Deep venous thrombosis after minor surgery

Abstract

We read with interest the article by Ong and coauthors1 describing a case of deep venous thrombosis (DVT) after uneventful phacoemulsification and the letter by Cannon2 in response. We would like to highlight prolonged postoperative bed rest and immobility as an additional risk factor for DVT after ocular surgery. Au Eong et al.3 report a case of pulmonary embolism from DVT in a 38-year-old white woman on the eighth day after retinal reattachment surgery with intravitreal gas injection and postoperative face-down head positioning. After the pulmonary embolism, screening for thrombophilia disclosed the patient had activated protein C resistance caused by factor V Leiden heterozygous mutation. Chu and Pince4 also report DVT in a patient 1 week after prone positioning after retinal reattachment surgery with intraocular gas tamponade. Deep venous thrombosis and pulmonary embolism, therefore, remain a major concern in patients requiring postoperative head positioning for prolonged duration. These patients may benefit from the use of silicone oil tamponade to reduce the need for postoperative head positioning in addition to other DVT prophylactic measures such as compression stockings, intermittent pneumatic compression, stretch exercises while in bed, and walking for 5 to 10 minutes every hour while maintaining the desired head posture. Unlike vitreoretinal surgery, modern cataract surgery does not require prolonged postoperative bed rest. It is unclear from Ong and coauthors' report whether their patient had a prolonged period of bed rest or immobility after surgery. In addition to the usual postoperative advice to avoid trauma to and contamination of the operated eye, we currently encourage our patients to resume their usual physical activities from the first day after uneventful phacoemulsification if there is no wound leak. Ajeet M. Wagle FRCSEd Anurupa A. Wagle MBBS, DA Kah-Guan Au Eong MMed (Ophth), FRCS, DRCOphth Singapore, Singapore