Abstract
Purpose To assess whether to continue aspirin therapy while having uncomplicated phacoemulsification cataract surgery with different incisions. Methods Consecutive patients having cataract surgery under topical anesthesia with different incisions between May 2016 and August 2017 were followed. 236 eyes of 166 patients on routine aspirin therapy were randomized into 2 groups: continuation group, 112 eyes; discontinuation group, 124 eyes. 121 eyes of 94 patients on no routine anticoagulant therapy were used as the control group. Patients were examined 1 day preoperatively and 1 day and 7 days postoperatively. Intraoperative and postoperative complications were recorded. Results Statistically, there was no significant difference about postoperative BCVA among three groups. A higher incidence of subconjunctival hemorrhage was shown in the continuation group than in the discontinuation group and the control group (17.0% versus 8.1%, p=0.038; 17.0% versus 7.4%, p=0.025, resp.). Although corneal edema was greater in clear corneal incision cases than that of scleral tunnel incision cases (22.5% versus 12.0%, p=0.009), subconjunctival hemorrhage was greater in scleral tunnel incision cases (14.9% versus 6.6%, p=0.011). Subgroup analyses revealed that patients of scleral tunnel incision who continued taking aspirin had a higher incidence of subconjunctival hemorrhage compared with those who discontinued (25.5% versus 10.9%, p=0.038), but no same conclusion in clear corneal incision cases (8.8% versus 5.0%, p=0.483). Conclusions The outcomes indicated that phacoemulsification cataract surgery under topical anesthesia could be safely performed without ceasing systemic aspirin therapy. Clear corneal incision could be a better choice in patients treated with aspirin.
Highlights
Aspirin has been the cornerstone of preventing thromboembolic complications in patients with cerebrovascular, coronary artery, and peripheral vascular diseases
Phacoemulsification cataract surgery under topical anesthesia was performed in 357 eyes of 260 patients
We found no statistical difference of nonhemorrhagic complication, such as corneal edema, elevated intraocular pressure (IOP), hypotony, and posterior capsule rupture among the continuation group, discontinuation group, and control group. e incidence of corneal edema was significantly greater in the clear corneal incision cases than in the scleral tunnel incision cases (22.5% versus 12.0%, p 0.009), but this complication faded away spontaneously within a week without clinical consequences
Summary
Aspirin has been the cornerstone of preventing thromboembolic complications in patients with cerebrovascular, coronary artery, and peripheral vascular diseases. It is a weak anticoagulant and acts through the passivation of platelet cyclooxygenase 1 and suppression of thromboxane A2 production. Patients receiving long-term antiplatelet therapy face a significant clinical challenge when they need a cataract surgery. If antiplatelet therapy is suspended, there is a risk for vascular events; continuation of aspirin treatment may be closely associated with serious perioperative bleeding complications [9, 10]. There is an issue of whether the risk of thromboembolic events associated with temporarily ceasing antiplatelet treatment before surgery outweighs the advantages of fewer hemorrhagic events. At present, there is no clear consistent recommendation in these cases before cataract surgery
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
