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Risk of surgical failure and hemorrhagic complications associated with antithrombotic medication in glaucoma surgery

  • Glaucoma
  • Published:
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Abstract

Purpose

The purpose of this retrospective study was to determine the extent to which the use of antithrombotic drugs during glaucoma surgery contributes to surgical failure and postsurgical hemorrhagic complications.

Methods

Glaucoma surgeries were categorized into three groups: trabeculotomy (TLO), trabeculectomy (TLE), and long-Tube shunt surgery (Tube). At 1 year after surgery, the following criteria for surgical success were met: intraocular pressure (IOP) in the 5–21-mmHg range, IOP reduction of at least 20% from the preoperative level, and no additional glaucoma surgeries. We compared the percentages of the success rates and hemorrhagic complications between antithrombotic medication experiencers and non-experiencers. Furthermore, we adjusted the preoperative factors between the two groups using a propensity score analysis in TLO and TLE surgeries.

Results

A total of 910 glaucoma surgeries were included, with TLO, TLE, and Tube accounting for 353, 444, and 113 surgeries, respectively. Preoperative antithrombotic medications were administered to 149 patients in all glaucoma surgeries: 37 patients used only anticoagulants, 102 used only antiplatelets, and 10 used both. There was no significant difference in the success rates of any of the procedures. The hemorrhagic complications (hyphema and vitreous hemorrhage rate) were significantly higher in the patients who underwent TLE and Tube. The surgical success rates of TLO and TLE were not significantly different after the two groups were matched by propensity score.

Conclusion

The perioperative use of antithrombotic drugs did not affect success for any of the procedures. However, it increased early postoperative hemorrhagic complications for TLE and Tube.

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Data availability

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

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Author information

Authors and Affiliations

  1. Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Fumio Takano, Sotaro Mori, Mina Okuda, Yusuke Murai, Kaori Ueda, Mari Sakamoto, Takuji Kurimoto, Yuko Yamada-Nakanishi & Makoto Nakamura

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  1. Fumio Takano
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  2. Sotaro Mori
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  3. Mina Okuda
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Contributions

Conceptualization: S. M. and M. N.; data sampling: F. T., M. O., Y. M., and K. U.; data analysis: F. T., S. M., and Y. Y.-N.; drafting: F. T., S. M., and M. N.; critical reading and reviewing: M. S., T. K., Y. Y.-N., and M. N.; submission: M. N.

Corresponding author

Correspondence to Makoto Nakamura.

Ethics declarations

Ethics approval

This study was approved by the Institutional Review Board of the Kobe University Graduate School of Medicine (No. 200091).

Consent to participate

Opt-out consent was obtained from all patients. This method was used for participant recruitment in the study. Information regarding the research, their involvement, and where their participation is presumed unless they decline to participate was provided to the potential participant.

Conflict of interest

The authors declare no competing interests.

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Supplementary Information

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Supplemental Figure 1

Histograms of the eyes with surgical successes and hemorrhagic complications stratified by anti-thrombotic therapy experience in TLO after re-allocating Trabectome to TLE. A indicates TLO patients without Trabectome, while B denotes TLE patients including Trabectome. Black bars indicate patients with success or without hemorrhagic complications, while white bars denote patients with failure or hemorrhagic complications. Designations are the same as in Fig. 1. n.s., not significant. *, p < 0.05. (PNG 1265 kb)

High resolution image (TIF 635 kb)

Supplemental Tables 1, 2, and 3 (DOCX 35 kb)

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Cite this article

Takano, F., Mori, S., Okuda, M. et al. Risk of surgical failure and hemorrhagic complications associated with antithrombotic medication in glaucoma surgery. Graefes Arch Clin Exp Ophthalmol 260, 3607–3615 (2022). https://doi.org/10.1007/s00417-022-05719-1

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  • DOI: https://doi.org/10.1007/s00417-022-05719-1

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