Bacterial infection following implantation of an artificial corneal scaffold is a serious complication. Conventional
antibiotic prophylaxis, which includes topical
vancomycin application, is limited by low bioavailability, high dosing requirement, and poor patient compliance. The ideal option to overcome these issues is an
antibiotic-eluting corneal
prosthesis that sustains the local release of
drug. In this study, we incorporated
vancomycin in thick 15%
collagen hydrogels to create an artificial corneal scaffold with anti-infective capability. The incorporation of
vancomycin did not significantly alter the Young's modulus, transparency and refractive index of the
vancomycin-loaded
hydrogel (VH), which were 0.79 ± 0.04 MPa (p = 0.233 compared to blank
hydrogel), 94.3 ± 2.3% (p = 0.115) and 1.346 ± 0.005 (p = 0.264), respectively. In vitro, the
drug elution was sustained for up to 7 days. The VH was subsequently implanted intrastromally in rabbit corneas, replacing stromal tissue that was removed following femtosecond
laser-assisted small incision lenticule extraction procedure. In vivo, the vancomcyin could be detected in the aqueous humor for up to 10 days. We then created a corneal infectious
keratitis model by intrastromal injection of 1 × 108 CFU/ml of Staphylococcus aureus inoculate on day 2 postimplantation. On day 3 postinfection, the VH-implanted corneas were clear and nonedematous and showed a substantial reduction of log 2.5 in S. aureus compared to the blank
hydrogel-implanted corneas, which appeared hazy, edematous, and had excessive
inflammation. Immunohistochemistry of inflammatory marker, CD18, demonstrated a significant reduction in inflammatory cells in VH-implanted corneas (49 ± 9 cells/unit area) compared to blank
hydrogel-implanted corneas (523 ± 15 cells/unit area) (p < 0.001). In conclusion, we have demonstrated the efficacy of a
drug-eluting corneal implant in preventing perioperative
bacterial infections.