Intracameral Tissue Plasminogen Activator for Resolution of Fibrin Clots After Glaucoma Filtering Procedures

Tripathi, Ramesh C.; Tripathi, Brenda J.; Park, James K.; Quaranta, Luciano; Steinsapir, Kenneth D.; Lehman, Erica; Ernest, J. Terry

doi:10.1016/s0002-9394(14)72272-x

Cited by 49 publications

(10 citation statements)

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“…t-PA, unlike streptokinase and urokinase, is a more fibrin-selective plasminogen activator (13). It has been used to treat intraocular hemorrhage or fibrin formation, such as postvitrectomy anterior chamber clots (14), vitreous hemorrhage (15), post-penetrating keratoplasty excessive fibrin formation (16), postvitrectomy fibrin formation (12), postvitrectomy fibrin pupillary block glaucoma (17), postglaucoma filtering fibrin formation (18), and submacular hemorrhage (19)(20)(21). Lambrou et al examined the rate of clearance of experimental hyphema using t-PA.…”

Section: Discussionmentioning

confidence: 99%

Management of Postvitrectomy Diabetic Vitreous Hemorrhage with Tissue Plasminogen Activator (t-PA) and Volume Homeostatic Fluid-Fluid Exchanger

Chang²,

Chen³

et al. 2001

Journal of Ocular Pharmacology and Therapeutics

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The incidence of recurrent vitreous hemorrhage of proliferative diabetic retinopathy following posterior vitrectomy ranges from 29% to 75% in reported series. Fluid-gas exchange and vitreous cavity lavage are the popular methods of treating this kind of recurrent hemorrhage. The fluid-gas exchange cannot offer clear vision immediately after the procedure. To improve the function of the classic vitreous cavity lavage, we designed a volume homeostatic fluid-fluid exchanger - Chen's I/A device. Tissue plasminogen activator (t-PA) is a protease that preferentially converts fibrin-bound plasminogen to the active proteolytic enzyme, plasmin. It has been clinically and experimentally proven effective in lysis of postvitrectomy blood clot and fibrin formation. When the blood clot is formed in the vitreous cavity, intravitreal injection of t-PA can convert plasminogen to plasmin and remove the clot. From July 1999 to January 2000, ten eyes of postvitrectomy diabetic vitreous hemorrhage (PDVH) were collected. In each case, 4 days after intravitreal injection (IVI) of t-PA (30 microg), vitreous cavity lavage was performed with Chen's I/A device. Of these cases, 8 eyes (80%) experienced an immediate clearing of the vitreous cavity. Early complications included anterior hyaloid fibrovascular proliferation (2 eyes) and postoperative intraocular pressure elevation (3 eyes). On the basis of the results of this study, our conclusion is that volume homeostatic vitreous cavity lavage, combined with intravitreal injection of t-PA, is an excellent method for treatment of postvitrectomy diabetic vitreous hemorrhage but, in cases of PDVH with iris rubeosis, the advantage of this procedure is uncertain.

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Section: Discussionmentioning

confidence: 99%

Management of Postvitrectomy Diabetic Vitreous Hemorrhage with Tissue Plasminogen Activator (t-PA) and Volume Homeostatic Fluid-Fluid Exchanger

Chang²,

Chen³

et al. 2001

Journal of Ocular Pharmacology and Therapeutics

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“…Under sterile conditions, we had previously prepared an injectable solution by reconstituting 20 mg of lyophilized recombinant tPA in 20 ml of distilled water [Tripathi et al, 1991 J. For optimal pharmacokinetic activity, tPA should be reconstituted with distilled water rather than with saline [Ward and Weck, 19901.…”

Section: Methodsmentioning

confidence: 99%

“…The presence of fibrin in the anterior chamber for a prolonged period, therefore, implies that the amount of this naturally occumng protease is insufficient for fibrinolysis, and this provides a rationale for its supplementation as a therapeutic approach [Tripathi et al, 19881. Intracameral administration of tPA has been reported to be effective in an animal model for the clearance of fibrin clots in the anterior chamber and vitreous cavity [Snyder et al, 1987;Johnson et al, 19881. tPA has also been used for the rapid lysis of fibrin clots in man after vitrectomy Jaffe et al, 1989Jaffe et al, , 1990Dabbs et al, 19901, but only in isolated cases for lysis of fibrin clots or blood clots in the anterior chamber or in a filtration site after anterior segment surgery [Ortiz et al, 1988;Snyder et al, 1990;Tripathi et al, 1991;Baker et al, 19911. We now report on a series of 10 patients who underwent successful injection of tPA in the anterior chamber or in a subconjunctival bleb for treatment of complications that resulted from fibrin and/of blood clots after anterior segment surgery for cataract and/or glaucoma.…”

