When patients on aspirin antiplatelet therapy have surgery, the traditional practice has been to have them stop taking it beforehand. But when they have vitreoretinal surgery, staying on the drug does not significantly increase the risk for bleeding-related complications, according to the results of a new meta-analysis.

The analysis of seven studies and roughly 2900 patients, presented at European Society of Retina Specialists (EURETINA) 2026 in Vienna, found no statistically significant increase in the incidence of five bleeding-related eye complications, Hashem Abu Serhan, MD, a vitreoretinal surgeon at Hamad Medical Corporation in Doha, Qatar, reported.

“We frequently operate on older patients with cardiovascular comorbidities who are taking aspirin for primary or secondary prevention,” Serhan told Medscape Medical News. “The concern is that continuing aspirin may increase intraocular bleeding, whereas discontinuing it may expose patients to potentially serious thromboembolic complications, including myocardial infarction, stroke, and stent thrombosis.”

Vitreoretinal Evidence Lacking

However, Serhan noted that studies of aspirin in vitreoretinal surgery have been lacking “and sometimes conflicting,” unlike studies of aspirin in cataract surgery, for which a larger body of evidence exists.

In the meta-analysis, the overall risk ratio was 1.55 (95% CI, 0.73-3.29; P = .253). “Although the point estimate was above 1, the confidence interval included 1, meaning that the result was not statistically significant,” Serhan said.

Risk ratios for the five ocular complications were 1.52 for hyphema (0.56-4.17), 1.2 for subconjunctival hemorrhage (0.58-2.48), 1.06 for subretinal hemorrhage (0.15-7.63), 2.07 for choroidal hemorrhage (0.81-5.24), and 1.68 for retinal hemorrhage (0.33-8.52). The CIs for all were 95%.

However, even risk ratios well above 1 did not automatically establish an increased risk, Serhan explained. “We need to consider the confidence interval, the P value, and the precision of the estimate,” he said.

He cautioned that the findings do not mean aspirin carries no additional risk for bleeding. “Some confidence intervals were wide, particularly for uncommon complications, meaning that a clinically meaningful increase cannot be excluded,” Serhan said.

The meta-analysis also found no statistically significant difference in visual acuity after surgery, he said, but that should not be interpreted as a blanket statement that every patient having vitreoretinal surgery should continue aspirin.

“The decision should take into account the indication for aspirin, the patient’s systemic thrombotic risk, the underlying retinal pathology, and the complexity of the planned procedure,” Serhan said.

Patients undergoing extensive fibrovascular dissection for proliferative diabetic retinopathy or complex retinal detachment surgery may require an individualized approach, Serhan said. The surgical technique and potential bleeding during surgery may also factor in the bleeding risk, he said.

“Ultimately, we should avoid routinely discontinuing aspirin solely because a patient is scheduled for vitreoretinal surgery, particularly when interruption could expose them to avoidable systemic risk,” Serhan added. He also advised consulting with the physician who prescribed the aspirin therapy.

“The message is not that aspirin is risk free in every vitreoretinal procedure,” Serhan said. “Rather, it is that routine discontinuation may not be justified by the currently available evidence and that individualized, multidisciplinary decision-making is essential.”

Aspirin Has ‘No Large Effect’

“The meta-analysis gives us a number for something most vitreoretinal surgeons already do by instinct: Operate through aspirin,” said David Almeida, MD, MBA, PhD, a vitreoretinal surgeon and president and CEO of Erie Retina Research in Erie, Pennsylvania.

He cautioned against interpreting the results too loosely. “The confidence intervals are wide and the point estimates lean above 1, so the honest reading is ‘no large effect,’ not ‘no effect,’” Almeida said.

However, that conclusion is still clinically useful. “The harm on the other side of the ledger — stroke or myocardial infarction after stopping aspirin in a patient who has an indication for it — is well documented and is not small,” Almeida said.

The bottom line from the study, he said: “Continue aspirin for standard pars plana vitrectomy in a patient who takes it for a cardiovascular or cerebrovascular indication and talk to the prescribing physician rather than stopping it reflexively.”

A prospective registry that uses a standardized bleeding scale would be needed to validate the findings, Almeida said. Such a study should separate intraoperative from postoperative bleeding events and self-limiting from sight-threatening ones, taking into account the procedure type and agent and recording thrombotic outcomes, he said. “That is the trial the field actually needs: not whether aspirin raises bleeding but what the net benefit is per patient when both sides are counted.”

Serhan reported no relevant financial conflicts of interest. Almeida reports relationships with Dutch Ophthalmic Research Center and ZEISS. 

Richard Mark Kirkner is a medical journalist based in the Philadelphia area.