A One Year Randomized Clinical Trial On The Effect Of Intracameral Low Molecular Weight Heparin On Postoperative Inflammatory Reaction In High Risk Cataract Cases

Abstract

INTRODUCTION Cataract surgery has a higher incidence and more pronounced postoperative inflammatory reaction in high risk groups such as congenital cataract, traumatic cataract, complicated cataract, diabetic patients with cataract and lens induced glaucoma. Despite the improvements in surgical technique, equipments and pharmacologic strategies, risk of postoperative inflammation related complications are still high in high risk cataract cases. Heparin surface modified lens was used for this purpose but it is very expensive. We studied the effect of intracameral low molecular weight heparin on postoperative inflammation after cataract surgery in high risk cataract cases and also the complications associated with its use. MATERIALS AND METHOD It is a randomized clinical trial in which forty patients with high risk cataract like patients with diabetes, complicated cataract, traumatic cataract, congenital cataract, steroid induced cataract and lens induced glaucoma undergoing small incision cataract surgery with posterior chamber intraocular lens implantation were randomly assigned into two groups, group A and group B. All patients in group A received low molecular weight heparin (enoxaparin) in the concentration of 40mg/0.4ml in 500ml in the irrigating solution and patients in group B received irrigating solution without low molecular weight heparin. The patients were examined postoperatively on day 1, day 7, day 30 and day 60 for anterior chamber cells and flare, vitreous haze, iris pigments on the surface of intraocular lens and posterior capsular opacification by SL 115 Classic Carl Zeiss slit lamp. RESULTS A statistically significant reduction in postoperative cells (P <0.001) and flare (P=0.001) and vitreous haze (P=0.001) was noted on day1 and day 7 in group with addition of low molecular weight heparin. At day 30 and day 60 no statistically significant reduction in post-operative cells and flare and vitreous haze was seen. Iris pigments on the surface of intraocular lens were significantly reduced (P<0.05) in all follow-ups in group with addition of low molecular weight heparin. There was no significant difference in development of posterior capsular opacification, pupillary membrane and posterior synechiae. None of the patients in either group developed optic capture. Intraoperative and postoperative complications related to low molecular weight heparin supplementation like hyphema and corneal opacity were not noted in any of the patients. CONCLUSION Low molecular weight heparin used in the concentration of 40mg/0.4ml in 500 ml irrigating solution reduces the early postoperative inflammation in high risk cataract cases with no adverse effects.