FINANCIAL DISCLOSURES The authors have no financial interest

FINANCIAL DISCLOSURES The authors have no financial interest in the subject matter of this poster.

CATARACT SURGERY IN PATIENTS ON WARFARIN THERAPY: HAEMORRHAGIC COMPLICATIONS AND POSTOPERATIVE VISUAL ACUITY Paulo Silva Guerra MD, Walter Rodrigues MD, David Lopes MD, Lurdana Gomes MD, M. Monteiro Grillo MD Ophthalmology Department. Director: Prof. Dr. M. Monteiro Grillo Hospital de Santa Maria (HSM) / Lisbon - Portugal

Introduction • Traditionally, warfarin has been discontinued prior to cataract surgery because of concerns about increased risk of hemorrhagic complications • The trend amongst surgeons has shifted strongly towards continuation of anticoagulation • Recent surveys indicates the majority (˃70%) of surgeons keep cataract patients anticoagulated. 5 Purpose: ü To assess ophthalmic complications associated with cataract surgery under topical anesthesia in patients on warfarin therapy.

Material and Methods • Retrospective review of 49 eyes of 42 patients on warfarin therapy (Warfarin Group). • Undergoing cataract surgery by phacoemulsification and IOL placement with topical anesthesia. • We evaluate: - The rates of intraoperative hemorrhagic complications of the anterior and posterior segment - The rates of postoperative hemorrhagic complications of the anterior and posterior segment - The pre and postoperative Best Corrected Visual Acuity (BCVA)

Material and Methods • The results of are compared with a control group, not anticoagulated (age and surgeon matched). • All cataract surgeries were performed by three experienced surgeons from January 2008 to June 2009

Results Demographics Warfarin Group Control Group Patients 42 51 Eyes 49 60 Mean age 75, 3 (SD± 7, 1) 78, 7 (SD± 7, 9) Gender ♂ - 18 (43%) ♂ - 21 (41%) 0, 49 (SD± 1, 86) 0, 56(SD± 2, 02) Preoperative BCVA ü Intraoperative non-hemorrhagic complications Warfarin Group - 2 posterior capsule ruptures Control Group - 3 posterior capsule ruptures

Results Intraoperative Hemorrhagic Complications Warfarin Group n=49 Control Group n=60 0 0 2 (4, 1%) 0 0 0 Subconjunctival hemorrhage Hyphema Suprachoroidal hemorrhage P = 0, 11 2 2 1, 8 1, 6 1, 4 1, 2 1 0, 8 0, 6 0, 4 0, 2 0 0 0 Control Group Subconjunctival H. Warfarin Group Hyphema Suprachoroidal H

Results Postoperative Hemorrhagic Complications Warfarin Group n=49 Control Group n=60 Subconjuntival H. 6 (12, 2%) 1 (1, 7%) P = 0, 02 Hyphema 2 (4, 1%) 0 P = 0, 11 Vitreous Hemorrhage 0 0 Suprachoroidal H. 0 0 4 (8, 1%) 5 (8, 3%) Retinal Hemorrhages 6 Warfarin Group P = 0, 9 Control Group 5 6 4 5 4 2 3 2 1 0 0 0 Subconjuntival H Hyphema Vitreous H Suprachoroidal H Retinal H

Results Postoperative BCVA Warfarin Group n=49 Control Group n=60 BCVA 0, 81 0, 84 SD ± 0, 25 ± 0, 24 Variation 0, 2 -1 0, 3 -1 1 0, 9 0, 8 0, 7 0, 6 0, 5 0, 4 0, 3 0, 2 0, 1 0 Warfin Group Control group P = 0, 58

Discussion • Subconjuntival Hemorrhage: - Most frequent hemorrhagic complication in Warfarin Group - The only statistically significant (P<0, 05) • There was no statistically significant difference in the other hemorrhagic complication between the 2 groups (P>0, 05). • There was no statistically significant difference in postoperative BCVA between the 2 groups (P>0, 05).

Conclusions ü Continuation of treatment with warfarin in patients undergoing phacoemulsification and IOL placement with topical anesthesia is safe and was not associated with increased risk of vision threatening complications.

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