Hydroxyurea (Hydrea) Management for Cataract Surgery
Continue hydroxyurea through cataract surgery without interruption, as cytoreductive therapy can be maintained throughout the perioperative period for low-bleeding-risk procedures like cataract surgery unless the surgical team expresses unique contraindications. 1
Primary Recommendation
Hydroxyurea should be continued perioperatively for cataract surgery based on NCCN guidelines for myeloproliferative neoplasms, which explicitly state that cytoreductive therapy (including hydroxyurea) can be continued throughout the perioperative period unless unique contraindications exist 1
Cataract surgery is classified as a low-bleeding-risk procedure where even full anticoagulation can be safely continued, making continuation of hydroxyurea even more appropriate 2, 3
Supporting Evidence for Continuation
The American College of Chest Physicians classifies cataract surgery among minor ophthalmologic procedures where medications affecting hemostasis can be safely continued 2
Topical or sub-Tenon's anesthesia (the preferred techniques for cataract surgery) carries minimal bleeding risk even with medications that affect coagulation 2, 3
Studies demonstrate that even warfarin continuation during cataract surgery results in bleeding rates of only approximately 10%, with almost all bleeds being self-limiting 2
When to Consider Holding Hydroxyurea
If retrobulbar anesthesia is planned (rather than topical/sub-Tenon's), discuss with the surgical team as this technique poses higher bleeding risk due to potential for retrobulbar hematoma 2
If the surgical team expresses specific concerns about bleeding risk in the context of the individual patient's clinical situation 1
Common Pitfalls to Avoid
Do not routinely discontinue hydroxyurea for standard cataract surgery, as this unnecessarily interrupts disease control without meaningful reduction in bleeding risk 1
Confirm the anesthesia technique with the ophthalmologist, as retrobulbar blocks carry higher bleeding risk than topical approaches 2
Avoid bridging strategies or complex perioperative medication adjustments for this low-risk procedure 2