• Retina/Vitreous

    Review of: Risk factors for severe bleeding complications in vitreoretinal surgery and the role of antiplatelet or anticoagulant agents

    Lauermann P, Klingelhöfer A, Mielke D, et al. Ophthalmology Retina, August 2021

    In this study, investigators identified risk factors for severe bleeding during vitreoretinal surgery.

    Study design

    This prospective single-center study assessed 374 eyes undergoing pars plana vitrectomy or scleral buckling surgery. Using a standard form with a scale of 0 to 5, researchers recorded the incidence and severity of bleeding events immediately after surgery and 1 day postoperatively. For the vitrectomy arm, severe bleeding was defined as requiring endodiathermy to stop bleeding, or uncontrolled bleeding despite endodiathermy. For the scleral-buckle arm, severe bleeding was defined as extensive subretinal bleeding with or without posterior pole involvement.

    The authors also considered the effect of preoperative systemic disorders, the type of anesthesia and surgical procedure, intraoperative blood pressure, and use of antiplatelet (AP) or anticoagulant (AC) agents on intraoperative bleeding.

    Outcomes

    Fifteen eyes (4%) had a severe intraoperative bleeding event. Severe events were significantly linked to concomitant disease such as diabetes and carotid artery stenosis, the presence of diabetic retinopathy, young age, and scleral buckling with a transscleral puncture. The use of AP and/or AC agents had no influence on severe intraoperative bleeding events.

    Limitations

    The low number of severe bleeding events is the biggest limitation of this study. The bleeding severity grading scale was novel and subjective, and many of the recorded bleeding events were not clinically significant.

    Clinical significance

    This study supports previous findings that failed to find any effect of AP or AC agents on the perioperative bleeding risk when performing vitreoretinal procedures. Halting any such agents needs to be weighed against the risk of thromboembolic events in high-risk patient populations.