Heparin in the intraocular irrigating solution in pediatric cataract surgery

J Cataract Refract Surg. 2004 Oct;30(10):2163-9. doi: 10.1016/j.jcrs.2004.07.003.

Abstract

Purpose: To investigate the antiinflammatory effects of adding heparin sodium to the irrigating solution to prevent fibrinoid reaction and related long-term complications after pediatric cataract surgery.

Setting: Department of Ophthalmology, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey.

Methods: Thirty eyes of 18 children who had cataract or other ocular surgery were included in the study. Bilateral cataract surgery was performed in 20 eyes of 10 children and bilateral secondary intraocular lens (IOL) implantation in 4 eyes of 2 children (Group 1). Four eyes of 4 children had unilateral cataract surgery and 2 eyes of 2 children with previous perforating eye injury had synechiotomy and pupilloplasty (Group 2). Heparin sodium was added to the irrigating solution during surgery in 12 left eyes of children with bilateral surgery (Group 1a) and in all eyes in Group 2. Heparin sodium was not added during surgery in 12 right eyes of children having bilateral surgery (Group 1b, control). Early and late postoperative intraocular reactions were recorded and compared.

Results: In Group 1a (heparin added), 6 eyes had less fibrinoid reaction and fewer related complications such as posterior synechias, pupil irregularity, and intraocular lens (IOL) decentration than the fellow right eyes. No eye in Group 1a having primary cataract surgery had hyphema or intraocular bleeding. Hyphema occurred on the first postoperative day in 1 eye in Group 1a that had secondary IOL implantation.

Conclusions: Adding heparin sodium to the irrigating solution decreased postoperative inflammatory and fibrinoid reactions and related complications such as synechias, pupil irregularity, and IOL decentration in pediatric cataract surgery. However, the use of heparin during surgery can be risky in eyes with a defective blood-aqueous barrier such as after previous ocular surgery.

MeSH terms

  • Adolescent
  • Bicarbonates
  • Child
  • Child, Preschool
  • Drug Combinations
  • Female
  • Fibrinolysis / drug effects*
  • Fibrinolytic Agents / therapeutic use*
  • Glutathione
  • Heparin / therapeutic use*
  • Humans
  • Infant
  • Lens Implantation, Intraocular*
  • Male
  • Ophthalmic Solutions
  • Phacoemulsification*
  • Postoperative Complications / prevention & control*
  • Prospective Studies
  • Therapeutic Irrigation
  • Thrombolytic Therapy*

Substances

  • Bicarbonates
  • Drug Combinations
  • Fibrinolytic Agents
  • Ophthalmic Solutions
  • glutathione-bicarbonate-Ringer solution
  • Heparin
  • Glutathione