Discussion
Enterococci, P. aeruginosa, Candida albicans, Depressions, Candida albicans yeast, S. aureus
PROSTHETIC INFECTION, PROLIFERATION, ADHESION, CAVITY, PSEUDOMONAS, KLEBSIELLA, HEAT
While various factors can influence the comfort level of ocular prosthesis patients, the disturbance of ocular flora may be the most crucial factor affecting their ocular comfort. Previous studies have examined changes in microbial flora within anophthalmic sockets. However, the majority of these studies focused on comparing the flora of the anophthalmic socket with that of a healthy eye [All of these studies have reported a higher level of microorganism formation in the anophthalmic cavity and ocular prosthesis compared to the contralateral eye. This increased presence was observed for total bacteria, S. aureus, S. epidermidis, and Candida albicans. Staphylococcus species are significant pathogens associated with prosthetic infections. Furthermore, the anophthalmic cavity provides an ideal environment for the proliferation of undesirable fungi, especially Candida albicans yeast [Some studies have examined the effects of various cleansing methods, the frequency of ocular prosthesis manipulation, the age of the ocular prosthesis, the frequency of polishing, and the administration of antibiotic eye drops on the flora of the socket and ocular prosthesis biofilm [Since all patients in both groups received their prostheses for the first time and were assessed three months later to eliminate the age of the prosthesis as a factor, all patients in our study underwent the same cleaning procedures for their ocular prostheses. This cleaning regimen included washing them with water and soap once a week. Furthermore, none of the prostheses were polished within the first three months of use, and all patients were instructed not to use antibiotic eye drops.A number of earlier studies [The results of the current study showed a lower percentage of microbial growth in Group II (digitally designed 3D-printed) ocular prostheses, with (72.7) % of sockets showing no growth after three months of prosthesis use. This is in contrast to a higher percentage of microbial growth observed in Group I patients (conventional heat cured PMMA). Although Group II shows positive results, there is no statistically significant difference between the two groups and the null hypothesis was accepted. We observed a positive correlation between the material and design of the prosthesis and changes in microbial flora. This could be explained by the effect of surface roughness, which is considered one of the key factors influencing the adhesion and colonization of microorganisms on biomaterials. Depressions, micro-cracks and porosities in roughened surfaces provide more favorable colonization sites [The findings of the current study, along with those of previous studies, clarify that Group II patients have significantly higher levels of comfort than Group I patients. Group II patients also experience less discharge, although both groups’ discharge rates started to decline after three months of use.In contrast, some studies have reported opposing results. Teixeira et al. [Another important factor in reducing microbial growth is the fit and design of the ocular prosthesis, which plays a crucial role in eliminating dead space between the prosthesis fitting surface and the anophthalmic socket. This eliminates the accumulation of secretions and creates an environment less favorable for microbial growth. The lower percentages of microbial growth in Group II can be explained by the precision of 3D-printing and software design technology, as reported by other authors who found that 3D-printed restorations exhibited higher accuracy and better fit. Aldahian et al. [The insignificant difference between the two groups may be attributed to the hydrophobicity of both materials. Several studies have demonstrated the importance of the material’s hydrophobic effect on initial adhesion, showing a linear correlation between an increase in hydrophobicity and the number of attached cells [Pseudomonas spp. were recorded in the post-prosthetic swabs of four patients, two from Group I (CG) and two from Group II (DG). However, their pre-prosthetic swabs were free from Pseudomonas spp. This can be primarily attributed to the socio-cultural environment of the patients, which is directly related to their hygiene habits. This airborne bacterium is mainly introduced to the socket during manipulation of the prosthesis with inadequate hygienic habits of the patients. These habits are not only related to their socio-economic status but may also be influenced by their occupation [P. aeruginosa can also effectively colonize a variety of surfaces, including most medical materials, and is a well-known biofilm former. This biofilm acts as a scaffold for adhesion to the prosthesis surface and protects it from the surrounding environment. Biofilms of P. aeruginosa are composed of polysaccharides and extracellular DNA, which play critical roles in protecting the bacterial communities from exogenous stresses caused by antimicrobial agents [In Group I, two patients had positive pre-prosthetic swabs. One had Klebsiella spp., and the other had Enterococci. However, both had negative post-prosthetic swabs. This can be explained by considering both patients as treated individuals who used prophylactic antibiotic eye drops prescribed during the first week of prosthesis use.The limitation of this RCT was the short follow-up period restricted to 3 months. More RCTs are needed with longer follow-up periods to allow for evaluation of long term effect of the material and design of 3D-printed ocular prosthesis on the health of the anophthalmic socket.