warfarin and Retinal-Detachment

To determine if oral anticoagulation alters the association between vitreous hemorrhage (VH) and retinal tears in eyes with acute, posterior vitreous detachment (PVD).. In this retrospective chart review, the complete records of consecutive patients with spontaneous, symptomatic acute PVD from a single referral-based practice were reviewed. The use of oral anticoagulants, the presence of a VH, and the presence of a retinal tear or detachment were recorded.. A total of 336 consecutive eligible patients (336 eyes) were included in the final analysis. Vitreous hemorrhage occurred in 118 (35%) eyes; in 43% of patients taking aspirin, clopidogrel, or warfarin versus 31% not taking these medications (P = 0.03). Retinal tears occurred in 46% of patients with VH versus 27% of patients without VH (P = 0.0007). Retinal tears occurred in 39% of patients with VH taking aspirin, clopidogrel, or warfarin compared with 52% of patients not taking these medications. (P = 0.20) A decreased proportion of patients with acute PVD taking one or more of the oral anticoagulant medications studied, regardless of the presence of VH, were diagnosed with a retinal tear (P = 0.0017) or retinal detachment (P = 0.0001).. Retinal tears are commonly found (46%) in the eyes of patients who present with symptoms and signs of acute PVD and VH. Patients taking aspirin, clopidogrel, or warfarin who develop an acute PVD are more likely to present with VH. No statistically significant association was demonstrated between the use of oral anticoagulants in patients with acute PVD and VH and the presence of retinal tears or retinal detachment.

Topics: Acute Disease; Administration, Oral; Adult; Aged; Aged, 80 and over; Anticoagulants; Aspirin; Clopidogrel; Female; Humans; Male; Middle Aged; Retinal Detachment; Retinal Perforations; Retrospective Studies; Risk Assessment; Ticlopidine; Vitreous Detachment; Vitreous Hemorrhage; Warfarin

Warfarin is a commonly used anticoagulant whose effect in vitreoretinal surgery has not been well studied.. A series of 60 patients on warfarin therapy undergoing pars plana vitrectomy were retrospectively case controlled to 60 patients with similar presenting complaints. In addition, an online survey was performed of current practice in the UK.. 2% of the patients receiving vitrectomy were on warfarin. There were 33 males and 27 females with a median age of 72.5 years; follow-up was for a mean of 0.88 years. The international normalised ratio (INR) ranged between 0.94 and 4.6 (median 2.3). Two cases of suprachoroidal haemorrhages occurred in the control group (one with preoperative choroidal haemorrhage from dislocated lens nucleus), while none occurred in the warfarin group. 12 patients with rhegmatogenous retinal detachment (RRD) in the warfarin group presented with vitreous haemorrhage compared with only four in the control group (p=0.04). From the online survey, 48 respondents (81%) would ask patients to withhold warfarin prior to vitreoretinal surgery based on the INR.. There was no increase in complications in patients continuing to take warfarin compared with controls. Patients with RRD are more likely to have vitreous haemorrhage at presentation if they are on warfarin.

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Case-Control Studies; Contraindications; Female; Humans; International Normalized Ratio; Intraoperative Complications; Male; Middle Aged; Postoperative Complications; Practice Guidelines as Topic; Retinal Detachment; Retrospective Studies; Risk Factors; Scleral Buckling; United Kingdom; Vitreoretinal Surgery; Vitreous Hemorrhage; Warfarin

Topics: Aged; Aged, 80 and over; Anticoagulants; Female; Humans; Male; Retinal Detachment; Retinal Hemorrhage; 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

Topics: Aqueous Humor; Cataract Extraction; Diabetes Mellitus; Diagnosis, Differential; Eye Neoplasms; Geriatrics; Glaucoma; Humans; Macula Lutea; Macular Degeneration; Pathology; Postoperative Complications; Retinal Detachment; Retinal Hemorrhage; Warfarin