Barequet Irina S, Sachs Dan, Priel Ayelet, Wasserzug Yael, Martinowitz Uri, Moisseiev Joseph, Salomon Ophira
Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel.
Am J Ophthalmol. 2007 Nov;144(5):719-723. doi: 10.1016/j.ajo.2007.07.029. Epub 2007 Sep 17.
To assess the risks of intra- and postoperative bleeding tendency associated with uncomplicated cataract surgery by phacoemulsification in patients receiving Coumadin treatment.
Prospective, nonrandomized, interventional, consecutive case series.
Sixty-three consecutive patients underwent cataract extraction with lens implantation in 75 eyes. All patients were receiving Coumadin therapy at the time of surgery, and nine patients (14.3%) were also taking antiaggregants. The operations were performed by phacoemulsification technique under topical anesthesia. All patients underwent a hemostatic work-up before intervention. Structured questionnaires were completed by the surgeon immediately after the operation. In 18 (24%) eyes, the surgery was videotaped, and the tapes were reviewed subsequently for any bleedings by an independent observer.
Twelve patients (19%) underwent surgery in both eyes, not simultaneously. The mean prothrombin time international normalized ratio (INR) was 2.03 at the time of the surgery. No significant intraoperative bleeding occurred. Four (6.3%) patients had minor postoperative ocular bleeding. A microscopic hyphema and a dot retinal hemorrhage were each seen in one eye on the first postoperative day, and small iris hemorrhages were identified in two additional eyes at the one-week visit. All bleedings disappeared within one week without affecting the visual acuity. The mean INR of the four patients with minor bleedings was 2.1.
Cataract surgery by phacoemulsification in uncomplicated eyes can be performed safely in patients receiving Coumadin treatment. However, a large clinical trial is required to assess the safety of continuous Coumadin treatment associated with phacoemulsification in eyes with complicated cataract.
评估接受香豆素治疗的患者在进行单纯性白内障超声乳化手术时术中及术后出血倾向的风险。
前瞻性、非随机、干预性、连续病例系列。
63例连续患者的75只眼接受了白内障摘除联合晶状体植入术。所有患者在手术时均接受香豆素治疗，9例患者（14.3%）还服用抗血小板药物。手术采用表面麻醉下的超声乳化技术进行。所有患者在干预前均进行了止血检查。外科医生在手术后立即填写结构化问卷。18只眼（24%）的手术进行了录像，随后由一名独立观察者查看录像以检查是否有出血情况。
12例患者（19%）先后对双眼进行了手术，而非同时进行。手术时的平均凝血酶原时间国际标准化比值（INR）为2.03。术中未发生明显出血。4例患者（6.3%）术后出现轻微眼部出血。术后第一天，一只眼中可见显微镜下前房积血和点状视网膜出血，在一周随访时，另外两只眼中发现了小的虹膜出血。所有出血均在一周内消失，未影响视力。4例轻微出血患者的平均INR为2.1。
接受香豆素治疗的患者，在单纯性眼内进行白内障超声乳化手术可安全进行。然而，需要进行一项大型临床试验来评估在复杂性白内障眼中进行超声乳化手术时持续使用香豆素治疗的安全性。
