EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/115557
58 EW CATARACT March 2013 Complicated cataract cases Management of medications in cataract patients by Alan S. Crandall, M.D. T here are a number of topical and systemic medications that complicate the life of the cataract surgeon. They include obvious ones such as miotic agents used to treat glaucoma; alpha-receptor antagonists used to treat prostatic hypertrophy; and anticoagulants such as aspirin, clopidogrel, and warfarin. There are many others, however, including topical corticosteroids, nonsteroidal anti-inflammatory agents, and prostaglandins used to treat glaucoma. Continuation or discontinuation of these medications must be done in the context of a patient's overall ocular and systemic health. In this article, Alan Crandall, M.D., discusses his approach to the management of these medications in the perioperative period. While no absolute guidelines can be given because each situation is unique, he provides general guidance that should be useful to cataract surgeons. Kevin Miller, M.D. Complicated cataract cases editor T here are a number of situations where patients are on medications both systemically and topically and questions concerning altering or stopping the medications must be dealt with prior to cataract surgery. Many patients (if not most) are on blood thinners. This is not much of a concern for routine cataract patients especially with clear corneal small incisions, however patients who are having a combined cataract and standard glaucoma procedure could be at risk for choroidal hemorrhage. The patients who are at risk for hemorrhage include patients with glaucoma, high myopia, blood dyscrasia, and simply older age. One must weigh the risk of the hemorrhage against the possibilities of the systemic problems such as stroke or heart issues that can occur if the medicine is stopped. I do not routinely stop the medications, espe- cially warfarin, without discussing this with the internal medicine doctor, but I mostly want to make sure that patients are not over-coumadinized (that their INR is within the desired range) and during surgery try to minimize the time that there is hypotony. One of the great advantages of doing these cases with topical anesthesia is that the patient will have sudden severe pain and can warn you that things are happening; this can alert you, and I will quickly continued on page 60