Comment on: Thrombocytopenia and clear corneal incision cataract surgery

Abstract

Comment on: Thrombocytopenia and clear corneal incision cataract surgeryWe read with great interest the study by Reilly et al., in which the authors described complications and outcomes of clear corneal incision cataract surgery in a large cohort of patients with thrombocytopenia. 1 In their retrospective review, the authors found only 2 cases (1%) of intraoperative iris hemorrhage of 196 eyes from 150 thrombocytopenic patients. This study provides evidence that preoperative testing for thrombocytopenia before cataract surgery is unlikely to benefit patients. We commend the authors for their work and would like to compare their results with our own experience.Perioperative preparation for thrombocytopenic or anticoagulated patients is challenging for surgeons, with the obvious risk being intraoperative bleeding. [1][2][3][4][5] Recently, we have retrospectively studied the hematologic and ocular factors that may affect intraocular hemorrhage risk during clear cornea cataract surgery in anticoagulated patients. In 299 patients taking anticoagulants for at least 6 months, 16 of 229 eyes (6.9%) experienced intraoperative hemorrhage (ie, iris bleeding) (Table 1).In our study, hematologic factors such as prothrombin time (international normalized ratio), platelet count, cessation or continuation of anticoagulants before surgery, or type of anticoagulant used did not seem to affect the risk for intraocular hemorrhage during cataract surgery. Rather, ocular factors, such as shallow anterior chamber, smaller pupil size requiring iris hooks, or use of anterior vitrectomy significantly affected the intraocular hemorrhage.