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Study shows no bleeding in hemophilia patients during or after cataract surgery
Am J Ophthalmol. 2009;148(6):920-924.
Hemophilia patients safely underwent phacoemulsification with IOL implantation without prophylactic treatment for coagulation protein deficiency, a study showed.
Cataract surgery also proved safe for patients with antibodies against the coagulation protein in addition to the deficiency, the study authors reported.
The prospective study included 11 eyes of seven patients with severe factor XI (FXI) deficiency, also known as hemophilia C, who had a median age of 79 years. Four patients underwent bilateral surgery. Three patients had inhibitor antibodies against FXI in addition to FXI deficiency.
Mean preoperative visual acuity was 20/140 and mean preoperative IOP was 17 mm Hg.
All patients underwent phacoemulsification with topical anesthesia through a clear corneal incision and received a foldable acrylic IOL implanted in the capsular bag. Patients were examined for at least 1 week after surgery.
Study data showed that no bleeding occurred during surgery or follow-up. Mean visual acuity improved to 20/80 at 1 day and 20/60 at 1 week after surgery. Mean IOP improved to 13 mm Hg at 1 day and 1 week after surgery.
"Our work suggests that prophylactic treatment for simple cataract extraction by phacoemulsification is not required for patients with severe FXI deficiency when the surgery is performed by skilled surgeons," the authors said.
I applaud the authors for taking the time to write this article. While in the general ophthalmic practice the likelihood of maybe actually doing cataract surgery in a factor XI deficiency is rare, it is a welcome sight to find an article like this when faced with the challenge. The article is well thought through and points out previous treatments and risks associated with that, as well as the technological advances that have allowed us to undertake patients such as these in their recommend outline.
Two important points we must take away from this article. First, this is not a routine case. Skill in clear corneal surgical techniques is a must. Second, they added the following precautions that one may miss by just reading the abstract of the paper or generally skimming the content:
“As an added precaution, our patients on aspirin therapy were instructed to discontinue the drug 10 days prior to the surgery, in spite of the fact that cataract surgery is routinely performed without cessation of aspirin in the general population. A further precautionary measure was to avoid the use of nonsteroidal anti-inflammatory drops because of the potential risk of thrombocytopathia when they are absorbed systemically.”
The other important point is that complicated patients don’t fall into the same category and we must heed their warnings of prophylactic intervention in these patients who present with other preoperative surgical issues or who have the potential for intraoperative complications.
I applaud the authors for taking the time to collect the data and give us the review on this rare but important patient population.
– Karl G. Stonecipher, MD
Medical
Director, TLC Vision, Greensboro, N.C.