Omega-3 fatty acids after trabeculectomy: Anti-inflammatory ally or bleeding risk?

This audio article is from VisualFieldTest.com.Read the full article here: https://visualfieldtest.com/en/omega-3-fatty-acids-after-trabeculectomy-anti-inflammatory-ally-or-bleeding-riskTest your visual field online: https://visualfieldtest.comSupport the show so new episodes keep coming: https://www.buzzsprout.com/2563091/supportExcerpt:Omega-3 Fatty Acids after Trabeculectomy: Anti-Inflammatory Ally or Bleeding Risk? Trabeculectomy – a common surgery to lower eye pressure in glaucoma – creates a bleb (a fluid-filled reservoir) under the conjunctiva. After surgery, patients often face ocular surface inflammation and dry eye because of disrupted tear films and inflammation from wound healing. Since omega-3 fatty acids (the anti-inflammatory oils in fish oil) are known to calm inflammation elsewhere in the body, some surgeons and patients wonder: Can fish oil supplements help with eye comfort and bleb health after trabeculectomy, or do they pose a bleeding risk? We review the evidence. Overall, many trials show that the EPA/DHA omega-3 oils can reduce inflammation and improve tear quality after eye surgery, but their direct effects on bleb function are unproven. On the other hand, omega-3s do make platelets less sticky – a theoretical concern for bleeding. Fortunately, large analyses indicate routine omega-3 doses have minimal impact on surgical bleeding. In practice, moderate omega-3 supplements may help with post-op eye comfort, but clinicians should watch for any extra bleeding in high-risk patients. What Are Omega-3 Fatty Acids? Omega-3 fatty acids (especially eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)) are healthy polyunsaturated fats found in fatty fish (salmon, mackerel, etc.) or supplements. They cannot be made by our bodies and must come from diet or pills. Omega-3s are famously anti-inflammatory: in the body they compete with the usual inflammatory fats (arachidonic acid) and lead to the production of anti-inflammatory molecules (resolvins and protectins) (). In practical terms, omega-3s can reduce swelling and improve tissue healing in many parts of the body. In the eye, inflammation and tear-film imbalance underlie dry eye symptoms. Omega-3s are thought to improve the oily layer of tears (from the eyelid glands) and calm surface inflammation. Indeed, trials in dry-eye patients have shown that omega-3 supplements can lengthen the time between eye blinks before tearing occurs (tear break-up time) and reduce tear osmolarity (less irritating, more stable tears) () (). These changes translate to patients feeling less dryness, burning and scratchiness when it works. (Note: for severe chronic dry eye, a very large trial (the DREAM study) found 3,000 mg/day of omega-3 did not beat placebo on symptom scores, a result that some experts debate due to study design ().) In summary: Omega-3s are generally anti-inflammatory fats that can improve tear-film stability and may soothe irritated eyes after surgery () (). This forms the rationale for trying them after trabeculectomy. Omega-3 Supplements and Post-Op Eye Comfort Several randomized trials have tested omega-3 supplements for post-surgical dry eye and inflammation. Although no study has looked specifically at trabeculectomy patients, we can apply findings from cataract and refractive surgery cases: Cataract surgery: In a 2017 trial, patients with new dry eye symptoms after cataract removal were given standard treatment with or without omega-3 capsules (each tablet: 180 mg EPA + 120 mg DHA, taken 3 times daily). After a few weeks, the omega-3 group had significantly greater improvement in symptom scores and tear stability than controls (). For example, the average eye-comfort score fell more in the fish-oil group, and tear break-up time improved more on omega-3 (P<0.05) (). This suggests that adding fish oil to routine therapy reduced postoperative inflammation and improved ocular surface comfort. Photorefractive keratectomy (PRK): Another small trial looked at patients undergoing PRK (another eye surgery that can cause dry eye). Those who took omega-3 supplements before and after surgery healed quicker and had better vision outcomes and tear stability than those without omega-3 (). (This pilot study supports that omega-3 may speed corneal healing after surgery.) Chronic dry eye (non-surgical): A trial comparing krill oil vs. fish oil vs. placebo in people with dry eye (not after surgery) found both omega-3 groups improved objective tear measures. After 3 months, tear osmolarity and tear break-up time were significantly better with krill or fish oil than placebo (). In that study the krill-oil group (higher EPA ratio) also had a significantly greater drop in symptom scores (patient