Aspirin is not a risk factor of haemorrhagic complications during or after surgery of primary rhegmatogenous retinal detachment

Objectif: Evaluer le risque et les complications hémorragiques de l acide acétylsalicylique, lors de la chirurgie de décollement de rétine (DR) rhegmatogène. Méthodes: Cette étude comparative prospective de type cas-témoins incluait une cohorte de 835 patients présentant un DR rhegmatogène primitif. Deux groupes ont de patients ont été étudiés selon la survenue ou non de complications per et/ou post opératoires, en fonction de différents facteurs dont le traitement par acide acétylsalicylique. Les critères d exclusions étaient les yeux ayant bénéficié d une chirurgie vitréo-rétinienne antérieurement,le traitement par clopidogrel et/ou par anti-vitamine K. Résultat : Parmi les 835 patients inclus, 74 yeux (8,9%) ont présenté une complication hémorragique (hyphéma, hémorragie sous-rétinienne, hémorragie intra-vitréenne et/ou hématome choroïdien). Le groupe avec complication hémorragique différait significativement du groupe sans hémorragie pour le taux d hémorragie du vitré initial (35,1% vs 8,5%), le nombre (3.7+-3.9 vs 2.7+-2.4) et la taille des déhiscences (16+-30 vs 6+-16), le nombre de cryothérapies (9.8+-5.6 vs 7.2+-4.1) et le taux de vitrectomie postérieure (63.5% vs 50.2%). Discussion : Le risque hémorragique dépend essentiellement des gestes associés lors de la chirurgie. Myopie, ponction de liquide sous-rétinien, indentation et/ou prise d'aspirine ne semblent pas favoriser l'hémorragie per ou post-opératoire. Conclusion : L acide acétylsalicylique, n est pas un facteur de risque indépendant de complications hémorragiques. Il n est donc pas nécessaire d arrêter l aspirine et de différer la chirurgie lors de la prise en charge des patients avec DR.Objective: To evaluate the hemorrhagic risk of treatment by acetylsalicylic acid, during the management of primary rhegmatogenous retinal detachment (RD). Design: case-control study (according to presence of perioperative bleeding complications). Participants: 322 patients (322 eyes) from a prospective cohort of 835 patients with primary rhegmatogenous RD operated on between 2004 and 2007. Methods: After exclusion of patients with RD secondary to trauma, subjects with a history of vitreoretinal surgery, diabetic retinopathy, aphakia or taking clopidogrel and/or a vitamin K antagonist, 74 patients were included in the hemorrhagic group and patients without hemorrhagic complications were randomly selected in order to reach a 1:3 case: control population. Univariate and multivariate analyses were performed to identify risk factors of perioperative bleeding. Main outcome measures: Occurrence of hemorrhagic complications such as hyphema and intravitreal, subretinal and suprachoroidal hemorrhage. Prognostic factors included final visual acuity (LogMAR) and the single-operation attachement rate. Results: Univariate analysis showed that the presence of initial vitreous hemorrhage, size of breaks, number of breaks, pars plana vitrectomy (PPV) and the number of cryotherapy impacts were significantly associated with perioperative bleeding. Independent risk factors of perioperative hemorrhage were the number of cryotherapy sessions (odds ratio =1.12 [1.06; 1.20], 95% CI), transscleral drainage (OR =4.22 [1.62; 10.98]), and PPV (OR =3.39 [1.36; 8.47]). The occurrence of bleeding complications was associated with a lower single-operation anatomical success rate. There was also a trend toward an association between bleeding complications, the total number of RD recurrences, and final visual acuity. Conclusion: Aspirin was not an independent risk factor of hemorrhagic complications during and after surgery of primary rhegmatogenous RD. The bleeding risk is instead associated with surgical factors such as PPV, cryotherapy, and subretinal fluid drainage.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

FRIENDS Group: clinical and microbiological characteristics of post-filtering surgery endophthalmitis.

International audiencePURPOSE: To study the clinical and microbiological characteristics as well as the prognostic factors for post-filtering surgery endophthalmitis. METHODS: Twenty-three eyes were included in the study in four tertiary centres between 2004 and 2010. The clinical and microbiological data were collected prospectively (minimum follow-up, 6 months). Microbiological diagnosis was based on conventional cultures and panbacterial PCR (16SrDNA amplification and sequencing). RESULTS: The onset of endophthalmitis was early (<6 weeks) in 22 % of the cases and delayed in 78 %. Elevated intraocular pressure and hypopyon were more frequent in delayed than in early presentations (p = 0.04). By combining the results of culture and panbacterial PCR, a bacterial species could be identified in 73.9 % of the cases, including 56.5 % of commensal species of the digestive tract such as Moraxella spp., oropharyngeal streptococci and Enterococcus faecalis. Good final visual acuity (VA ≥ 20/40) was correlated with initial VA greater than light perception (p = 0.05). Poor final VA (≤20/400) was correlated with a higher virulence of the infecting bacterial species (p = 0.006), and was noted in all patients with early-onset endophthalmitis. CONCLUSION: Acute early- or delayed-onset post-filtering surgery endophthalmitis is frequently caused by bacteria of the digestive tract (e.g., Streptococcus and Enterococcus spp.). The combination of conventional cultures and panbacterial PCR allowed us to identify the causative microorganism in three-quarters of the cases, i.e., 21 % more cases than through culture alone. Despite adequate antibiotic and surgical treatment, the anatomical and visual prognosis remains poor

Update on the prevention and treatment of endophthalmitis

Endophthalmitis remains a rare but serious cause of visual loss. Over time, changes have been noted in endophthalmitis in terms of predominant causes, infecting organisms, and antibiotic susceptibilities. There is controversy regarding the use of intracameral prophylactic antimicrobials during cataract surgery. Alternatively, there appears to be increasing evidence against using routine topical antibiotics for intravitreal injections. There are also increasing reports of multidrug-resistant organisms causing endophthalmitis, but the combination of vancomycin and ceftazidime appears effective for the vast majority of cases. Future trends may involve increasing utilization of polymerase chain reaction for diagnosis, and possibly office-based pars plana vitrectomy for treatment of endophthalmitis