[Safety of "needle" regional anaesthesia for anterior segment surgery under antiplatelet agents and anticoagulants therapies]

Introduction: cataracts preferentially affect the elderly. More than 560,000 procedures are performed annually in France on vulnerable patients that are exposed to cardio-circulatory conditions requiring antiplatelet and/or anticoagulants. Haemorrhagic complications resulting from cataract surgery and/or eye regional anaesthesia are rare but can lead to serious damage to eye function.

Patients and methods: in this study, we compared the management care of two types of antiplatelet and/or anticoagulants successively utilizing the following procedure: first, the cessation of antiplatelet agents and anticoagulants were relayed with rapid elimination agents (constituting our reference "before" cohort [November 2004-May 2005]), then the antiplatelet or anticoagulant management was continued without stint according to recent data from literature (constituting our "after" cohort (April 2007-March 2008)).

Results: a reference population, consisting of 229 patients, was operated on exclusively with "surgical" sub-Tenon's anaesthesia. A second group, consisting of 178 patients, was operated on using "needle" regional anaesthesia. In both populations, nearly 33% of patients received antiplatelet or anticoagulant treatment. The incidence of subconjonctival haemorrhage occurred more frequently when anticoagulants agents were relayed (33% vs 0%; P<0,05), but there was no significant difference with antiplatelet agents (23% vs 8%; NS). The most common non-bleeding event was Chemosis and related to the type of anaesthetic technique utilized, although not serious it tended to jeopardize surgical comfort (anticoagulants: 35% vs 36% (NS), antiplatelet agents: 38% vs 40%; NS).

Conclusion: the technical changes do not explain fully that occurrence of the HSC, in patients under anticoagulant treatment, decreased in the second period. The achievement of "needle" regional anaesthesia in the anterior segment eye surgery is a safe technique that does not require stopping antiplatelet treatment or anticoagulation.