Cataract Extraction Without Prophylactic Treatment in Patients With Severe Factor XI Deficiency

PURPOSE: To assess the risks of intraoperative and postoperative bleeding associated with cataract extraction without prophylactic treatment in patients with severe factor XI (FXI) deficiency. DESIGN: Prospective interventional case series. METHODS: SETTING: Single institute. STUDY POPULATION: Consecutive unrelated patients with severe FXI deficiency who underwent cataract extraction under topical anesthesia, with a clear corneal incision, phacoemulsification, and implantation of a foldable posterior chamber intraocular lens (PCIOL) were enrolled. Patients with associated intraocular conditions that could complicate the surgery were excluded. INTERVENTION: Cataract extraction without prophylactic treatment for the FXI deficiency. MAIN OUTCOME MEASURES: Assessment of intraoperative and postoperative ocular bleeding and other related complications. RESULTS: Seven patients ranging in age from 61 to 95 years (median, 79) underwent phacoemulsification and PCIOL implantation in 11 eyes. Five patients (71%) were homozygotes for type II mutation of the FXI gene (activity level of <1 U/dl), I patient was a homozygote for type III mutation (activity level of II U/dl), and I patient was a compound heterozygote for types II and III (activity level of 3 U/dl). Three of the patients (43%), all type II homozygotes, also had an inhibitor antibody to FXI. All 7 patients were followed for at least I week after the operation. The surgery was uneventful in all eyes, and neither major nor minor bleeding events were observed in any of the operated eyes during surgery and follow-up. CONCLUSIONS: Cataract extraction by phacoemulsification in uncomplicated eyes can be performed safely without prophylactic treatment in patients with severe FXI deficiency with or without inhibitor antibodies against FXI. (Am J Ophthalmol 2009;148:920-924. (C) 2009 by Elsevier Inc. All rights reserved.)