Thrombocytopenia and the Risks of Intraocular Surgery

Abstract

* BACKGROUND AND OBJECTIVE: In thrombocytopenia, a hemorrhagic diathesis is usually present due to a low platelet count and has been related to the development of cataracts and retinopathy. The concomitant administration of nonsteroidal anti-inflammatory drugs can increase the hemorrhagic diathesis. The purpose of this study was to investigate the impact of thrombocytopenia during and after intraocular surgery. * PATIENTS AND METHODS: A retrospective study of medical files of patients who had undergone cataract and glaucoma filtering surgery and were diagnosed as having thrombocytopenia between 1994-1995 and 1998-1999 was conducted. Eight patients with a total of 11 surgical procedures were included in this study. * RESULTS: Hemorrhagic complications occurred in 2 of the 11 procedures, for an incidence of 18%. These 2 cases are described in detail. * CONCLUSIONS: The current study confirms that thrombocytopenia is a significant risk factor for perioperative bleeding in ocular surgery. A routine questionnaire should be completed before ocular surgery and a complete blood cell count obtained in suspect cases. Consultation with a hematologist is warranted in cases of thrombocytopenia. [Ophthalmic Surg Lasers Imaging 2005 ;36: 103107.]

Adverse postoperative outcomes in surgical patients with immune thrombocytopenia

“…Haemorrhagic episodes, including intracranial haemorrhage, are long‐term complications of ITP, . In other studies, postoperative bleeding was noted as a major complication in patients with ITP after splenectomy and minor procedures, , but not cardiac operations. Studies in non‐surgical settings have associated ITP with risk of thromboembolism, , .…”

Thrombocytopenia and clear corneal incision cataract surgery

“…8,9 Previous studies of patients with thrombocytopenia undergoing large-incision cataract surgeries or combination cataract extraction and glaucoma surgery have raised concerns about an increased risk for perioperative bleeding. 3 A small retrospective review of 6 cases of thrombocytopenic patients undergoing phacoemulsification did not identify any bleeding complications; however, it is limited by the small sample size. 4 Other studies of suprachoroidal hemorrhage, a sight-threatening complication of cataract surgery, have not identified thrombocytopenia as a risk factor.…”

“…2 A more recent 2005 study analyzed both cataract and glaucoma procedures and concluded that thrombocytopenia carried an increased risk for perioperative bleeding after ocular surgery, with bleeding complications in 2 of 11 cases: 1 trabeculectomy with retrobulbar anesthesia and 1 cataract surgery with peribulbar anesthesia. 3 The risk for bleeding in clear corneal incision cataract surgeries is presumably lower than that in extracapsular cataract extraction or glaucoma procedures, given the avascular nature of the cornea and crystalline lens. Although 2 case reports described intraoperative occurrences of iris and suprachoroidal hemorrhages during clear corneal incision cataract surgery, with reported platelet counts of 75.0 and 30.0 × 10 3 /μL, respectively.…”

Photodynamic Therapy for the Treatment of Skin Cancer in Patients with Idiopathic Thrombocytopenia: A Case Report

“…There are bleeding risks in those patients during or following the surgery. 10 Baas et al have shown that PDT may be combined with other techniques such as surgery with great success. Nevertheless, the PDT alone with adequate lesion penetration can also promote excellent outcome.…”