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Joseph Bogaard, Iris S Kassem; Evaluatation of Therapeutic Interventions for Postoperative Inflammation and Fibrosis in a Juvenile Rabbit Animal Model of Lensectomy with Intraocular Lens Insertion. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3217.
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© ARVO (1962-2015); The Authors (2016-present)
The Infant Aphakia Treatment study showed that infants with unilateral cataracts that were removed with intraocular lens (IOLs) implanted had significantly more postoperative adverse events and additional surgeries, often due to visual axis opacification. We previously demonstrated that 10mg of Enoxaparin, a low molecular weight heparin, showed a significant improvement in optical clarity after lensectomy in a juvenile model of lensectomy with aphakia. To test the hypothesis that postoperative inflammation and fibrosis can also be reduced even with IOL insertion, we tested the safety of candidate interventions to prevent postoperative fibrosis and inflammation.
All experiments were approved and in compliance with Animal Care Committee at the University of Illinois at Chicago. Juvenile (6-7 week old) New Zealand White rabbits (Harlan) had lensectomy with IOL insertion under general anesthesia with ketamine and xylazine. Clear-cornea lens extraction surgery was performed with Simcoe irrigation and aspiration followed by insertion of an acrylic foldable IOL (Alcon SN60WF 30D). After all wounds were closed, 0.5mg triamcinolone, 8mg enoxaparin, or a combination of both, or balanced salt solution (BSS) were injected into the anterior chamber. Only topical antibiotic ointment was given for 3 days postoperatively. Under sedation with ketamine and dexmeditomidine, rabbits were examined postoperatively on days 3 through 7 and on day 14 with optical coherence tomography (OCT) (Spectralis OCT, Heidelberg Engineering) and slit lamp biomicroscopy. OCT signal strength was used as a quantification of the clarity of the central visual axis.
Both OCT signal strength and anterior segment examination of eyes treated with the combination of triamcinolone and enoxaparin had less postoperative inflammation and improved visual axis clarity compared to control eyes or eyes treated with either medication alone.
Enoxaparin with triamcinolone used in the anterior chamber at the end of lensectomy appears to be an effective therapeutic modality to reduce postoperative inflammation and fibrosis in a juvenile rabbit model. Intraocular injection into the anterior chamber at the end of surgery may reduce postoperative inflammation after lensectomy and improve visual axis clarity.
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