From the Guidelines
Patients with a positive Roplas test result should be managed with careful consideration of their anticoagulation therapy and thrombotic risk before undergoing ophthalmic surgery. The primary concern in these patients is the increased risk of thrombosis, which can be exacerbated by surgery. However, the provided evidence does not directly address the management of patients with a positive Roplas test result 1.
In the context of ophthalmic surgery, it is essential to balance the risk of thrombosis with the risk of bleeding complications. Although the study by 1 discusses preoperative evaluation and counseling for cataract surgery, it does not specifically address the management of patients with a positive Roplas test result.
Given the potential risks, continuing anticoagulation therapy while coordinating with hematology for perioperative management is crucial. The specifics of anticoagulation management, such as targeting an INR of 2.0-3.0 for patients on warfarin or discontinuing direct oral anticoagulants 48-72 hours before surgery, should be individualized based on the patient's condition and the type of surgery 1.
Key considerations in the preoperative management of these patients include:
- Laboratory testing, such as a complete blood count and coagulation profile
- Anesthesia consultation to determine the safest approach, often favoring local or topical anesthesia when possible
- Coordination with hematology for perioperative management of anticoagulation therapy
- Careful assessment of the patient's overall medical condition and potential risks associated with surgery 1.
By prioritizing these considerations, clinicians can minimize the risks associated with ophthalmic surgery in patients with a positive Roplas test result and optimize outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Preoperative Management Considerations for Ophthalmic Surgery Patients with a Positive Roplas Test Result
- The Roplas test, also known as regurgitation on pressure over the lacrimal sac, is used to diagnose nasolacrimal duct obstruction (NLDO) prior to intraocular surgeries 2.
- A positive Roplas test result indicates the presence of NLDO, which can increase the risk of complications during ophthalmic surgery.
- The sensitivity and specificity of the Roplas test have been reported to be 54.5% and 100%, respectively, with a positive predictive value of 75.3% and a negative predictive value of 99.4% 2.
- Another study reported a sensitivity and specificity of 93.2% and 99.3%, respectively, for the Roplas test in diagnosing chronic dacryocystitis 3.
- Preoperative management considerations for patients with a positive Roplas test result may include:
- Further evaluation and treatment of NLDO or chronic dacryocystitis before proceeding with ophthalmic surgery.
- Consideration of alternative surgical approaches or techniques to minimize the risk of complications.
- Close monitoring of the patient's condition during surgery and postoperative period.
- It is also important to note that patients with autoimmune diseases, such as antiphospholipid syndrome, may be at increased risk of complications during ophthalmic surgery 4, 5.
- The management of antiplatelet and anticoagulant drugs in patients undergoing elective ophthalmic surgery is also crucial to prevent bleeding complications 6.