General Medicine and Perioperative Care
Core concepts
Understand perioperative risk assessment for ophthalmic surgery. Know the management of patients on anticoagulants and antiplatelets. Learn the systemic associations of ocular disease: diabetes, hypertension, and autoimmune disease. Understand the preoperative evaluation for cataract surgery, including history and medications. Know the signs of systemic complications: endophthalmitis, retrobulbar hemorrhage, and oculocardiac reflex.
Traps
Do not routinely stop anticoagulants for cataract surgery without consulting the prescribing physician. Recognize that retrobulbar hemorrhage is an emergency requiring pressure and possibly lateral canthotomy. The oculocardiac reflex can cause bradycardia during strabismus surgery. Be aware of the risk of infection in patients on immunosuppressants.
Rule of thumb
For a patient on warfarin undergoing cataract surgery, check INR and coordinate with the internist; do not stop anticoagulation without a plan.
Worked example
A patient on warfarin for atrial fibrillation is scheduled for cataract surgery. The INR is 2.5. Proceed with surgery after coordination, as the risk of bleeding is low with topical anesthesia.