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Abstract #5891 Published in IGR 2-1
Therapeutic and prophylactic application of TPA (recombinant tissue plasminogen activator) into the anterior chamber of the eye)
Rehfeldt K; Hoeh HOphthalmologe 1999; 96:587-593
BACKGROUND: In therapy-resistant fibrin reactions within the anterior chamber, especially following combined cataract and glaucoma surgery, injection of TPA is indicated. The authors report their results. PATIENTS AND METHODS: From August 1994 to August 1998, they applied TPA 185 times into anterior chambers. A total of 123 injections were for therapeutic reasons (if local therapy with eyedrops showed no fibrinolytic effect), 32 for prophylactic reasons at the end of the operation with intensive manipulation of the iris and following postoperative fibrin risk, and 30 applications for nonfunctional filtering blebs following glaucoma surgery. The authors applied 10 μg/0.1 ml. RESULTS: On the first day after therapeutic application of TPA, the fibrin was completely dissolved in 61% of the eyes, and in 36.6% partial fibrinolysis occurred (total 97.6%). Only 2.4% of the eyes showed no fibrinolysis. Seventy-five percent of the eyes showed no fibrin reaction within the anterior chamber after prophylactic application of TPA. In all eyes (100%) the authors would have expected fibrin reactions. Application of TPA for a filtering blebs disorder after glaucoma surgery resulted in restoration of the filtering bleb function in two-thirds of the eyes. COMPLICATIONS: After 185 applications of TPA into the anterior chamber, ten occurrences anterior chamber bleeding were seen (5.4%). In six eyes (3.2%), transient clouding of the corneal endothelium and/or corneal stroma was seen. These complications were reversible, except for irreversible endothelial decompensation in one eye with Fuchs' corneal dystrophy. CONCLUSIONS: TPA is effective for treating fibrin formation within the anterior chamber and maintaining the function of the filtering bleb. To confirm and quantify the efficiency of prophylactic use, a controlled prospective study is recommended. LA: German
Dr. K. Rehfeldt, Augenklinik, Klinikum Nübrandenburg, Akademisches Lehrkrankenhaus der Ernst-Moritz-Arndt-Universität, Greifswald, Germany
Classification:
12.8.11 Complications, endophthalmitis (Part of: 12 Surgical treatment > 12.8 Filtering surgery)