warfarin and Glaucoma--Angle-Closure

Topics: Acetazolamide; Adult; Anticoagulants; Behcet Syndrome; Blood Coagulation Factors; Consciousness Disorders; Drug Synergism; Female; Glaucoma, Angle-Closure; Humans; Ibuprofen; International Normalized Ratio; Lupus Coagulation Inhibitor; Metrorrhagia; Thrombophilia; Warfarin

To our knowledge, this is the first study to describe the correlation of anterior chamber bleeding after laser peripheral iridotomy (LPI) and antiplatelet therapy.. To determine the incidence and amount of anterior chamber bleeding after laser peripheral iridotomy in patients whose condition is suggestive of primary angle-closure glaucoma (PACS) who continued their antiplatelet or anticoagulant treatment before undergoing LPI compared with when they discontinued treatment.. A prospective controlled trial.. Patients with suspected bilateral primary angle-closure and no other ocular disease who take antiplatelet or anticoagulant medications regularly (from January 2010-October 2011) were enrolled.. The incidence of anterior chamber bleeding with and without antiplatelet and anticoagulant therapy.. A total of 104 patients (208 eyes) participated in the study. Thirty-six eyes (34.6%) in the treated and untreated arms bled. The amount of bleeding did not differ significantly when the patient was on or off antiplatelet or anticoagulant treatment, nor did the immediate postprocedure mean intraocular pressure (P = .13). The type of antiplatelet or anticoagulant, total laser energy, age, sex, or color of irides were not risk factors for increased bleeding (P = .156 for all parameters).. No indication was noted for discontinuing these medications before a high-powered pulsed laser peripheral iridotomy.

Topics: Adult; Aged; Aged, 80 and over; Anterior Chamber; Anticoagulants; Aspirin; Clopidogrel; Eye Color; Female; Glaucoma, Angle-Closure; Gonioscopy; Humans; Hyphema; Incidence; Intraocular Pressure; Iridectomy; Iris; Laser Therapy; Lasers, Solid-State; Male; Middle Aged; Platelet Aggregation Inhibitors; Postoperative Complications; Prospective Studies; Risk Factors; Ticlopidine; Tonometry, Ocular; Warfarin

Suprachoroidal haemorrhage is a rare complication of either medical anticoagulation treatment or intraocular surgical procedures. Suprachoroidal haemorrhages often have devastating visual outcome despite conservative and/or surgical intervention.. A patient with known Open Angle Glaucoma and Atrial Fibrillation on warfarin presents symptoms and signs suggestive acute angle closure. Examination reveals the underlying cause is a large, macula involving, spontaneous suprachoroidal haemorrhage secondary to loss of anti-coagulation control. Following aggressive medical treatment and surgical intervention, including drainage combined cataract extraction with intraocular lens implant, pars-plana vitrectomy, and external drainage of suprachoroidal haematoma, we managed to preserve the patient's eye and some of its function.. Spontaneous suprachoroidal haemorrhages are rare complications of loss of anticoagulation control. Our case shows that aggressive treatment in selected cases can offer a relatively good outcome.

Topics: Acute Disease; Aged; Anticoagulants; Atrial Fibrillation; Blood Coagulation Disorders; Choroid Hemorrhage; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Male; Visual Acuity; Warfarin

To describe bilateral hemorrhage of the posterior segment and secondary angle-closure glaucoma as sequelae of anticoagulation therapy in a nanophthalmic patient.. An 80-year-old man who was nanophthalmic and was undergoing anticoagulation therapy presented with declining visual acuity in left eye. Six months later, he experienced declining visual acuity in his right eye.. In the LE and six months later in the RE, ocular examination disclosed angle-closure glaucoma and a hemorrhagic retinal detachment. Peripheral iridoplasty successfully treated the initial attack. The subretinal hemorrhage was successfully drained by pars plana vitrectomy, retinotomy, and air-fluid exchange in the left eye. Anatomic success and intraocular pressure control were obtained, but visual recovery was limited.. Intraocular hemorrhage and angle-closure glaucoma are potential complications of anticoagulation therapy in a patient with nanophthalmos.

Topics: Aged; Aged, 80 and over; Anticoagulants; Glaucoma, Angle-Closure; Humans; Male; Microphthalmos; Retinal Detachment; Retinal Hemorrhage; Ultrasonography; Visual Acuity; Vitrectomy; Warfarin

Age-related macular degeneration (ARMD) is the leading cause of legal blindness in the elderly, causing profound loss of central vision.. A 90-year-old patient with exudative age-related macular degeneration who had been placed on anticoagulant therapy for pulmonary emboli experienced a massive choroidal hemorrhage and retinal detachment. Angle closure glaucoma was precipitated by forward movement of the iris-lens diaphragm and vision was lost in the eye. The patient was subsequently removed from anticoagulant therapy, although he had potentially fatal bilateral pulmonary emboli, because of the patient's concern for the quality of his remaining life.. This case report is intended to alert optometrists to the ocular complications of anticoagulant therapy, particularly the risk of massive choroidal hemorrhage in anticoagulated patients with exudative ARMD.. An optometrist's responsibility to inform primary care providers of the potential ocular complications of anticoagulant therapy for patients with exudative ARMD is also described.

Topics: Aged; Aged, 80 and over; Anticoagulants; Choroid Hemorrhage; Fundus Oculi; Glaucoma, Angle-Closure; Humans; Macular Degeneration; Male; Pulmonary Embolism; Retinal Detachment; Warfarin