The following is the summary of “Hemorrhagic Complications Following Trabecular Bypass Microstent Surgery in the Setting of Antithrombotic Therapy,” published in the May 2023 issue of Glaucoma by Shalaby, et al.
In this retrospective analysis, chronic antithrombotic treatment (ATT) was not associated with an increased risk of hemorrhagic events following trabecular bypass micro stent surgery and phacoemulsification. Hyphema was linked to the female gender and stent type. To document the frequency of bleeding issues during phacoemulsification with and without a trabecular bypass micro stent.
iStent, iStent inject, and Hydrus trabecular bypass micro stent surgery with phacoemulsification in patients with chronic ATT between 2013 and 2019; ≥3-month follow-up. The primary endpoint was the incidence of bleeding problems within three months after surgery. Factors predictive of hemorrhagic complications were identified using generalized estimating equations for accounting for inter-eye correlation and logistic regression analysis. Age and baseline ocular parameters were comparable across the ATT and non-ATT groups (n=333, 435 eyes), in which 161 patients (211 eyes) were treated.
About 84 eyes (19.3%) experienced hyphema (41 ATT eyes, 43 non-ATT eyes; P = 1.00), the sole hemorrhagic event. There was no distinction between the ATT and non-ATT groups in terms of timing of onset (98.8% on postoperative day 1) or duration (73.8% at 1 week).
Compared to the iStent (19.9%) and the iStent inject (8.5%), the Hydrus micro stent had a significantly higher rate of hyphema (36.4%) (P = 0.003). In the multivariate analysis, the female gender significantly predicted hyphema (hazard ratio [HR] = 2.062, P= 0.009). At the same time, iStent injection was protective (HR = 0.379, P = 0.033), and Hydrus did not approach statistical significance (HR = 2.007, P = 0.081). No significant correlations were found between age, systemic comorbidities, ATT use, or baseline ocular features. Transient hyphema was the only reported consequence of trabecular bypass micro stent surgery, and it was not linked to prolonged ATT usage. Hyphema was related to the female gender and stent type.