Department of Ophthalmology, University Medical Center Göttingen, Göttingen, Germany.
Department of Ophthalmology, University Medical Center Göttingen, Göttingen, Germany.
Ophthalmol Retina. 2021 Aug;5(8):e23-e29. doi: 10.1016/j.oret.2021.04.013. Epub 2021 Apr 26.
To evaluate the influences and risk factors for severe bleeding complications during vitreoretinal surgery and to investigate the role of antiplatelet and anticoagulant agents.
Prospective trial.
Patients undergoing vitreoretinal surgery.
The procedures included were pars plana vitrectomy and scleral buckling. We developed a uniform classification to grade the bleeding severity. Bleeding was graded on an ordinal scale ranging from 0 to 5. Immediately after surgery and 1 day later, the incidence and the severity of bleeding events was documented on a standardized form. A grade of 3 or more was defined as severe bleeding. Furthermore, the influence of known systemic disorders before surgery, the type of anesthesia, type of surgical procedure, intraoperative blood pressure, and the use or change of antiplatelet or anticoagulant agents on intraoperative bleeding was analyzed.
Incidence and risk factors for severe intraoperative bleeding events.
Data from 374 eyes undergoing vitreoretinal procedures were included in our study (mean age, 67.6 ± 12.9 years). A severe intraoperative bleeding event was observed in 15 eyes (4%). We found that concomitant diseases such as diabetes mellitus and carotid artery stenosis, the presence of diabetic retinopathy, younger age, and scleral buckling combined with a transscleral puncture were associated significantly with severe bleeding events. By contrast, use of antiplatelet or anticoagulant agents, or both, had no significant influence on severe intraoperative bleeding events.
Although external manipulations during buckling surgery (e.g., drainage of subretinal fluid) and concomitant diseases such as diabetes mellitus and carotid artery stenosis influences the risk of severe intraoperative bleeding events, we did not detect an increased risk related to coexisting antiplatelet or anticoagulant medication use, or both.
评估玻璃体视网膜手术中严重出血并发症的影响因素和风险因素，并探讨抗血小板和抗凝药物的作用。
前瞻性试验。
接受玻璃体视网膜手术的患者。
手术包括经睫状体平坦部玻璃体切除术和巩膜扣带术。我们制定了一个统一的分级系统来评估出血的严重程度。出血按等级分为 0 到 5 级。手术后立即和第 1 天，使用标准化表格记录出血事件的发生率和严重程度。等级为 3 级或 3 级以上定义为严重出血。此外，还分析了术前已知的系统性疾病、麻醉类型、手术类型、术中血压以及抗血小板或抗凝药物的使用或改变对术中出血的影响。
严重术中出血事件的发生率和危险因素。
本研究纳入了 374 只眼（平均年龄 67.6±12.9 岁）的玻璃体视网膜手术数据。15 只眼（4%）发生严重术中出血事件。我们发现，并存疾病如糖尿病和颈动脉狭窄、糖尿病视网膜病变、年龄较小以及巩膜扣带术联合经巩膜穿刺与严重出血事件显著相关。相比之下，使用抗血小板或抗凝药物或两者联合对严重术中出血事件没有显著影响。
尽管扣带手术中的外部操作（例如，视网膜下液引流）和并存疾病如糖尿病和颈动脉狭窄会增加严重术中出血事件的风险，但我们没有发现与同时使用抗血小板或抗凝药物或两者联合相关的风险增加。
