[Cataract surgery and anticoagulation--current status]

Patients on anticoagulation therapy run an increased risk for intraoperative bleeding, but withholding this rheologic therapy increases the danger of thromboembolic complications. Management of cataract patients on anticoagulation therapy is not standardized. In this multicenter survey, we ascertained perioperative management trends.

Questionnaires from 122 centers were received (81.3%), each performing an average of 1558 cataract surgeries/year (total: 172.880 surgeries in 1995).

The majority of surgeons continued their surgical (73%) and anesthetic (75%) technique, continued aspirin (63%) and discontinued coumarine therapy (77%). The preferred kind of anesthesia was retro- (28%) or peribulbar (18%) followed by systemic and/or retrobulbar anesthesia (25%). 64% of surgeons changed their treatment to intravenous heparin, 36% stopped coumarine without supplement therapy, while 16% of these surgeons did not check for thromboplastine time. Those who continued cumarine therapy preferred a corneal approach (85%) with subconjunctival and topical anesthesia (51%), respectively.

Anticoagulation therapy slightly influences anesthetic technique or the surgical approach chosen in these patients. Usually coumarine therapy was discontinued which implicates the possibility of life-threatening complications and mandates tight control of coagulation parameters. Ophthalmic surgeons who continued anticoagulation therapy preferred a corneal approach followed by phacoemulsification. The advantages of discontinuing anticoagulation therapy have to be weighed against potential risks.