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Risk of perioperative bleeding complications in rhegmatogenous retinal detachment surgery: a retrospective single-center study

  • Retinal Disorders
  • Published:
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Abstract

Purpose

The goal of this study was to analyze the incidence of perioperative bleeding complications in rhegmatogenous retinal detachment. The handling of perioperative anticoagulation during vitreoretinal surgery remains controversial, since the risk of bleeding complications by its continuation has to be balanced against the risk of progression of retinal detachment and the risk of thromboembolic events when anticoagulation is interrupted. Nevertheless, only few studies have investigated the risk of perioperative bleeding complications in an emergency such as retinal detachment surgery.

Methods

We therefore examined the rate of all perioperative hemorrhages and separately the rate of only severe bleedings during vitrectomy, scleral buckling with or without drainage of subretinal fluid (SRD), or combined procedures due to retinal detachment in patients undergoing different types of perioperative anticoagulation including acetylsalicylic acetate (ASA), clopidogrel, heparin, low molecular weight heparin, and phenprocoumon.

Results

This retrospective single-center study included 893 patients with primary rhegmatogenous retinal detachment, n = 192 on anticoagulation and n = 701 serving as control without anticoagulation. Our analysis revealed no significantly increased rate of perioperative hemorrhages under anticoagulation with ASA 100 mg (all, 11.4%; severe, 5.0%) or phenprocoumon (all, 11.6%; severe, 2.3%) compared with controls (all, 13.0%; severe, 5.4%). However, frequencies of bleeding complications varied markedly regarding the type of surgical procedure: Scleral buckling plus SRD showed the highest rates of hemorrhages (all, 18.9%; severe, 9.1%) with significant difference (P < 0.001) compared with scleral buckling without SRD (all, 3.8%; severe, 0.6%) and vitrectomy (all, 9.2%; severe, 1.5%), respectively. Furthermore, subretinal bleeding was the most common type of perioperative hemorrhage.

Conclusions

The data suggest not to stop ASA therapy prior to vitreoretinal surgery. Furthermore, we found no evidence of an increased risk for perioperative bleedings in patients under anticoagulation with vitamin-k antagonists with an INR within the sub-therapeutic range. SRD during scleral buckling procedure should be avoided as possible and regardless of any type of anticoagulation.

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Authors and Affiliations

  1. Department of Ophthalmology, University Medical Center Goettingen, Robert-Koch-Str, 40 37075, Goettingen, Germany

    Sebastian Bemme, Peer Lauermann, Nina Antonia Striebe, Mohammed Haitham Khattab, Josep Callizo, Thomas Bertelmann, Hans Hoerauf & Nicolas Feltgen

  2. Department of Radiology, St. Franziskus Hospital, Muenster, Hohenzollernring 70, 48145, Münster, Germany

    Johannes Affeldt

  3. Department of Research, Teaching and Clinical Science, University Medical Center Goettingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany

    Sebastian Pfeiffer

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  1. Sebastian Bemme
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  2. Peer Lauermann
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Correspondence to Sebastian Bemme.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Bemme, S., Lauermann, P., Striebe, N.A. et al. Risk of perioperative bleeding complications in rhegmatogenous retinal detachment surgery: a retrospective single-center study. Graefes Arch Clin Exp Ophthalmol 258, 961–969 (2020). https://doi.org/10.1007/s00417-019-04554-1

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