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. 2020 Nov;258(11):2483-2487.
doi: 10.1007/s00417-020-04894-3. Epub 2020 Aug 20.

Influence of oral anticoagulation on success rates and risk of bleeding events after iStent inject implantation combined with phacoemulsification

Randolf A Widder  1   2 , Alexandra Lappas  3 , Corinna Rennings  4 , Matthias Hild  4 , Gernot F Roessler  4   5 , Thomas S Dietlein  3
Affiliations

Influence of oral anticoagulation on success rates and risk of bleeding events after iStent inject implantation combined with phacoemulsification

Randolf A Widder et al. Graefes Arch Clin Exp Ophthalmol. 2020 Nov.

Erratum in

Abstract

Purpose: We conducted a retrospective study to evaluate the intraocular pressure (IOP) lowering effect, the success rates, and the risk of bleeding events of patients receiving an iStent inject combined with phacoemulsification under anticoagulation therapy compared with a matched control group.

Methods: In this retrospective study, sixty-four eyes underwent an iStent inject implantation combined with phacoemulsification at two centers. Thirty-two eyes received surgery while under anticoagulation therapy, and another thirty-two eyes served as a control group matched for visual acuity, IOP, and medication score. Success was defined as criteria A and B (IOP < 18/21 mmHg, > 20% IOP reduction, no resurgery) and criteria C (IOP ≤ 15 mmHg, IOP reduction ≥ 40%, no resurgery). The clinical goal of the study was to determine the difference between the study and control groups with respect to IOP, medication score, and the frequency of intraoperative and postoperative bleeding events.

Results: After a mean follow-up time of 1 year, the IOP lowered 28% from 20.1 ± 4.8 to 14.5 ± 3.7 mmHg in the group of 64 eyes. The medication score lowered 38% from 2.1 ± 1.1 to 1.3 ± 1.2. The two groups with and without anticoagulant agents did not significantly differ in postoperative IOP, medication score, success rates, or number of bleeding events.

Conclusion: We conclude that in cataract surgery combined with the iStent inject a discontinuation of anticoagulant agents might not be necessary. It might be a good option in glaucoma surgery when anticoagulation treatment should not be interrupted and the target pressure is not very low.

Keywords: Anticoagulation therapy; Glaucoma; Glaucoma surgery; MIGS; iStent.

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Conflict of interest statement

Randolf A. Widder, Alexandra Lappas, Corinna Rennings, Matthias Hild, Gernot Roessler: No financial disclosures.

Thomas S. Dietlein: Consulting and lectures: Santen Pharmaceutical Osaka, Japan; Alcon Fort Worth, USA. Stock interest: Bayer Leverkusen, Germany; Johnson & Johnson New Brunswick, New Jersey. Lectures: Thea Pharma Schaffhausen, Switzerland; iStar Medical Wavre, Belgium; MeyeTech Alsdorf, Germany.

Figures

Fig. 1
Fig. 1
Success rates: Criteria A = IOP at follow-up < 18 mmHg, IOP reduction > 20%, no resurgery; Criteria B = IOP < 21 mmHg, > 20% reduction, no resurgery; Criteria C = IOP ≤ 15 mmHg, ≥ 40% reduction, no resurgery. The p value was calculated by the log rank test
See this image and copyright information in PMC

References

    1. Kong K-L, Khan J. Ophthalmic patients on antithrombotic drugs: a review and guide to perioperative management. Br J Ophthalmol. 2015;99:1025–1030. doi: 10.1136/bjophthalmol-2014-306036. - DOI - PubMed
    1. Rahman SI, Turalba A. Anticoagulation in glaucoma surgery. Semin Ophthalmol. 2018;33:108–111. doi: 10.1080/08820538.2017.1353828. - DOI - PubMed
    1. Sozeri Y, Salim S. Anticlotting agents and the surgical management of glaucoma. Curr Opin Ophthalmol. 2018;29:185–189. doi: 10.1097/ICU.0000000000000456. - DOI - PubMed
    1. Makuloluwa AK, Tiew S, Briggs M. Peri-operative management of ophthalmic patients on anti-thrombotic agents: a literature review. Eye (Lond) 2019;151:934. doi: 10.1038/s41433-019-0382-6. - DOI - PMC - PubMed
    1. Cobb CJ, Chakrabarti S, Chadha V, Sanders R. The effect of aspirin and warfarin therapy in trabeculectomy. Eye (Lond) 2007;21:598–603. doi: 10.1038/sj.eye.6702277. - DOI - PubMed

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