Moshirfar Majid, Reynolds Jonathon C, Moin Kayvon A, Lim Ming Y, Stoakes Isabella M, Hoopes Phillip C
Hoopes Vision Research Center, Hoopes Vision, Draper, UT.
John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT.
Cornea. 2024 Dec 1;43(12):1599-1607. doi: 10.1097/ICO.0000000000003631. Epub 2024 Jul 26.
To synthesize the current literature regarding patients with inherited bleeding disorders and suggest comprehensive evaluation and preoperative recommendations for these patients before undergoing corneal refractive surgery.
The literature search was conducted through PubMed, Embase, and Google Scholar databases for publications through January 4, 2024 for reports of ocular bleeding manifestations in patients with inherited bleeding disorders and reports of patients without a history of bleeding disorders who had intraoperative or postoperative hemorrhagic complications with corneal refractive surgery. Additional cases from the literature and a retrospective chart review at a corneal practice were obtained describing patients with inherited bleeding disorders who underwent corneal refractive surgery.
Four articles were found detailing ocular bleeding manifestations in patients with inherited bleeding disorders who underwent ocular surgery other than corneal refractive surgery. Thirty articles were found detailing intraoperative and postoperative bleeding manifestations in patients without a history of inherited bleeding disorders who underwent corneal refractive surgery. Eight cases (3 patients from the literature search and 5 patients from a retrospective chart review) were found regarding patients with inherited bleeding disorders who underwent corneal refractive surgery.
For corneal refractive surgery with topical anesthesia, the perioperative risk and need for any hemostasis intervention in individuals with an inherited bleeding disorder depends on the type of disorder, status of preoperative factor level concentrations, or a prior history of bleeding. If required, clotting factor optimization should be tailored to each candidate on a case-by-case basis.
综合有关遗传性出血性疾病患者的现有文献，并针对这些患者在接受角膜屈光手术前提出全面评估和术前建议。
通过PubMed、Embase和谷歌学术数据库进行文献检索，查找截至2024年1月4日发表的关于遗传性出血性疾病患者眼部出血表现的报告，以及无出血性疾病病史但在角膜屈光手术中有术中或术后出血并发症的患者报告。从文献中获取了其他病例，并对一家角膜诊所进行了回顾性病历审查，描述了接受角膜屈光手术的遗传性出血性疾病患者。
发现4篇文章详细描述了接受非角膜屈光手术的遗传性出血性疾病患者的眼部出血表现。发现30篇文章详细描述了无遗传性出血性疾病病史但接受角膜屈光手术的患者的术中及术后出血表现。发现8例（3例来自文献检索，5例来自回顾性病历审查）接受角膜屈光手术的遗传性出血性疾病患者。
对于表面麻醉下的角膜屈光手术，遗传性出血性疾病患者围手术期的风险以及是否需要任何止血干预取决于疾病类型、术前凝血因子水平浓度状况或既往出血史。如有必要，应根据具体情况为每位患者量身定制凝血因子优化方案。
