Transcript שקופית 1 - ASCRS/ASOA 2008

SMALL INCISION MANUAL ECCE
(BLUMENTHAL TECHNIQUE) IN
PATIENTS ON WARFARIN THERAPY
Yossi Yatziv M.D., Moshe Lazar M.D.
Tel Aviv Medical Center
Background
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The use of Warfarin in the elderly population
undergoing cataract surgery is not uncommon
A recent survey done in the U.K. found that 5.1%
of patients undergoing cataract surgery were
taking Wafarin at the time of surgery1.
Despite the wide use of oral anticoagulants in
candidates for cataract surgery the is no
consensus addressing the issue of whether to
continue these medications during surgery.
Background
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
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Phacoemulsification is, by far the most widely
used technique for cataract extraction in
developed countries.
Due to the costly machinery and consumables
manual ECCE is increasingly employed in
developing countries and has shown to yield
similar surgical outcomes2.
In a modern environment, due to the surgeons’
preference or surgical considerations, a
considerable percentage of cataract extractions
are done using the manual technique.
Background
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

Several studies documented the safety of
phacoemulsification cataract surgery in patients
on Warfarin therapy3-5.
A few earlier reports examined the hemorrhagic
complications in patients undergoing manual
ECCE cataract surgery4,6-8. they reported only
minor complications.
Some of these studies compared the rate of
hemorrhagic complications between the manual
and phaco techniques. They concluded that
phacoemulsification should be the preferred
technique when performing cataract surgery on
patient receiving Warfarin4,8.
Purpose

The purpose of our study is to examine
the rate of hemorrhagic complications
in patients under Warfarin therapy
undergoing cataract surgery using the
small incision manual ECCE
(Blumenthal technique)
Methods
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
We retrospectively examined the files of
21 non-selected patients who underwent
cataract surgery between the years 20042007 using the small incision manual
ECCE technique while on uninterrupted
Warfarin (Coumadin, Taro, Israel) therapy.
Patient files were reviewed and data
regarding the patient systemic illnesses
and indication for Warfarin therapy was
recorded.
Methods
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All patients underwent complete
ophthalmologic and systemic
examination.
Patients were instructed to continue taking
all their medications, including Warfarin as
usual.
The prothrombine time before surgery was
determined using the international
normalized ratio (INR).
Patients with an INR above 3.0 were
excluded from the study.
Methods
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All surgeries were performed by a single
surgeon (M.L.) using the small incision
manual ECCE technique.
All cases were done under subtenon
anesthesia with 2% Lidocaine.
The surgical technique included an anterior
chamber maintainer and expression of the
nucleus through a 4-5mm scleral tunnel. An
non foldable PMMA lens was implanted.
Records of any intraoperative complications
were recorded in the postoperative report.
Patients were examined 1,7 and 30 days
postoperatively and any late complications
were noted.
Results
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The mean age of 8 men and 13 women
was 72 years.
The indications for anticoagulant therapy
was chronic atrial fibrillation (12 patients),
artificial valves (6 patients),
cardiomyopathy (2 patients) and deep
vein thrombosis (1 patient)
The mean INR before surgery was 2.1
(±0.5)
Results
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There were no instances of
significant bleeding during or after
surgery.
11 patients had postoperative
subconjunctival hemorrhage which
resolved spontaneously.
The postoperative visual outcome
was favorable with 82% of the
patients achieving visual acuity of
20/40 or better at 30 days.
Conclusions

This study demonstrates that cataract
surgery in nonselected patients receiving
Warfarin therapy (with an INR<3.0) can
be safely performed using the small
incision manual technique (Blumenthal
technique).
In memory of Professor Michael Blumenthal (1935-2007)
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