EFFECT OF LOW-MOLECULAR-WEIGHT HEPARIN ON POSTOPERATIVE INFLAMMATION IN PHACOMORPHIC GLAUCOMA

Background – Low-molecular-weight heparin (LMWH) has been shown to reduce the severity of postoperative inflammatory response. We decided to evaluate the specific effect of intraoperative LMWH in reducing the severity of postoperative inflammatory response after standard extracapsular cataract extraction and posterior chamber intraocular lens implantation in cases of phacomorphic glaucoma. Methods . In a randomized, double-blind, clinical trial, 46 eyes (23 case eyes and 23 control eyes) were operated on by a single surgeon. In the first group, 5 IU/mL LMWH (Fragmin) was added to the irrigating fluid. Intraoperative and postoperative hemorrhage, degree of postoperative inflammation, fibrin and posterior synechiae formation, pigment deposits on the intraocular lens surface, visual acuity and intraocular pressure (IOP) were evaluated. The control group underwent a routine conventional surgery. Results – The mean age was 68 years (standard deviation, 8.1; range, 63 . 79 yr). No statistically significant difference in age, sex, duration of operation and hospitalization, preoperative IOP, concurrent ocular and systemic illness, or smoking was found between the cases and controls. There was a statistically significant difference between the two groups in terms of density of cell and flare in anterior chamber, fibrin formation, pigment deposition over intraocular structure, and severity of postoperative inflammation. There was also a statistically significant difference in postoperative visual acuity between cases and controls (20/50 vs 20/125, respectively; p = 0.001). The incidences of intra- and postoperative hemorrhage were similar between the two groups (p = 1.0). Conclusion – LMWH can be used safely in patients with phacomorphic glaucoma. In this study, it was positively correlated with reduced postoperative inflammation and fibrin formation, and gave rise to better visual acuity.