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Perioperative Recommendations for Corneal Refractive Surgery Patients With Inherited Bleeding Disorders
Majid Moshirfar1,2,3, Jonathon C Reynolds4, Kayvon A Moin1
1Hoopes Vision Research Center, Hoopes Vision, Draper, UT.
Insights
Patients with inherited bleeding disorders considering corneal refractive surgery require individualized preoperative evaluation. Risk assessment and tailored hemostasis interventions are crucial for safe outcomes in these unique cases.
Area of Science:
- Ophthalmology
- Hematology
- Genetics
Background:
- Inherited bleeding disorders (IBDs) pose unique challenges for elective surgeries.
- Corneal refractive surgery, while generally safe, carries a risk of bleeding complications.
Purpose of the Study:
- To review literature on IBDs and ocular bleeding.
- To propose preoperative recommendations for IBD patients undergoing corneal refractive surgery.
Main Methods:
- Comprehensive literature search (PubMed, Embase, Google Scholar) up to January 2024.
- Inclusion of case reports and a retrospective chart review of patients with IBDs undergoing corneal refractive surgery.
Main Results:
- Limited literature on IBDs and corneal refractive surgery (8 cases identified).
- Extensive literature on bleeding complications in patients without IBDs undergoing similar procedures.
- Ocular bleeding manifestations were reported in IBD patients undergoing other ocular surgeries.
Conclusions:
- Perioperative bleeding risk in IBD patients for corneal refractive surgery is variable.
- Risk depends on the specific bleeding disorder, factor levels, and bleeding history.
- Hemostasis intervention and clotting factor optimization should be individualized.
Purpose:
To synthesize the current literature regarding patients with inherited bleeding disorders and suggest comprehensive evaluation and preoperative recommendations for these patients before undergoing corneal refractive surgery.
Methods:
The literature search was conducted through PubMed, Embase, and Google Scholar databases for publications through January 4, 2024 for reports of ocular bleeding manifestations in patients with inherited bleeding disorders and reports of patients without a history of bleeding disorders who had intraoperative or postoperative hemorrhagic complications with corneal refractive surgery. Additional cases from the literature and a retrospective chart review at a corneal practice were obtained describing patients with inherited bleeding disorders who underwent corneal refractive surgery.
Results:
Four articles were found detailing ocular bleeding manifestations in patients with inherited bleeding disorders who underwent ocular surgery other than corneal refractive surgery. Thirty articles were found detailing intraoperative and postoperative bleeding manifestations in patients without a history of inherited bleeding disorders who underwent corneal refractive surgery. Eight cases (3 patients from the literature search and 5 patients from a retrospective chart review) were found regarding patients with inherited bleeding disorders who underwent corneal refractive surgery.
Conclusions:
For corneal refractive surgery with topical anesthesia, the perioperative risk and need for any hemostasis intervention in individuals with an inherited bleeding disorder depends on the type of disorder, status of preoperative factor level concentrations, or a prior history of bleeding. If required, clotting factor optimization should be tailored to each candidate on a case-by-case basis.
