American journal of ophthalmology · 2009
Cataract extraction without prophylactic treatment in patients with severe factor XI deficiency.
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Fabian Ido Didi, Sachs Dan, Moisseiev Joseph, Alhalel Amir, Grinbaum Aharon, Seligsohn Uri, Salomon Ophira
Аннотация
PURPOSE: To assess the risks of intraoperative and postoperative bleeding associated with cataract extraction without prophylactic treatment in patients with severe factor XI (FXI) deficiency.
DESIGN: Prospective interventional case series.
SETTING: Single institute.
STUDY POPULATION: Consecutive unrelated patients with severe FXI deficiency who underwent cataract extraction under topical anesthesia, with a clear corneal incision, phacoemulsification, and implantation of a foldable posterior chamber intraocular lens (PCIOL) were enrolled. Patients with associated intraocular conditions that could complicate the surgery were excluded.
INTERVENTION: Cataract extraction without prophylactic treatment for the FXI deficiency.
MAIN OUTCOME MEASURES: Assessment of intraoperative and postoperative ocular bleeding and other related complications.
RESULTS: Seven patients ranging in age from 61 to 95 years (median, 79) underwent phacoemulsification and PCIOL implantation in 11 eyes. Five patients (71%) were homozygotes for type II mutation of the FXI gene (activity level of <1 U/dl), 1 patient was a homozygote for type III mutation (activity level of 11 U/dl), and 1 patient was a compound heterozygote for types II and III (activity level of 3 U/dl). Three of the patients (43%), all type II homozygotes, also had an inhibitor antibody to FXI. All 7 patients were followed for at least 1 week after the operation. The surgery was uneventful in all eyes, and neither major nor minor bleeding events were observed in any of the operated eyes during surgery and follow-up.
CONCLUSIONS: Cataract extraction by phacoemulsification in uncomplicated eyes can be performed safely without prophylactic treatment in patients with severe FXI deficiency with or without inhibitor antibodies against FXI.
DESIGN: Prospective interventional case series.
SETTING: Single institute.
STUDY POPULATION: Consecutive unrelated patients with severe FXI deficiency who underwent cataract extraction under topical anesthesia, with a clear corneal incision, phacoemulsification, and implantation of a foldable posterior chamber intraocular lens (PCIOL) were enrolled. Patients with associated intraocular conditions that could complicate the surgery were excluded.
INTERVENTION: Cataract extraction without prophylactic treatment for the FXI deficiency.
MAIN OUTCOME MEASURES: Assessment of intraoperative and postoperative ocular bleeding and other related complications.
RESULTS: Seven patients ranging in age from 61 to 95 years (median, 79) underwent phacoemulsification and PCIOL implantation in 11 eyes. Five patients (71%) were homozygotes for type II mutation of the FXI gene (activity level of <1 U/dl), 1 patient was a homozygote for type III mutation (activity level of 11 U/dl), and 1 patient was a compound heterozygote for types II and III (activity level of 3 U/dl). Three of the patients (43%), all type II homozygotes, also had an inhibitor antibody to FXI. All 7 patients were followed for at least 1 week after the operation. The surgery was uneventful in all eyes, and neither major nor minor bleeding events were observed in any of the operated eyes during surgery and follow-up.
CONCLUSIONS: Cataract extraction by phacoemulsification in uncomplicated eyes can be performed safely without prophylactic treatment in patients with severe FXI deficiency with or without inhibitor antibodies against FXI.