First Case Report of Mortality Post Manual Small Incision Cataract Surgery in a Known Case of Immune Thrombocytopenic Purpura

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ABSTRACT We present the first case of death due to profuse bleeding from the wound margin following manual small incision cataract surgery (SICS) in a known case of immune thrombocytopenic purpura (ITP), a rare outcome in a common case. A 62-year-old male patient presented with profuse bleeding from the surgical wound of the left eye for 2 days following manual SICS. He was a known case of ITP with a history of gastrointestinal bleeding for which he was admitted few years back but had discontinued prescribed medications and did not mention this medical history to the concerned ophthalmic surgeon before surgery. His platelet count was 5000/mm3 on admission. The patient was admitted to the general medicine ward and was infused with 8 units of random donor platelets and started on injectable high-dose corticosteroids. Despite prompt interventions, the patient succumbed to profound bleeding and multiorgan failure. This case report underscores the importance of comprehensive preoperative evaluation, especially in patients with known bleeding disorders or a history of bleeding complications. While routine cataract surgeries may not typically require extensive preoperative testing as commonly used techniques these days are bloodless and sutureless, certain high-risk patients, such as those with ITP or other bleeding disorders, warrant thorough screening to assess the patient’s hemostatic status accurately to identify and mitigate any adverse outcomes.