Häufigkeit der intra- und frühen postoperativen Blutungskomplikationen bei Glaukomoperationen in Abhängigkeit von gerinnungshemmenden Substanzen

Frequency of Intraoperative and Early Postoperative Bleeding Complications in Glaucoma Surgery in Relation to Antithrombotic Medication

by Lucas Leonard Martin
Doctoral thesis
Date of Examination:2026-01-12
Date of issue:2026-01-06
Advisor:Prof. Dr. Nicolas Feltgen
Referee:Prof. Dr. Nicolas Feltgen
Referee:PD Dr. Ingo Fiss
Referee:PD Dr. Martin Sebastian Winkler
Persistent Address: http://dx.doi.org/10.53846/goediss-11738

 

 

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Abstract

English

With the increasing age of the population, the number of patients requiring ophthalmologic care continues to rise. Comorbidities and pre-existing conditions often necessitate treatment with antithrombotic medication, which, in the context of ophthalmic surgery, raises concerns regarding perioperative bleeding complications. While guidelines and explicit recommendations have been established in many surgical disciplines, no uniform consensus exists in ophthalmology, particularly in glaucoma surgery, regarding the perioperative management of antithrombotic agents. Consequently, ophthalmologists lack a clear decision-making framework. The present study addresses this clinical uncertainty. Although hemorrhagic events in ophthalmology are rarely hemodynamically relevant, they may nonetheless threaten visual acuity and compromise surgical outcomes. At the same time, discontinuation of antithrombotic therapy must be carefully weighed against the risk of thromboembolic events during and after surgery. To generate robust data, patients who underwent elective glaucoma surgery between 2012 and 2017 were retrospectively analyzed. This observational study evaluated data from 376 patients who underwent trabeculectomy, filtration surgery with drainage implants (Baerveldt or Ahmed), or trabeculotomy. The primary focus was the perioperative management of antithrombotic medication and the occurrence of intraoperative or early postoperative bleeding complications. Additionally, the need for reoperation due to bleeding was assessed. For analytical purposes, patients were categorized into four groups according to their antithrombotic therapy. Overall, 7 intraoperative and 56 early postoperative bleeding complications were observed. Only one bleeding event required reoperation and resulted in permanent visual loss. Patients undergoing angle-based glaucoma surgery exhibited a higher rate of bleeding complications compared to those undergoing filtration procedures. No significant association was found between perioperative bleeding complications and patient sex, age, preoperative intraocular pressure, INR values, or type of anesthesia. However, patients receiving antithrombotic medication demonstrated an increased likelihood of hemorrhagic events. The perioperative discontinuation or continuation of antithrombotic therapy did not reveal a clinically significant difference in bleeding risk. These findings raise the question of whether additional factors not examined in this study, such as vascular status or comorbid conditions, may contribute to bleeding risk. Further studies are required to better elucidate these associations.
Keywords: Glaucoma surgery; Antithrombotic therapy; Bleeding complications; Perioperative management; Anticoagulation