• Written By: Liliana Werner, MD, PhD, Lisa B. Arbisser, MD, John A Hovanesian, MD, FACS
    Cataract/Anterior Segment

    The results of the study suggest that enoxaparin added to the infusion fluid may reduce postoperative inflammation in diabetes mellitus (DM) patients undergoing cataract surgery.

    However, the addition of solutions to the procedure always raises concerns about toxic anterior segment syndrome (TASS). Nonetheless, many surgeons use Triesence (triamcinolone acetonide injectable suspension) intracamerally in patients with diabetic macular edema and some with advanced nonproliferative diabetic retinopathy (NPDR) at the time of surgery.

    We're going to see a number of irrigation-based anti-inflammatories in the near future, like Omeros' Omidria, a ketorolac-based irrigating fluid additive designed to reduce inflammation and improve pupil dilation. Such products will be part of our future in cataract surgery.

    The study included 51 eyes of 51 DM patients with moderate NPDR and grade 2 to 3 nuclear cataracts. Group 1 included randomly selected patients who received enoxaparin, a low-molecular-weight heparin, in balanced salt solution during cataract surgery, while standard salt solution was used in group 2. They were followed until two months after surgery.

    Postoperatively, 20 patients from the treatment group and four from the placebo group had less than a mean of 10 anterior chamber cells at day one (P = 0.012). At the first week, 20 patients from the treatment group and 10 patients from the placebo group had less than a mean of 10 cells (P = 0.004).

    In flare, 20 patients from the treatment group and eight patients from the placebo group had anterior chamber flare between scores 0 and +1 at postoperative day one (P < 0.001). By the end of the postoperative first week, 24 patients from the treatment group and 18 patients from the placebo group had flare between 0 and +1 (P = 0.012). There was no difference between groups in terms of postoperative inflammation at the first and second months after the surgery.

    The authors conclude that the effect of different doses of enoxaparin on inflammation should be investigated in larger series and with quantitative measurements of inflammation.