Pradeep Tejus, Schwartz Turner, Sankar Prithvi S, Miller-Ellis Eydie G, Ying Gui-Shang, Cui Qi N
Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
J Glaucoma. 2025 Feb 1;34(2):77-83. doi: 10.1097/IJG.0000000000002518. Epub 2024 Nov 18.
Perspectives and practice patterns regarding perioperative anticoagulation management and minimally invasive glaucoma surgery were queried among surgeons of American Glaucoma Society. Management varied based on surgeon preference and the type of procedure performed.
The purpose of this study was to characterize anticoagulation and antiplatelet practice patterns for minimally invasive glaucoma surgery (MIGS) in the perioperative period.
This was a survey of surgeons of American Glaucoma Society (AGS) about anticoagulation decision-making for their most performed MIGS procedures.
A total of 103 surgeons completed the survey, with 43.6% in an academic setting, 49.5% in a private practice setting, and 6.8% in a mixed practice. Median MIGS per month was 10 [interquartile range (IQR) 20-5]. The 2 most performed MIGS were trabecular meshwork (TM) bypass with either device implantation (24.9%) or tissue excision (40.0%). Half of the respondents (50.5%) deferred to the primary care physician about anticoagulation most/all the time. Most (59.3%) managed anticoagulation differently for MIGS compared with trabeculectomy and tube implantation. Respondents reported an average of 1.3 (SD 2.5) bleeding complications related to anticoagulation and MIGS in the last year. Bleeding risk perception depended upon the type of surgery (e.g., 74.0% reported no/mild concern regarding surgeries involving TM bypass with device implantation vs. 48.0% reported high concern for TM bypass with tissue excision). Respondents stopped blood thinners at the highest rates for procedures enhancing aqueous outflow through the subconjunctival space and stopped least frequently for iStent implantation. Antiplatelets were held for a longer duration than anticoagulants before surgery, and most resumed both agents within 1-4 days after surgery.
Anticoagulation management is highly varied, and this study may help to inform practice guidelines and optimize surgical outcomes by elucidating surgeon perspectives toward MIGS and anticoagulation management.
在美国青光眼协会的外科医生中，对围手术期抗凝管理和微创青光眼手术的观点及实践模式进行了调查。管理方式因外科医生的偏好和所施行手术的类型而异。
本研究的目的是描述围手术期微创青光眼手术（MIGS）的抗凝和抗血小板实践模式。
这是一项针对美国青光眼协会（AGS）外科医生关于其最常施行的MIGS手术抗凝决策的调查。
共有103名外科医生完成了调查，其中43.6%在学术机构工作，49.5%在私人诊所工作，6.8%在混合诊所工作。每月MIGS手术的中位数为10例[四分位间距（IQR）20 - 5]。最常施行的两种MIGS手术是小梁网（TM）旁路手术，其中器械植入占24.9%，组织切除占40.0%。一半的受访者（50.5%）在大多数/所有时间都将抗凝问题交给初级保健医生处理。大多数受访者中大多数（59.3%）在MIGS手术中与小梁切除术和引流管植入术相比，对抗凝的管理方式不同。受访者报告在过去一年中平均有1.3例（标准差2.5）与抗凝和MIGS相关的出血并发症。出血风险认知取决于手术类型（例如，74.0%的人表示对涉及器械植入的TM旁路手术无/轻度担忧，而48.0%的人表示对组织切除的TM旁路手术高度担忧）。对于通过结膜下间隙增加房水流出的手术，受访者停用血液稀释剂的比例最高，而对于iStent植入术，停用的比例最低。术前停用抗血小板药物的时间比停用抗凝药物的时间更长，并且大多数人在术后1 - 4天内恢复使用这两种药物。
抗凝管理差异很大，本研究通过阐明外科医生对MIGS和抗凝管理的观点，可能有助于为实践指南提供信息并优化手术结果。
