Influence of oral anticoagulation on success rates and risk of bleeding events after iStent inject implantation combined
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GLAUCOMA
Influence of oral anticoagulation on success rates and risk of bleeding events after iStent inject implantation combined with phacoemulsification Randolf A. Widder 1,2 Thomas S. Dietlein 2
&
Alexandra Lappas 2 & Corinna Rennings 1 & Hild Matthias 1 & Gernot F. Roessler 1,3 &
Received: 13 June 2020 / Revised: 4 August 2020 / Accepted: 11 August 2020 # The Author(s) 2020
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 Glaucoma . Glaucoma surgery . MIGS . Anticoagulation therapy . iStent
Introduction Glaucoma is a disease of the elder population where anticoagulant agents are used frequently. While it is generally accepted that intraocular bleeding after standard phacoemulsification cataract surgery does not justify the withdrawal of anticoagulant agents,
* Randolf A. Widder [email protected] 1
Department of Ophthalmology, St. Martinus-Krankenhaus Düsseldorf, Gladbacher Strasse 26, 40219 Düsseldorf, Germany
2
Center of Ophthalmology, University of Cologne, Kerpener Strasse 62, 50937 Köln, Germany
3
Department of Ophthalmology, RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
there is no clear guidance for glaucoma surgery [1–4]. For trabeculectomy, Cobb et al. recommended the discontinuation of warfarin [5]. Little is known about the complication rate of performing minimally invasive glaucoma surgery (MIGS) under anticoagulation therapy. Surgery on angle structures may lead to intracameral bleeding by tr
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