Risk of perioperative bleeding complications in rhegmatogenous retinal detachment surgery: a retrospective single-center study

Bemme, Sebastian; Lauermann, Peer; Striebe, Nina Antonia; Khattab, Mohammed; Affeldt, Johannes Karl; Callizo, Josep; Bertelmann, Thomas; Pfeiffer, Sebastian; Hoerauf, Hans; Feltgen, Nicolas

doi:10.1007/s00417-019-04554-1

Cited by 10 publications

(4 citation statements)

References 23 publications

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“…This shift toward undergoing PPV alone in older patients may be attributed to an increased risk of perioperative bleeding during SB given potential anticoagulation concerns in elderly patients. 22 Furthermore, scarring from previous ophthalmic surgeries or age-related tissue atrophy may make scleral buckling more difficult in elderly patients. 23 Indeed, in this study, older patients were more likely to have a previous intraocular surgery (PPV, cataract surgery, or glaucoma surgery) compared with younger patients.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and Surgical Outcomes of Rhegmatogenous Retinal Detachment in Older Adults

Patel

Starr

Obeid

et al. 2021

Retina

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To describe characteristics and outcomes of primary rhegmatogenous retinal detachment in older adults (age $ 80).Methods: Consecutive patients with rhegmatogenous retinal detachment undergoing pars plana vitrectomy (PPV), scleral buckling (SB), or PPV/SB in the Primary Retinal Detachment Outcomes Study were evaluated. Outcome measures included single surgery anatomic success and visual acuity.Results: Of 2,144 patients included, 125 (6%) were 80 years or older. Compared with younger patients (age 40-79), older adults were more likely to be pseudophakic (P , 0.001), have macula-off detachments (P , 0.001), and have preoperative proliferative vitreoretinopathy (P = 0.02). In older adults, initial surgery was PPV in 73%, PPV/SB in 27%, and primary SB in 0%. Single surgery anatomic success was 78% in older adults compared with 84% in younger patients (P = 0.03). In older adults, single surgery anatomic success was 74% for PPV and 91% for PPV/SB (P = 0.03). The final mean logMAR was lower for older adults (0.79 [20/125] vs. 0.40 [20/40], [P , 0.001]). In older adults, the final mean logMAR for eyes that underwent PPV was 0.88 (20/160) compared with 0.50 (20/63) for PPV/SB (P = 0.03).Conclusion: Octogenarians and nonagenarians presented with relatively complex pseudophakic rhegmatogenous retinal detachments. Single surgery anatomic success and visual outcomes were worse compared with younger patients, and PPV/SB had better outcomes compared with PPV alone.RETINA 41:947-956, 2021W ith the population of older Americans expected to double by 2050, the number of elderly patients undergoing primary rhegmatogenous retinal detachment (RRD) surgery has been projected to grow substantially in the coming years. 1 In particular, the population of octogenarians and nonagenarians is expected to increase from 9.3 million in 2000 to 19.5 million in 2030. 2 These patients will be a critical segment of the population undergoing RRD repair given that the annual incidence of primary RRD is approx-imately 10 to 15/100,000 with a lifetime risk of up to 3% by the age of 85. 3,4 Previous studies have suggested that older age may be a predictor of worse anatomic and visual outcomes after RRD surgery. 5,6 These findings raise concerns about the safety and efficacy of surgical interventions in view of the unique considerations in older adults including anesthesia risks, medical comorbidities, and postoperative positioning. [7][8][9] Currently, published data on outcomes of retinal detachment surgery in older 947

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Section: Discussionmentioning

confidence: 99%

Characteristics and Surgical Outcomes of Rhegmatogenous Retinal Detachment in Older Adults

Patel

Starr

Obeid

et al. 2021

Retina

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“…Bemme et al [ 17 ], in 2020, aimed at exploring the risk of perioperative bleeding in the perioperative period of surgery for retinal detachment in patients taking antiplatelets or anticoagulants versus those who do not take them. To do so, they investigated the rate of all perioperative hemorrhages during PPV; scleral buckling, with or without drainage; or combined procedures in patients receiving various types of anticoagulation, such as acetylsalicylic acetate (ASA), clopidogrel, heparin, low molecular weight heparin, and phenprocoumon.…”

