Eva Brillat1,2, Frédéric Rouberol3, Karine Palombi2, Jean-Louis Quesada1,4, Diane Bernheim2, Pierre Albaladejo1,5, Florent Aptel1,2, Jean-Paul Romanet1,2, Christophe Chiquet6,7. 1. UJF-Grenoble 1, Grenoble, F-38041, France. 2. Department of Ophthalmology, University Hospital, CHU Grenoble, Grenoble Cedex 09, F-38043, France. 3. Kleber Center of Ophthalmology, Lyon, France. 4. INSERM CIC03, Clinical Research Center, University Hospital, CHU Grenoble, Grenoble, F-38043, France. 5. Department of Anaesthesia, University Hospital, CHU Grenoble, Grenoble, F-38043, France. 6. UJF-Grenoble 1, Grenoble, F-38041, France. christophe.chiquet@inserm.fr. 7. Department of Ophthalmology, University Hospital, CHU Grenoble, Grenoble Cedex 09, F-38043, France. christophe.chiquet@inserm.fr.
Abstract
PURPOSE: The purpose of this study was to evaluate the hemorrhagic risk factors during the management of primary rhegmatogenous retinal detachment (RD). METHODS: Three hundred and twenty-two patients with (n = 74) or without (n = 248) bleeding (anterior segment, choroidal, intravitreal and/or subretinal) during or after RD surgery were included in this case-control study. Exclusion criteria were: history of trauma, vitreoretinal surgery, diabetic retinopathy, and taking clopidogrel and/or a vitamin K antagonist. Univariate and multivariate analyses were performed to identify risk factors of perioperative bleeding. RESULTS: Aspirin was not significantly associated with bleeding complications during or after surgery (p = 0.8). Scleral buckling (with cryotherapy and gas tamponnade) was performed in 47 % of the cases and pars plana vitrectomy in 53 % of the cases. Independent risk factors of perioperative hemorrhage were the number of cryotherapy impacts (odds ratio =1.12 [1.06; 1.20], 95 % confidence interval), transscleral drainage (OR = 4.22 [1.62; 10.98]), and use of pars plana vitrectomy (OR = 3.39 [1.36; 8.47]). Bleeding complications were associated with a lower single-operation anatomical success rate (74 % vs 84 %, p = 0.03). There was also a trend toward an association between bleeding complications, a higher total number of RD recurrences (0.19 ± 0.5 in the non-bleeding group vs 0.34 ± 0.6, p = 0.06), and a lower final visual acuity (0.5 ± 0.6 logMAR vs 0.7 ± 0.7, p = 0.09). CONCLUSION: This case-control study suggests that aspirin is not a major risk factor of hemorrhagic complications during and after RD surgery. Perioperative bleeding leads to a lower single-operation anatomic success rate.
PURPOSE: The purpose of this study was to evaluate the hemorrhagic risk factors during the management of primary rhegmatogenous retinal detachment (RD). METHODS: Three hundred and twenty-two patients with (n = 74) or without (n = 248) bleeding (anterior segment, choroidal, intravitreal and/or subretinal) during or after RD surgery were included in this case-control study. Exclusion criteria were: history of trauma, vitreoretinal surgery, diabetic retinopathy, and taking clopidogrel and/or a vitamin K antagonist. Univariate and multivariate analyses were performed to identify risk factors of perioperative bleeding. RESULTS:Aspirin was not significantly associated with bleeding complications during or after surgery (p = 0.8). Scleral buckling (with cryotherapy and gas tamponnade) was performed in 47 % of the cases and pars plana vitrectomy in 53 % of the cases. Independent risk factors of perioperative hemorrhage were the number of cryotherapy impacts (odds ratio =1.12 [1.06; 1.20], 95 % confidence interval), transscleral drainage (OR = 4.22 [1.62; 10.98]), and use of pars plana vitrectomy (OR = 3.39 [1.36; 8.47]). Bleeding complications were associated with a lower single-operation anatomical success rate (74 % vs 84 %, p = 0.03). There was also a trend toward an association between bleeding complications, a higher total number of RD recurrences (0.19 ± 0.5 in the non-bleeding group vs 0.34 ± 0.6, p = 0.06), and a lower final visual acuity (0.5 ± 0.6 logMAR vs 0.7 ± 0.7, p = 0.09). CONCLUSION: This case-control study suggests that aspirin is not a major risk factor of hemorrhagic complications during and after RD surgery. Perioperative bleeding leads to a lower single-operation anatomic success rate.
Authors: J Mantz; C M Samama; F Tubach; P J Devereaux; J-P Collet; P Albaladejo; B Cholley; R Nizard; J Barré; V Piriou; N Poirier; A Mignon; S Schlumberger; D Longrois; F Aubrun; M E Farèse; P Ravaud; P G Steg Journal: Br J Anaesth Date: 2011-08-27 Impact factor: 9.166