Tissue plasminogen activator for preserving inferior peripheral iridectomy patency in eyes with silicone oil.
OBJECTIVE
An inferior peripheral iridectomy (IPI) was used to prevent forward migration of silicone oil in vitrectomized eyes; however, in approximately one third of eyes, the IPI closed spontaneously. Occlusion of the IPI by fibrin is believed to be an early event in permanent IPI closure by scar tissue. The authors determined whether intraocular tissue plasminogen activator (tPA) would restore and maintain IPI patency in eyes that had early occlusion of the IPI by fibrin.


METHODS
Between November 1993 and January 1995, 12 patients who underwent vitrectomy with silicone tamponade and IPI for complicated retinal detachment received an anterior chamber injection of tPA (6.25 or 12.5 microgram) for occlusion of the IPI by fibrin.


RESULTS
All 12 patients had lysis of fibrin and maintained a patent IPI at the last follow-up (124+/-95 days). One patient required multiple tPA injections for recurrent fibrin formation. In another patient, a small hyphema developed after the tPA injection, which did not occlude the IPI. When compared with the natural course in a very similar group of patients previously reported, tPA had a statistically significant beneficial effect in the maintenance of IPI patency (P = 0.040).


CONCLUSIONS
Intraocular tPA can be safely used to lyse postoperative fibrin occluding the IPI in eyes with silicone oil tamponade. Early lysis of this fibrin maintains IPI patency.
MacCumber
M W
MW
Department of Ophthalmology, Duke University, Durham, NC 27710, USA.
McCuen
B W
BW
Toth
C A
CA
Ferrone
P J
PJ
Jaffe
G J
GJ
D000328:Adult; D000368:Aged; D000867:Anterior Chamber / Q000187:drug effects; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects; D005500:Follow-Up Studies; D006801:Humans; D007498:Iris / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010030:Ostomy; D010960:Plasminogen Activators / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy* / Q000209:etiology; D012163:Retinal Detachment / Q000601:surgery; D012827:Silicone Oils; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014821:Vitrectomy / Q000009:adverse effects
D012827:Silicone Oils; D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator