Cataract surgery safe in patients receiving anticoagulation therapy

Cataract surgery can be safely performed using phacoemulsification in patients with uncomplicated cataracts who receive anticoagulation therapy with warfarin, according to a prospective study by researchers in Israel.

Irina S. Barequet, MD, and colleagues investigated the risks of intra- and postoperative bleeding associated with uncomplicated cataract surgery performed under topical anesthesia in 75 eyes of 63 patients. Surgeons performed non-simultaneous bilateral surgery in 12 patients (19%). All patients were receiving warfarin, and nine patients (14.3%) were also taking antiaggregants.

Preoperatively, all patients received a hemostatic workup. At the time of surgery, patients had an average prothrombin time international normalized ratio of 2.03, according to the study.

For each case, the operating surgeon completed a structured questionnaire immediately after surgery. Additionally, 18 procedures (24%) were videotaped and reviewed by an independent observer to identify any bleeding.

The researchers observed no significant intraoperative bleeding in any eyes.

However, four patients (6.3%) had minor postoperative ocular bleeding. These four patients had a mean prothrombin time international normalized ratio of 2.1, the authors reported.

"A microscopic hyphema and a dot retinal hemorrhage were each seen in one eye on the first postoperative day, and small iris hemorrhages were identified in two additional eyes at the 1-week visit," the authors said. "All bleedings disappeared within 1 week without affecting the visual acuity."

"A large clinical trial is required to assess the safety of continuous [warfarin] treatment associated with phacoemulsification in eyes with complicated cataract," the authors noted.

The study is published in the November issue of American Journal of Ophthalmology.