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Joseph Bechay, Sonali Patel, Sophia Lam, Izzy Zadrozny, Johannie N. Reyes, Wesam Shamseldin Shalaby, daniel lee, Jonathan S. Myers, Michael J. Pro, Marlene R. Moster, Aakriti Garg Shukla; Hemorrhagic Complications Following Trabecular Bypass Microstent Surgery in the Setting of Antithrombotic Therapy. Invest. Ophthalmol. Vis. Sci. 2021;62(8):3423.
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© ARVO (1962-2015); The Authors (2016-present)
To compare the incidence of postoperative hemorrhagic complications in patients on antithrombotic therapy (ATT), including antiplatelet (AP) or anticoagulant (AC) therapy, and controls following combined trabecular stent implantation and phacoemulsification.
This single center, retrospective, case-control study included patients on chronic ATT who underwent iStent/iStent inject (Glaukos Corp., Laguna Hills, CA) or Hydrus (Ivantis Inc., Irvine, CA) with phacoemulsification between 2013-2019 and had ≥3-month follow-up. The primary outcome measure was hemorrhagic complications within the 3-month postoperative period. Changes were not made to ATT therapy during this time. Secondary measures included visual acuity (VA), intraocular pressure (IOP), and number of glaucoma medications.
Of 333 patients (435 eyes), 161 patients (211 eyes) were on ATT, and 172 patients (224 eyes) were controls. Baseline characteristics including age, sex, VA, IOP, cup-to-disc ratio, and number of glaucoma medications were similar between groups. Hyphema, the only hemorrhagic complication, was seen in 94 eyes (21.6%). Hyphema incidence differed by stent type (21.8% in iStent, 11.8% in iStent inject, and 42.4% in Hydrus (P=0.002)).Incidence and duration of hyphema did not vary between ATT and control groups (P=0.827) (Figure 1). Of 35 ATT eyes with hyphema, 7 eyes (20.0%) were on AC therapy, 29 eyes (82.9%) were on AP therapy, and 1 eye was on combined therapy. Of the 102 patients who had two eyes included, hyphema was present in both eyes in 18 patients (17.6%). Hyphema was associated with an IOP increase of ≥10mmHg from baseline in 22 ATT eyes (10.4%) and 25 control eyes (11.2%) (P=0.878). Reoperations were not required for hyphema or associated IOP spike. At month 3, VA improvement, reduction of IOP, and number of glaucoma medications were similar between the ATT and control groups (P<0.001 for all).
Hyphema was present in 21.6% of eyes, and was most common following Hydrus microstent and least common following iStent inject. ATT was not identified as a risk factor for the presence or prolonged duration of hyphema. Although hyphema was associated with an IOP increase of ≥10mmHg from baseline in approximately one-tenth of eyes, reoperations were not required for this indication, and nearly all hyphemas resolved by postoperative month 1.
This is a 2021 ARVO Annual Meeting abstract.
Figure 1. Duration of hyphema.
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