Recombinant hirudin for prevention of experimental postoperative intraocular fibrin.
OBJECTIVE
To determine the efficacy of a specific antithrombin agent (recombinant desulphatohirudin variant 1 [Revasc, Ciba-Geigy, Ltd., Basel, Switzerland]) administered in the infusion fluid to prevent early postoperative fibrin formation in a rabbit lensectomy and vitrectomy model.


METHODS
Standard fragmatome lensectomies and core vitrectomies were performed prospectively in a masked fashion on ten control eyes with lactated Ringer's infusion and on ten eyes treated with 10 microgram of recombinant hirudin/ml in the infusate. The amounts of fibrin and hemorrhage were graded in a masked fashion by using slit-lamp examination and indirect ophthalmoscopy on postoperative days 1 through 5 and on day 7.


RESULTS
The difference in the mean grade of fibrin formed on the first postoperative day in the eyes treated with recombinant hirudin (mean, 0.9) in relation to the mean grade of fibrin in the control eyes (mean, 3.5) was statistically significant (P = .004). This difference was also significant on the second postoperative day (P = .01). None of the treated eyes developed intraoperative or postoperative hemorrhage.


CONCLUSIONS
Recombinant desulphatohirudin variant 1 is an effective inhibitor of postoperative fibrin formation in a rabbit model and is not associated with an increased risk of intraoperative or postoperative bleeding at the tested dose. This drug may be a useful adjunct in vitreous surgery for both proliferative vitreoretinopathy and the complications of proliferative diabetic retinopathy.
Nasir
M A
MA
Department of Ophthalmology, Duke University Medical Center, Durham, NC 27710, USA.
Toth
C A
CA
Mittra
R A
RA
D000818:Animals; D000991:Antithrombins / Q000627:therapeutic use*; D004195:Disease Models, Animal; D005130:Eye Hemorrhage / Q000209:etiology / Q000517:prevention & control; D005337:Fibrin / Q000187:drug effects*; D005342:Fibrinolysis / Q000187:drug effects; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D024764:Hirudin Therapy; D007908:Lens, Crystalline / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D011446:Prospective Studies; D011817:Rabbits; D011994:Recombinant Proteins / Q000627:therapeutic use; D015912:Thrombolytic Therapy; D014821:Vitrectomy / Q000009:adverse effects
D000991:Antithrombins; D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D005337:Fibrin