ANTICOAGULATION THERAPY AND OCULAR SURGERY

BACKGROUND AND OBJECTIVE: It is not rare for patients receiving antico agulant therapy to undergo ocular surgery; however, there are no clear guidelines with reference to the operative management of the eye. Thi s study examines the complications in patients receiving anticoagulant therapy who undergo ocular operations and suggests a management regim en for these patients. PATIENTS AND METHODS: The authors retrospective ly analyzed 52 patients receiving anticoagulant therapy who underwent ocular surgery between 1993 and 1995. Data included sex, age, reason f or anticoagulant therapy, operative procedure, complication rate, and length of time anticoagulant therapy was stopped or reduced prior to s urgery. To show the base-line complication rate at their institution, data of patients not receiving anticoagulation therapy were added. RES ULTS: Ticlopidine hydrochloride, an antiplatelet drug, was administere d to 24 patients. Warfarin sodium was administered to 8 patients, hepa rin was administered to 8 patients, and other anticoagulants were admi nistered to 20 patients. There were no significant differences in comp lications between the groups that stopped or reduced anticoagulant the rapy and those that did not, but speech disturbance due to thrombotic complication occurred in 1 of 10 patients in whom ticlopidine hydrochl oride was stopped or reduced. Hemorrhagic complications occurred in 50 % of those who continued ticlopidine hydrochloride, but in none of tho se who discontinued it (P = .019). There was a significant difference in hemorrhagic complications after cataract surgery between the phacoe mulsification, aspiration, and intraocular lens implantation (PEA+IOL) and the planned extracapsular cataract extraction and intraocular len s implantation (PECCE+IOL) groups that continued the drug (P = .0011). No patients showed visual acuity reduction due to hemorrhagic complic ations. CONCLUSIONS: To avoid life-threatening systemic complications, one need not always stop anticoagulant therapy before performing only cataract surgery. Cataract surgery in patients receiving ticlopidine hydrochloride should be performed with PEA+IOL via a small sclerocorne al or a corneal incision. In cataract surgery for patients receiving a nticoagulant therapy, hemorrhagic complications are more frequent than in patients not receiving anticoagulant therapy.