Perioperative antithrombotic administration in glaucoma did not affect success surgical outcomes

A new study by Fumio Takano and team found that the success rate of the surgeries were unaffected by the perioperative administration of antithrombotic medications. The findings of this study were published in Graefe's Archive for Clinical and Experimental Ophthalmology.

At least in part because of accelerated atherosclerotic alterations, the number of aged individuals at risk for cardiovascular or cerebrovascular events, such as stroke or myocardial infarction, is rising quickly. Due to this, the number of patients receiving antithrombotic medications has significantly increased. One of the main causes of blindness in the globe is glaucoma. The only proven strategy to reduce or stop the course of glaucomatous optic neuropathy is lowering intraocular pressure (IOP). This study looked at whether and how much the perioperative use of antithrombotic medications in glaucoma surgery affected hemorrhagic complications and surgical success.

Three types of glaucoma procedures were distinguished: trabeculotomy (TLO), trabeculectomy (TLE), and long-tube shunt surgery (Tube). The following indicators of surgical success were reached one year after the procedure: intraocular pressure in the 5–21 mmHg range, a 20% or greater drop in IOP from preoperative levels, and no further glaucoma procedures. Researchers evaluated the rates of success and hemorrhagic complications between those who had used antithrombotic medication before and people who had not. In addition, propensity score analysis was used in TLO and TLE operations to modify the preoperative characteristics between the two groups.

The key findings of this study were:

1. There were 910 glaucoma procedures altogether, of which TLO, TLE, and Tube surgeries accounted for 353, 444, and 113, respectively.

2. In all glaucoma procedures, 149 patients received preoperative antithrombotic medications: 37 patients used just anticoagulants, 102 patients used only antiplatelets, and 10 patients used both.

3. None of the techniques' success rates varied noticeably from one another.

4. The patients who received TLE and Tube had considerably more hemorrhagic problems (hyphema and vitreous hemorrhage rate).

5. After the two groups were matched by propensity score, there was no discernible difference in the surgical success rates of TLO and TLE.

Reference:

Takano, F., Mori, S., Okuda, M., Murai, Y., Ueda, K., Sakamoto, M., Kurimoto, T., Yamada-Nakanishi, Y., & Nakamura, M. (2022). Risk of surgical failure and hemorrhagic complications associated with antithrombotic medication in glaucoma surgery. In Graefe's Archive for Clinical and Experimental Ophthalmology (Vol. 260, Issue 11, pp. 3607–3615). Springer Science and Business Media LLC. https://doi.org/10.1007/s00417-022-05719-1