Heparinised intraocular infusion and bacterial contamination in cataract surgery
a Department of Ophthalmology, West Norwich Hospital,
Norwich, b Public Health Laboratory, West Norwich Hospital, Norwich
Correspondence to: Mr T D Manners, West Norwich Hospital, Bowthorpe Road, Norwich NR2 3TU.
Accepted for publication 28 April 1997
BACKGROUND/AIMS
Heparin in solution reduces
bacterial adhesion to intraocular lenses and a lower incidence of
postoperative endophthalmitis has been reported with the use of heparin
coated lenses. The safety of adding low molecular weight heparin to the
infusion fluid during routine cataract surgery was investigated. Any
direct antibacterial effect was looked for by culturing anterior
chamber fluid samples taken at the completion of surgery.
METHODSA randomised, double blind, controlled
study of 111 patients undergoing routine cataract surgery. Low
molecular weight heparin at a concentration of 5 IU/ml was added to the
infusion fluid in the trial patients. Samples from the anterior chamber
taken at completion of surgery were cultured. Twenty nine samples of sterile infusion fluid were also cultured as further controls.
RESULTSNo complications were found in either
group, and no difference in observed postoperative inflammation in each
group. In the heparinised group (n=55) bacterial contamination was
found in 31% of samples, compared with 27% in the no heparin group
(n=56) (no significant difference).
CONCLUSIONSThere appears to be no direct
antibacterial effect of heparin, and other possible mechanisms of
action are discussed. Heparin avoids many of the drawbacks of
traditional antibiotic prophylaxis and may have the potential to be a
safe and effective addition to endophthalmitis prevention.
© 1997 by British Journal of Ophthalmology
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