Manners T D, Turner D P, Galloway P H, Glenn A M
Department of Ophthalmology, West Norwich Hospital.
Br J Ophthalmol. 1997 Nov;81(11):949-52. doi: 10.1136/bjo.81.11.949.
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.
A 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.
No 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).
There 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.
背景/目的：溶液中的肝素可减少细菌对人工晶状体的粘附，并且有报道称使用肝素涂层晶状体可降低术后眼内炎的发生率。本研究旨在探讨在常规白内障手术期间向输注液中添加低分子量肝素的安全性。通过培养手术结束时采集的前房液样本，寻找其直接抗菌作用。
对111例行常规白内障手术的患者进行随机、双盲、对照研究。试验组患者的输注液中添加浓度为5 IU/ml的低分子量肝素。对手术结束时采集的前房样本进行培养。另外培养29份无菌输注液样本作为进一步对照。
两组均未发现并发症，且两组术后观察到的炎症无差异。肝素化组（n = 55）31%的样本中发现细菌污染，无肝素组（n = 56）这一比例为27%（无显著差异）。
肝素似乎没有直接抗菌作用，并对其他可能的作用机制进行了讨论。肝素避免了传统抗生素预防的许多缺点，可能有潜力成为预防眼内炎的一种安全有效的药物。
