Lauermann Peer, Klingelhöfer Anthea, Mielke Dorothee, Bahlmann Dirk, Hoerauf Hans, Koscielny Juergen, Sucker Christoph, Feltgen Nicolas, van Oterendorp Christian
Department of Ophthalmology, University Medical Center Goettingen, Goettingen, Germany.
Department of Neurosurgery, University Medical Center Goettingen, Goettingen, Germany.
Clin Ophthalmol. 2022 Apr 22;16:1245-1254. doi: 10.2147/OPTH.S361867. eCollection 2022.
To evaluate the influences and risk factors for severe bleeding complications during glaucoma surgery, and to investigate the role of antiplatelet (AP) and anticoagulant (AC) agents.
This prospective study enrolled patients undergoing trabeculectomy, trabeculotomy (with Trabectome® or Kahook Dual Blade®), viscocanaloplasty and Ahmed or Baerveldt implants. Bleeding severity was graded on an ordinal scale ranging from 0 to 5. Immediately after surgery and one day later, the incidence and severity of bleeding events was documented on a standardized form. A grade ≥3 was defined as severe bleeding. The influence of known systemic disorders, the type of anesthesia, surgical procedure, intraoperative blood pressure, and the use of or change in AP or AC agents on intraoperative bleeding were analyzed.
Data from 89 eyes undergoing glaucoma procedures were included (age 71.3y ± 10.5). We observed severe intraoperative bleeding in 8 eyes (9%) and found that concomitant diseases such as the history of a deep vein thrombosis or peripheral arterial occlusive disease, and the type of surgical procedure (trabeculectomy and viscocanaloplasty) were significantly associated with severe bleeding events. By contrast, the use of AP/ AC agents had no significant influence on severe intraoperative bleeding events.
According to the results of our study cohort, glaucoma procedures entailing scleral manipulations (trabeculectomy and viscocanaloplasty) and concomitant diseases such as the history of a deep vein thrombosis or peripheral arterial occlusive disease influence the risk of severe intraoperative bleeding events, we detected no increased risk related to concomitant antiplatelet and/ or anticoagulant medication use.
评估青光眼手术期间严重出血并发症的影响因素和风险因素，并研究抗血小板（AP）和抗凝（AC）药物的作用。
这项前瞻性研究纳入了接受小梁切除术、小梁切开术（使用Trabectome®或Kahook双刀片®）、粘小管成形术以及Ahmed或Baerveldt植入物植入术的患者。出血严重程度按0至5的顺序量表进行分级。术后即刻和术后一天，用标准化表格记录出血事件的发生率和严重程度。≥3级定义为严重出血。分析已知全身性疾病、麻醉类型、手术方式、术中血压以及AP或AC药物的使用或变化对术中出血的影响。
纳入了89只接受青光眼手术眼的数据（年龄71.3岁±10.5岁）。我们观察到8只眼（9%）术中发生严重出血，发现诸如深静脉血栓形成或外周动脉闭塞性疾病史等伴随疾病以及手术方式（小梁切除术和粘小管成形术）与严重出血事件显著相关。相比之下，AP/AC药物的使用对术中严重出血事件没有显著影响。
根据我们研究队列的结果，需要进行巩膜操作的青光眼手术（小梁切除术和粘小管成形术）以及诸如深静脉血栓形成或外周动脉闭塞性疾病史等伴随疾病会影响术中严重出血事件的风险，我们未发现与同时使用抗血小板和/或抗凝药物相关的风险增加。