Section: Resultsmentioning

confidence: 99%

“…El-Sanhouri et al [ 29 ] expanded on that by showing anticoagulation to even be a protective factor; patients with vitreous hemorrhages and acute PVD taking anticoagulants were shown to have a lower risk of retinal tears. A plethora of further studies confirmed that it is safe continue, and possibly inappropriate to stop, taking anticoagulants and antiplatelets, especially in the face of an increased risk of systemic thromboembolic accidents [ 16 , 17 , 20 , 22 , 24 , 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

Antiplatelets and Anticoagulants in Vitreoretinal Surgery: A Systematic Review

Ferraro

Maria

et al. 2023

Life

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Background: Antiplatelets and anticoagulants have substantially influenced contemporary vitreoretinal surgical practices. The availability of new oral blood thinners has recently spurred a renewed interest in the clinical approach to vitreoretinal surgical conditions since it may be difficult for the surgeon to collect sufficient evidence-based data to decide whether to discontinue or continue such medications. Materials and Methods: We conducted a systematic review on the use of antiplatelets and/or anticoagulants in the perioperative setting in vitreoretinal surgery and their possible complications, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The level of evidence, according to the Oxford Centre for Evidence-Based Medicine (OCEM) 2011 guidelines, and the quality of evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, were assessed for all included articles. Results: In total, 2310 articles were initially extracted, out of which 1839 articles were obtained after duplicates were removed and their abstracts were screened. A total of 27 articles were included in the full-text review. Finally, a remaining 22 articles fulfilled the inclusion criteria. Conclusions: Even though there is just a small number of studies with solid results, the advantage of using antiplatelets and/or anticoagulants in vitreoretinal surgery seems to outweigh the disadvantages, which are mainly related to postoperative hemorrhagic complications.

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“…The sample size calculation for this prospective study was based on an incidence of primary RRD of 17 patients per month in our clinic estimated on a previous trial (Bemme et al. 2020). Because the study was planned to enrol patients over a period of approximately 18 months, the anticipated population size during this period was N = 306.…”

Section: Methodsmentioning

confidence: 99%

Incidence and risk factors for macular oedema after primary rhegmatogenous retinal detachment surgery: a prospective single‐centre study

Gebler¹,

Pfeiffer²,

Callizo³

et al. 2021

Acta Ophthalmologica

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Purpose To assess the incidence of cystoid macular oedema (CME) diagnosed by spectral domain optical coherence tomography (SD‐OCT) after primary rhegmatogenous retinal detachment (RRD) surgery. Methods From April 2016 to October 2017, 150 eyes of 150 patients presenting with primary RRD were included consecutively in this prospective single‐centre study. Patients with the following characteristics were excluded: previous vitreoretinal surgery, combined cataract surgery, preoperatively presentation with any intraocular or systemic inflammatory condition, visible macular oedema or epiretinal membrane (ERM) on funduscopy. SD‐OCT (Spectralis, Heidelberg Engineering) was conducted 3 and 6 weeks after surgery. Results One hundred and twenty‐eight of the 150 patients completed the study, of whom 107 (age: 61.7 ± 11.5 years, mean ± SD) showed successful retinal attachment during follow‐up visits. The most frequent operation method was scleral buckling (54.2%), followed by vitrectomy (25.2%) and the combination of both techniques (20.6%). Postoperative SD‐OCT revealed CME, neurosensory detachment and ERM in 18.7, 31.8 and 32.7% of all cases, respectively. The risk of postoperative CME was significantly elevated in patients with ERM (42.9 versus 6.9%, p < 0.001). In addition, patients with initial detachment of the macula had more postoperative CME (26.5 versus 11.1%, p = 0.044). BCVA improvement was significantly lower in patients with CME compared to patients without 6 weeks after surgery for macula‐on RRD. Conclusions This prospective study confirmed that postoperative CME is a frequent complication after RRD surgery; we identified ERM and macula‐off RRD as potential risk factors. As CME potentially delays visual recovery, postoperative follow‐ups should include SD‐OCT.

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Risk of perioperative bleeding complications in rhegmatogenous retinal detachment surgery: a retrospective single-center study

Cited by 10 publications

References 23 publications

Characteristics and Surgical Outcomes of Rhegmatogenous Retinal Detachment in Older Adults

Characteristics and Surgical Outcomes of Rhegmatogenous Retinal Detachment in Older Adults

Antiplatelets and Anticoagulants in Vitreoretinal Surgery: A Systematic Review

Incidence and risk factors for macular oedema after primary rhegmatogenous retinal detachment surgery: a prospective single‐centre study

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