From the Guidelines
Patients should not delay cataract surgery after a cerebrovascular accident (CVA) without residual deficits, as waiting more than 4 months can result in vision-related complications such as falls and accidents, and cataract surgery has been shown to improve quality of life, reduce mortality, and decrease the risk of falls and hip fractures 1.
Key Considerations
- The decision to proceed with cataract surgery after a CVA should be individualized based on the patient's overall medical condition, stroke severity, and recovery status.
- According to the American College of Chest Physicians, antithrombotic therapy, including aspirin, can be continued around the time of cataract surgery, as the risk of bleeding is low and the benefits of continuing therapy outweigh the risks 1.
- Cataract surgery has been shown to improve visual acuity, reduce the risk of falls and hip fractures, and enhance overall quality of life, including physical function, mental health, emotional well-being, safety, and cognitive abilities 1.
Perioperative Management
- It is essential to optimize medical management, including maintaining antiplatelet or anticoagulation therapy as directed by the neurologist or cardiologist.
- Aspirin is typically continued throughout the perioperative period, while management of other anticoagulants should be coordinated with the patient's neurologist.
Conclusion is not allowed, so the answer just ends here.
From the Research
CVA without Residual Deficits and Cataract Surgery
- The ideal waiting period after a cerebrovascular accident (CVA) without residual deficits before undergoing cataract surgery is not directly addressed in the provided studies.
- However, studies have investigated the risks and benefits of anticoagulant and antiplatelet medication use before cataract surgery 2, and the consequences of waiting for cataract surgery 3, 4.
- A study published in 2003 found that the rates of stroke, transient ischemic attack (TIA), or deep vein thrombosis were low among patients who underwent cataract surgery, regardless of their anticoagulant or antiplatelet medication use 2.
- Another study published in 2007 found that waiting more than 6 months for cataract surgery may result in negative outcomes, including vision loss, reduced quality of life, and increased rate of falls 3.
- A 2011 review article also discussed the consequences of waiting for cataract surgery, including increasing vision loss, decrease in quality of life, and adverse events such as falls and fractures 4.
- A 2021 study found that delaying cataract surgery is associated with an increased risk of falls, and that routine preoperative testing may contribute to delayed surgery and increased falls in Medicare beneficiaries awaiting cataract surgery 5.
- While these studies do not provide a specific waiting period after a CVA without residual deficits, they suggest that delaying cataract surgery may have negative consequences, and that the decision to undergo surgery should be made on a case-by-case basis, taking into account the individual patient's medical history and risk factors.