inoculated into culture media and all growth were identified and quantified. RESULTS: Among the 190 newborns studied, 126 were delivered vaginally and 64 via caesarean section (C-section). A total of 180 different bacterial strains were acquired from the vaginally delivered infants and 77 from the C-section group (P=0.078, Student's t-test). Conjunctival cultures obtained within one hour of birth showed that 85 out of 101 samples (84%) from both the vaginal and C-section group had positive cultures, compared to 84 out of 89 samples (94%) obtained more than 1 h after birth (P<0.001). Among the vaginally delivered newborns, the most common bacteria isolated were coagulase-negative Staphylococcus (in 69 samples, 38%), Propionibacterium spp (36, 20%) and Corynebacterium spp (29, 16%). In the CES, the most common isolates were coagulase-negative Staphylococcus (39, 51%), Propionibacterium spp (22, 29%) and Staphylococcus aureus (6, 8%). There was a significantly higher proportion of gram-positive rods (P=0.017) isolated from infants delivered vaginally (16%) than from those delivered by C-section (5%). No Neisseria gonorrhoeae were isolated in conjunctival samples. Among the 130 organisms isolated from cervicovaginal secretions in 81 out of 189 mothers, the most common organisms were Lactobacillus spp. (47%), Corynebacterium spp (21%), Gardnerella vaginalis (15%), and Candida spp (14%). No Neisseria gonorrhoeae or Chlamydia trachomatis were found in cervicovaginal samples. CONCLUSION: The most common conjunctival bacteria in newborns delivered by either vaginal birth or C-section were coagulase-negative Staphylococcus. The proportion of positive conjunctival cultures was higher for infants delivered vaginally than for C-section delivery.