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Anti-inflammatory effect of low-molecular-weight heparin in pediatric cataract surgery: a randomized clinical trial
Viraj A Vasavada1, Mamidipudi R Praveen, Sajani K Shah
1Iladevi Cataract & IOL Research Centre, Ahmedabad, India.
Insights
This study found that intraocular infusion of enoxaparin did not reduce postoperative inflammation in pediatric cataract surgery. Enoxaparin did not offer a benefit in managing early inflammation or preventing complications like posterior synechiae.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Pharmacology
Background:
- Postoperative inflammation is a common complication following pediatric cataract surgery with intraocular lens (IOL) implantation.
- Low-molecular-weight heparin (enoxaparin) has been investigated for its anti-inflammatory properties.
Purpose of the Study:
- To evaluate the efficacy of intraocular enoxaparin infusion in reducing postoperative inflammation in pediatric eyes undergoing cataract surgery and IOL implantation.
Main Methods:
- A prospective, masked, randomized controlled trial was conducted.
- Twenty children (40 eyes) received either intraocular enoxaparin or a placebo in the infusion fluid during bilateral cataract surgery.
- Patients were assessed for anterior chamber flare and cells, IOL deposits, and posterior synechiae at intervals up to 3 months postoperatively.
Main Results:
- While no eyes had significant inflammation (>grade 2) one week postoperatively, eyes without enoxaparin showed a higher proportion of grade 2 cells (80% vs 40%).
- Eyes receiving enoxaparin had more small cell deposits initially (20% vs 0%), but large cell deposits and posterior synechiae rates were similar between groups by 3 months.
Conclusions:
- Intraocular enoxaparin infusion does not appear to provide a significant benefit in reducing early postoperative inflammation after pediatric cataract surgery.
- Further research may be needed to explore alternative anti-inflammatory strategies in this patient population.
Purpose:
To determine if intraocular infusion of low-molecular-weight heparin (enoxaparin) reduces postoperative inflammation in pediatric eyes undergoing cataract surgery with IOL implantation.
Design:
Prospective masked randomized controlled trial.
Methods:
setting: Private, institutional practice. study population: Twenty children (40 eyes) undergoing bilateral cataract surgery with IOL implantation were randomized to receive enoxaparin in the intraocular infusion fluid (BSS) (Group I) or not to receive enoxaparin (Group II). The first eye was randomly assigned to 1 of the 2 groups and the second eye received alternate treatment. observation procedure: Patients were followed up in the first week and 1 and 3 months after surgery. main outcome measures: Anterior chamber flare and cells (Hogan's criteria), cell deposits on IOL, posterior synechiae.
Results:
One week postoperatively, no eyes had >grade 2 flare/cells. Proportion of eyes with grade 2 cells was higher in eyes that did not receive enoxaparin (Group II: 80% vs Group I: 40%, P = .009). In the first week >10 small cell deposits were noted in the eyes that received enoxaparin (Group I: 20%, Group II: none, P = .005). Large cell deposits first appeared at 1 month in 40% of eyes in Group I and 55% of eyes in Group II (P = .34) and increased at 3 months (60% in both groups, P > .999). Posterior synechiae were seen in 10% of eyes in Group I at 1 month, which persisted at 3 months; no eyes in Group II showed posterior synechiae (P = .14).
Conclusion:
The results of our study suggest that there does not seem to be a benefit of using enoxaparin in the infusion fluid with respect to early postoperative inflammation.
