Diapositivo 1

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FINANCIAL DISCLOSURES
The authors have no financial interest in the
subject matter of this poster.
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CATARACT SURGERY IN PATIENTS ON WARFARIN THERAPY
HAEMORRHAGIC COMPLICATIONS AND POSTOPERATIVE
VISUAL ACUITY
Paulo Silva Guerra MD, Walter Rodrigues MD, David
Lopes MD, Lurdana Gomes MD, M. Monteiro Grillo MD
Ophthalmology Department. Director Prof. Dr. M.
Monteiro Grillo Hospital de Santa Maria (HSM) /
Lisbon - Portugal
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Introduction

• Traditionally, warfarin has been discontinued
  prior to cataract surgery because of concerns
  about increased risk of hemorrhagic complications
• The trend amongst surgeons has shifted strongly
  towards continuation of anticoagulation
• Recent surveys indicates the majority (?70) of
  surgeons keep cataract patients anticoagulated.5

Purpose

• To assess ophthalmic complications associated
  with cataract surgery under topical anesthesia in
  patients on warfarin therapy.

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Material and Methods

• Retrospective review of 49 eyes of 42 patients
  on warfarin therapy (Warfarin Group).
• Undergoing cataract surgery by
  phacoemulsification and IOL placement with
  topical anesthesia.
• We evaluate
• - The rates of intraoperative hemorrhagic
  complications of the anterior and posterior
  segment
• - The rates of postoperative hemorrhagic
  complications of the anterior and posterior
  segment
• - The pre and postoperative Best Corrected
  Visual Acuity (BCVA)

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Material and Methods

• The results of are compared with a control
  group, not anticoagulated (age and surgeon
  matched).
• All cataract surgeries were performed by three
  experienced surgeons from January 2008 to June
  2009

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Results
Demographics
Warfarin Group Control Group
Patients 42 51
Eyes 49 60
Mean age 75,3 (SD7,1) 78,7 (SD7,9)
Gender ? - 18 (43) ? - 21 (41)
Preoperative BCVA 0,49 (SD1,86) 0,56(SD2,02)

• Intraoperative non-hemorrhagic complications
• Warfarin Group - 2 posterior capsule ruptures
• Control Group - 3 posterior capsule ruptures

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Results
Intraoperative Hemorrhagic Complications
Warfarin Group n49 Control Group n60
Subconjunctival hemorrhage 0 0
Hyphema 2 (4,1) 0 P 0,11
Suprachoroidal hemorrhage 0 0
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Results
Postoperative Hemorrhagic Complications
Warfarin Group n49 Control Group n60
Subconjuntival H. 6 (12,2) 1 (1,7) P 0,02
Hyphema 2 (4,1) 0 P 0,11
Vitreous Hemorrhage 0 0
Suprachoroidal H. 0 0
Retinal Hemorrhages 4 (8,1) 5 (8,3) P 0,9
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Results
Postoperative BCVA
Warfarin Group n49 Control Group n60
BCVA 0,81 0,84 P 0,58
SD 0,25 0,24
Variation 0,2-1 0,3-1
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Discussion

• Subconjuntival Hemorrhage
• - Most frequent hemorrhagic complication in
  Warfarin Group
• - The only statistically significant (Plt0,05)
• There was no statistically significant
  difference in the other hemorrhagic complication
  between the 2 groups (Pgt0,05).
• There was no statistically significant
  difference in postoperative BCVA between the 2
  groups (Pgt0,05).

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Conclusions

• Continuation of treatment with warfarin in
  patients undergoing phacoemulsification and IOL
  placement with topical anesthesia is safe and was
  not associated with increased risk of vision
  threatening complications.

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References
1. Katz J, Feldman MA, Bass EB, Lubomski LH,
Tielsch JM, Petty BG et al. Risks and benefits of
anticoagulant and antiplatelet medication use
before cataract surgery. Ophthalmol. 2003. 110
1784-1788 2. Barequet IS, Sachs D, Priel A,
Wasserzug Y, Martinowitz U, Moisseiev J et
al. Phacoemulsification of cataract in patients
receiving Coumadin therapy  ocular
and hematologic risk assessment. Am J Ophthalmol.
2007 Nov144(5) 719-23 3. Morris A, Elder MJ.
Warfarin therapy and cataract surgery. Clin
Experiment Ophthalmol. 2000 Dec28(6)419-22 4.
Carter K, Miller KM. Phacoemulsification and lens
implantation in patients treated with aspirin or
warfarin. J Cataract Refract Surg. 1998 Oct
24(10)1361-4 5. Ong-Tone L, Paluck EC,
Hart-Mitchell RD. Perioperative use of warfarin
and aspirin in cataract surgery by Canadian
Society of Cataract and Refractive Surgery
members survey. 2005 May31(5)991-6 6. Stone
LS, Kline OR, Sklar C. Intraocular lenses and
anticoagulation and anti-platelet therapy. Am
Intra-Ocular Implant Soc J. 198511165-68 7.
Jonas JB, Pakdaman B, Sauder G. Cataract surgery
under systemic anticoagulation therapy with
coumarin. Eur J Ophthalmol 2006 1630-32 8.
Rotenstreich Y, Rubowitz A, Segev F et al. Effect
of warfarin therapy on bleeding during cataract
surgery. J Cataract Refract Surg 2001271344-46