Therapeutic application of tissue plasminogen activator for fibrin reaction after cataract surgery

Abstract

Complete lysis of fibrin after cataract surgery with conventional topical medications can take a long time and is not successful in some patients. Intracameral application of 3 microg rtPA was an efficient, safe method for the treatment of fibrin reaction after cataract surgery.

Intracameral recombinant tissue plasminogen activator (r-tPA) for refractory toxic anterior segment syndrome

“…This leads to a vicious cycle of fibrin formation. Rates of fibrin formation after cataract surgery vary between 2% and 8% in the general population 9 14. Findings of a significant decrease in endogenous tPA activity in the first days after cataract surgery with IOL implantation led to the suggestion that the process of fibrin formation may be associated with fluctuations in tPA in the aqueous humour of pseudophakic eyes 16.…”

“…Using a rabbit model of intraocular fibrin formation, Snyder et al 8 were the first to show (1987) that r-tPA promotes fibrin dissolution with minimal toxicity. Since then, r-tPA has been used in humans for anterior chamber fibrinolysis after intraocular surgeries, in dosages of 3–25 µg,9–17 with high effectiveness and safety 11 14 19…”

Anterior segment imaging in the management of postoperative fibrin pupillary–block glaucoma

“…1,2 Reports of fibrin formation after cataract surgery vary between 2% and 8% in a general population 3-5 and may be higher in patients with ocular conditions such as uveitis and pseudoexfoliation syndrome 5,6 and systemic conditions such as hypertension 4 and diabetes mellitus. 6,7 Intraocular pressure elevation as a result of fibrin formation appears to be uncommon.…”

Toxic Effects of Recombinant Tissue Plasminogen Activator on Cultured Human Corneal Endothelial Cells

“…8 It should be kept in mind that several previous reports suggest a lower dose of rtPA in the anterior chamber might also be effective. Ozveren et al 25 performed an intracameral application 3 g, resulting in a final concentration of 15 g/mL in the anterior chamber. Klais et al 26 described successful fibrinolysis after 10 g/mL.…”