Intraoperative enoxaparin minimizes inflammatory reaction after pediatric cataract surgery

Abstract

Purpose: To evaluate the effect of intraocular infusion of enoxaparin, a low-molecular-weight heparin, on postoperative inflammatory response in pediatric cataract surgery.

Design: Prospective, comparative, consecutive interventional case series.

Methods: Seventeen consecutive eyes (11 patients) underwent pediatric cataract surgery in two tertiary medical centers. During the procedure, balanced salt solution with enoxaparin (40 mg in 500 ml) was infused into the anterior chamber. Eleven consecutive eyes (eight patients) received balanced salt solution without enoxaparin in the infusion bottle. The inflammatory response in the anterior chamber was compared between the two groups by semiquantification with slit-lamp biomicroscopy. Postoperative inflammatory complications, including fibrin formation, intraocular lens precipitates, anterior and posterior synechiae, cyclitic and pupillary membrane formation, and anterior subluxation of the intraocular lens, were also compared. The follow-up period after surgery was between 3 and 36 months (average 12.3 months).

Results: The number of cells and the degree of flare were minimal in the group with enoxaparin in the infusion bottle (P < .001). The total number of postoperative inflammation-related complications was also lower in the enoxaparin-treated group (P = .007). All corneas remained clear, and the endothelial cell count, which was performed in two patients, did not show substantial decrease in their density or changes in shape and size. No other enoxaparin-related complications were observed.

Conclusions: Infusion of enoxaparin during pediatric cataract surgery may minimize the postoperative inflammatory response and decrease the number of postoperative inflammatory related complications. Enoxaparin should also be evaluated for cataract surgery in other conditions where postoperative inflammation may be exacerbated.