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The authors have no financial interest in the subject matter of this poster. FINANCIAL DISCLOSURES.

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Presentation on theme: "The authors have no financial interest in the subject matter of this poster. FINANCIAL DISCLOSURES."— Presentation transcript:

1 The authors have no financial interest in the subject matter of this poster. FINANCIAL DISCLOSURES

2 Paulo Silva Guerra MD, Walter Rodrigues MD, David Lopes MD, Lurdana Gomes MD, M. Monteiro Grillo MD Ophthalmology Department. Director: Prof. Dr. M. Monteiro Grillo Hospital de Santa Maria (HSM) / Lisbon - Portugal CATARACT SURGERY IN PATIENTS ON WARFARIN THERAPY: HAEMORRHAGIC COMPLICATIONS AND POSTOPERATIVE VISUAL ACUITY

3 Introduction Purpose : To assess ophthalmic complications associated with cataract surgery under topical anesthesia in patients on warfarin therapy. Traditionally, warfarin has been discontinued prior to cataract surgery because of concerns about increased risk of hemorrhagic complications The trend amongst surgeons has shifted strongly towards continuation of anticoagulation Recent surveys indicates the majority ( ˃ 70%) of surgeons keep cataract patients anticoagulated. 5

4 Material and Methods Retrospective review of 49 eyes of 42 patients on warfarin therapy (Warfarin Group). Undergoing cataract surgery by phacoemulsification and IOL placement with topical anesthesia. We evaluate: - The rates of intraoperative hemorrhagic complications of the anterior and posterior segment - The rates of postoperative hemorrhagic complications of the anterior and posterior segment - The pre and postoperative Best Corrected Visual Acuity (BCVA)

5 Material and Methods The results of are compared with a control group, not anticoagulated (age and surgeon matched). All cataract surgeries were performed by three experienced surgeons from January 2008 to June 2009

6 Results Demographics Warfarin GroupControl Group Patients 4251 Eyes 4960 Mean age 75,3 (SD±7,1)78,7 (SD±7,9) Gender ♂ - 18 (43%)♂ - 21 (41%) Preoperative BCVA 0,49 (SD±1,86)0,56(SD±2,02) Intraoperative non-hemorrhagic complications Warfarin Group - 2 posterior capsule ruptures Control Group - 3 posterior capsule ruptures

7 Results Warfarin Groupn=49 Control Groupn=60 Subconjunctival hemorrhage 00 Hyphema 2 (4,1%)0P = 0,11 Suprachoroidal hemorrhage 00 Intraoperative Hemorrhagic Complications

8 Results Postoperative Hemorrhagic Complications Warfarin Groupn=49 Control Groupn=60 Subconjuntival H. 6 (12,2%)1 (1,7%)P = 0,02 Hyphema 2 (4,1%)0P = 0,11 Vitreous Hemorrhage 00 Suprachoroidal H. 00 Retinal Hemorrhages 4 (8,1%)5 (8,3%)P = 0,9

9 Results Postoperative BCVA

10 Discussion Subconjuntival Hemorrhage: - Most frequent hemorrhagic complication in Warfarin Group - The only statistically significant (P<0,05) There was no statistically significant difference in the other hemorrhagic complication between the 2 groups (P>0,05). There was no statistically significant difference in postoperative BCVA between the 2 groups (P>0,05).

11 Conclusions Continuation of treatment with warfarin in patients undergoing phacoemulsification and IOL placement with topical anesthesia is safe and was not associated with increased risk of vision threatening complications.

12 References 1. Katz J, Feldman MA, Bass EB, Lubomski LH, Tielsch JM, Petty BG et al. Risks and benefits of anticoagulant and antiplatelet medication use before cataract surgery. Ophthalmol. 2003. 110: 1784-1788 2. Barequet IS, Sachs D, Priel A, Wasserzug Y, Martinowitz U, Moisseiev J et al. Phacoemulsification of cataract in patients receiving Coumadin therapy : ocular and hematologic risk assessment. Am J Ophthalmol. 2007 Nov;144(5): 719-23 3. Morris A, Elder MJ. Warfarin therapy and cataract surgery. Clin Experiment Ophthalmol. 2000 Dec;28(6):419-22 4. Carter K, Miller KM. Phacoemulsification and lens implantation in patients treated with aspirin or warfarin. J Cataract Refract Surg. 1998 Oct; 24(10):1361-4 5. Ong-Tone L, Paluck EC, Hart-Mitchell RD. Perioperative use of warfarin and aspirin in cataract surgery by Canadian Society of Cataract and Refractive Surgery members: survey. 2005 May;31(5):991-6 6. Stone LS, Kline OR, Sklar C. Intraocular lenses and anticoagulation and anti-platelet therapy. Am Intra-Ocular Implant Soc J. 1985;11:165-68 7. Jonas JB, Pakdaman B, Sauder G. Cataract surgery under systemic anticoagulation therapy with coumarin. Eur J Ophthalmol 2006; 16:30-32 8. Rotenstreich Y, Rubowitz A, Segev F et al. Effect of warfarin therapy on bleeding during cataract surgery. J Cataract Refract Surg 2001;27:1344-46

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