comfort) than placebo (). Meta-analyses of dry-eye trials generally conclude omega-3s give small but real benefits on tear-film health and symptoms – especially when doses are high and used long-term () (). However, not all reviews are uniformly positive. A 2023 Cochrane review concluded that omega-3s probably have little to no effect on patient-reported dry eye symptoms compared to placebo, though they may improve some tear-test signs (). Importantly, the Cochrane authors noted that combining omega-3 with standard treatments (like artificial tears) seemed more helpful than omega-3 alone. In practice, this suggests fish oil is an add-on therapy: it may work best alongside drops, lid hygiene and other post-op care. What does this mean for trabeculectomy? Trab patients often stop many glaucoma drops (which can irritate the surface) but still experience dry eye and inflammation from surgery trauma. The cataract and PRK trials above imply that omega-3 supplements can make a difference in post-op ocular comfort. While we lack a trial in trab patients, it is reasonable to extrapolate: an omega-3 supplement regimen (e.g. several hundred to a few thousand mg of combined EPA/DHA per day) might reduce irritation, dryness and redness after trabeculectomy, improving patient comfort. Potential Effects on Bleb Health A key question is whether reduced inflammation from omega-3 translates into better bleb healing. The ideal bleb is thin, functioning and leak-free; too much early inflammation can cause scarring and bleb failure. In theory, omega-3’s anti-inflammatory action could help keep fibrosis in check. To date, there are no direct trials of omega-3 on bleb outcomes. However, some clues come from studies of tear biochemistry after trabeculectomy. One 3-year cohort study measured inflammatory lipid mediators in tears before and after trab. It found that pro-inflammatory tear lipids (like certain prostaglandins) dropped markedly after surgery in most patients (). Interestingly, patients who later needed needling of their bleb (a sign of failing bleb with scarring) had higher levels of some inflammatory lipids in their tears than those with healthy blebs (). This suggests chronic inflammation may underlie some bleb problems. By extension, if an intervention like omega-3 could suppress that inflammation, bleb health might benefit. However, this is speculative: no data show that fish oil actually prevents bleb scarring or reduces needling rates. It is also possible that reducing inflammation too much could impair the normal wound closure of the conjunctiva. On balance, most experts would say omega-3’s potential benefits on wound healing via inflammation control are theoretical in the bleb context. We note it as a possible plus, but emphasize the lack of direct evidence. Platelet Function and Bleeding Risk Omega-3s and Platelets: One known effect of EPA/DHA is that they make platelets somewhat less likely to clump. In very high-fish diet populations (like Greenland Inuit), scientists observed prolonged bleeding times and altered platelet fatty acids compared to typical Western diets (). This anti-platelet effect has raised caution among surgeons that omega-3 supplements could increase surgical bleeding. In fact, many guidelines currently advise stopping fish oil before surgery and delaying non-urgent ops for a few days if patients are on fish-oil supplements (). The idea is largely precautionary: fish oil does change cell membranes to be less pro-thrombotic (). However, whether this translates into real harm is the question. Clinical evidence on bleeding risk: Recent analyses have been reassuring. A 2024 meta-analysis of 11 randomized trials (over 120,000 patients) compared bleeding rates in those taking omega-3 supplements vs. controls. It found no significant difference in overall bleeding events (including strokes or gastrointestinal bleeds) between the groups (). Only very high-dose purified EPA (like icosapent ethyl used for heart disease) showed a slight relative increase in bleeding (50% higher risk) – but this change was tiny in absolute terms (0.6% more events) (). Likewise, a large perioperative trial (OPERA, n≈1500) tested giving 8–10 g of fish oil before open-heart surgery and 2 g/day after. The fish-oil group did not have more bleeding – in fact, they had slightly fewer blood transfusions than placebo () (). The odds of major bleeding were not higher (OR≈0.8) in the fish-oil group (). These findings suggest that at least in major surgery, fish oil at high dose didn’t worsen bleeding outcomes. Bottom line on bleeding: In practical terms, normal omega-3 use (roughly 1–3 grams/day of fish oil) appears to have negligible effect on surgical bleeding risk () (). The small impairment in platelet function is mostly offsSupport the show