Section: Introductionmentioning

confidence: 99%

Use of tissue plasminogen activator for rapid dissolution of fibrin and blood clots in the eye after surgery for glaucoma and cataract in humans

Tripathi

Bornstein

et al. 1992

Drug Development Research

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Tripathi, R.C., B.J. Tripathi, S. Bornstein, E. Gabianelli, and J.T. Ernest: Use of tissue plasminogen activator for rapid dissolution of fibrin and blood clots in the eye after surgery for glaucoma and cataract in humans. Drug Dev. Res. 27:147-I 59, 1992.We treated 10 patients with tissue plasminogen activator (tPA) for complications that threatened the successful outcome of anterior segment surgery for glaucoma and/or cataract, and that endangered the structural and functional integrity of the eye. Eight patients who had developed massive fibrin or blood clots in the anterior chamber each received 10-20 p, g of tPA intracamerally, and two patients who had an extensive subconjunctival blood clot that blocked the filtration site received 25 or 30 pg of tPA subconjunctivally. The clots dissolved within 30 min to a few hours in all patients. Except in one patient who developed a 10% hyphema after the tPA injection, we observed no ocular complications in any of our patients during a follow-up period that ranged from 2-22 months. Our preliminary investigations show that intracameral injection of tPA is highly effective and safe for the rapid dissolution of fibrin and blood clots in the anterior chamber that obstruct the visual axis, obscure the view of the fundus, or cause failure of filtering blebs, and for lysis of synechiae of 2 to 3 days duration. Optimal results were obtained with intracameral injection of 2 10 pg tPA at 4 to 10 days after surgery. However, tPA should be regarded as an acute therapy and adjunctive modality for the treatment of fibrin and blood clots in the anterior segment of the eye. To

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“…The formation of fibrinous membranes in the anterior chamber causes many complica tions including pupillary block glaucoma, fixed pupil, displacement of the intra-ocular lens and decreased visual acuity [1][2][3][4], Generally, the management of intra-ocular fibrin consists primarily of attempting to sup press intra-ocular inflammation with steroidal and non-steroidal anti-inflammatory agents. These drugs decrease intra-ocular prostaglan din production and stabilize the blood-ocular barrier.…”

Section: Introductionmentioning

confidence: 99%

Effect of Suleparoide on Fibrinolysis in the Anterior Chamber of Rabbits

et al. 1996

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Intra-ocular fibrin deposition following ocular surgery is a serious postoperative complication. The current management of severe postoperative fibrin response is usually ineffective. A quantitative model of fibrin deposition in the rabbit anterior chamber was used to assess the efficacy of Suleparoide I.N.N. (HHS-5) in preventing fibrin formation and in promoting the clearance of fibrinous membranes. Citrated human plasma was injected intracamerally after paracentesis to induce the formation of fibrin clots: 10 min or 24 h after plasma injection, solutions of HHS-5 at different concentrations were injected into the anterior chamber of rabbits. Intra-ocular HHS-5 injection 10 min after plasma injection prevented the formation of fibrinous membranes in a dose-dependent fashion in almost all treated animals. When HHS-5 was injected at 24 h after fibrin clot formation, a reduction of clot areas was observed but the membranes did not completely disappear. No evidence of ocular toxicity was detected by slit-lamp bio microscopy, intra-ocular pressure and corneal thickness measurements. On the basis of the results obtained with the present animal model, HHS-5 appears as an effective and safe agent for the prevention of fibrinous membrane formation. The data suggest a potential use of HHS-5 for the prophylaxis of fibrin formation in human eyes undergoing extensive intraocular surgery, or in diabetic patients where a hypercoagulable state may be present.

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Intracameral Tissue Plasminogen Activator for Resolution of Fibrin Clots After Glaucoma Filtering Procedures

Cited by 49 publications

References 1 publication

Management of Postvitrectomy Diabetic Vitreous Hemorrhage with Tissue Plasminogen Activator (t-PA) and Volume Homeostatic Fluid-Fluid Exchanger

Management of Postvitrectomy Diabetic Vitreous Hemorrhage with Tissue Plasminogen Activator (t-PA) and Volume Homeostatic Fluid-Fluid Exchanger

Use of tissue plasminogen activator for rapid dissolution of fibrin and blood clots in the eye after surgery for glaucoma and cataract in humans

Effect of Suleparoide on Fibrinolysis in the Anterior Chamber of Rabbits

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