Saitoh A K, Saitoh A, Taniguchi H, Amemiya T
Department of Ophthalmology, Nagasaki University School of Medicine, Japan.
Ophthalmic Surg Lasers. 1998 Nov;29(11):909-15.
It is not rare for patients receiving anticoagulant therapy to undergo ocular surgery; however, there are no clear guidelines with reference to the operative management of the eye. This study examines the complications in patients receiving anticoagulant therapy who undergo ocular operations and suggests a management regimen for these patients.
The authors retrospectively analyzed 52 patients receiving anticoagulant therapy who underwent ocular surgery between 1993 and 1995. Data included sex, age, reason for anticoagulant therapy, operative procedure, complication rate, and length of time anticoagulant therapy was stopped or reduced prior to surgery. To show the base-line complication rate at their institution, data of patients not receiving anticoagulation therapy were added.
Ticlopidine hydrochloride, an antiplatelet drug, was administered to 24 patients. Warfarin sodium was administered to 8 patients, heparin was administered to 8 patients, and other anticoagulants were administered to 20 patients. There were no significant differences in complications between the groups that stopped or reduced anticoagulant therapy and those that did not, but speech disturbance due to thrombotic complication occurred in 1 of 10 patients in whom ticlopidine hydrochloride was stopped or reduced. Hemorrhagic complications occurred in 50% of those who continued ticlopidine hydrochloride, but in none of those who discontinued it (P = .019). There was a significant difference in hemorrhagic complications after cataract surgery between the phacoemulsification, aspiration, and intraocular lens implantation (PEA + IOL) and the planned extracapsular cataract extraction and intraocular lens implantation (PECCE + IOL) groups that continued the drug (P = .0011). No patients showed visual acuity reduction due to hemorrhagic complications.
To avoid life-threatening systemic complications, one need not always stop anticoagulant therapy before performing only cataract surgery. Cataract surgery in patients receiving ticlopidine hydrochloride should be performed with PEA + IOL via a small sclerocorneal or a corneal incision. In cataract surgery for patients receiving anticoagulant therapy, hemorrhagic complications are more frequent than in patients not receiving anticoagulant therapy.
接受抗凝治疗的患者进行眼科手术并不罕见；然而，关于眼部手术的操作管理尚无明确指南。本研究调查了接受抗凝治疗并进行眼科手术的患者的并发症情况，并为这些患者提出了一种管理方案。
作者回顾性分析了1993年至1995年间接受抗凝治疗并进行眼科手术的52例患者。数据包括性别、年龄、抗凝治疗的原因、手术方式、并发症发生率以及术前停用或减少抗凝治疗的时间长度。为了显示其机构的基线并发症发生率，还纳入了未接受抗凝治疗患者的数据。
24例患者使用了抗血小板药物盐酸噻氯匹定。8例患者使用了华法林钠，8例患者使用了肝素，20例患者使用了其他抗凝剂。停用或减少抗凝治疗的组与未停用或减少的组之间并发症无显著差异，但在10例停用或减少盐酸噻氯匹定的患者中有1例出现血栓形成并发症导致的言语障碍。继续使用盐酸噻氯匹定的患者中有50%发生出血并发症，但停用的患者中无一例发生（P = 0.019）。继续使用该药物的白内障超声乳化吸除联合人工晶状体植入术（PEA + IOL）组与计划的囊外白内障摘除联合人工晶状体植入术（PECCE + IOL）组之间，白内障手术后出血并发症存在显著差异（P = 0.0011）。没有患者因出血并发症而视力下降。
为避免危及生命的全身并发症，在仅进行白内障手术前不一定总是要停用抗凝治疗。接受盐酸噻氯匹定治疗的患者应通过小巩膜角膜或角膜切口采用PEA + IOL进行白内障手术。在接受抗凝治疗的患者进行白内障手术时，出血并发症比未接受抗凝治疗的患者更常见。
