Do multipurpose solutions damage porcine corneal epithelial cells?

To determine and compare the cytotoxic effects on porcine corneal epithelial cells of commercially available multipurpose solutions (MPS) using fluorescein staining and flow cytometry (FCM). Effects of exposure time of 10 s to 10 min of MPS containing polyquaternium-1 (MPS-A), polyaminopropyl biguanide (MPS-B), and polyhexanide (MPS-C), on porcine corneal epithelial cells were determined. Cell viability and membrane integrity were assessed by Annexin V-FITC/7-AAD staining and FCM. In further trials, whole corneas were immersed in MPS and control (buffered saline), and corneal fluorescein staining assessed before FCM analysis. Significantly higher percentages of 7-AAD-stained cells (early necrosis) were observed at all exposure times for MPS-A than for other solutions and control (p < 0.05). Exposure time in MPS-A and 7-AAD-stained cell proportions showed significant correlation (r = 0.9957; p < 0.0001). Significantly more cells dual-stained with Annexin V-FITC/7-AAD (late necrosis) after 5 min MPS-A exposure (11.8 ± 1.1%), compared with 1.2 ± 0.9% (MPS-B), 0.9 ± 0.5% (MPS-C), and 1.8 ± 0.2% (control). However, only 10 min exposure resulted in significant increases in fluorescein grades (p < 0.001), with median grade 0.75 for MPS-A, and 0.50 for the other MPS. MPS exposure, especially MPS-A, affected the viability and integrity of porcine corneal epithelial cells. Furthermore, our results confirmed that fluorescein staining correlates poorly with cytotoxicity. As fluorescein staining lacks sensitivity to determine cytotoxic effects of ophthalmic solutions, more objective and sensitive assessment methods such as differential staining and FCM should be developed.