[r-tPA in keratoplasty à chaud. Report of 50 patients].
BACKGROUND
Fibrinolytic treatment using recombinant plasminogen activator (r-tPA) has been reported in cataract surgery; however, reports are lacking with respect to complex surgical interventions including keratoplasty because of anterior segment infections.


METHODS
This report deals with a prospective study comprising 50 patients (50 eyes) suffering from a serpent ulcer treated by keratoplasty à chaud. r-tPA (25 micrograms) was instilled intracamerally at the end of surgery in 25 eyes.


RESULTS
The 25 eyes treated with r-tPA were subsequently less inflamed than the control population (decrease in inflammatory cells 1.5 days vs 7 days, fibrin reaction 1x vs 12x), had highly significantly better visual acuity and there was significantly reduced inpatient hospitalization (median 9.9 vs 19.3 days). No hemorrhages were observed in either population; medically treated infection recurrences (S. aureus, C. tropicalis, acanthameba) were observed in 3 and primary graft failure or rejection in both populations 3x.


CONCLUSIONS
This study showed that perioperative application of r-tPA had a beneficial effect. This therapeutic avenue should be further evaluated in a randomized, double-masked multicenter study.
Bialasiewicz
A A
AA
Augenklinik mit Poliklinik, Universitätskrankenhauses Hamburg-Eppendorf.
Hassenstein
A
A
Richard
G
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016039:Corneal Transplantation; D003320:Corneal Ulcer / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007322:Instillation, Drug; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000008:administration & dosage; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*
D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator
r-tPA bei der Keratoplastik à chaud. Bericht über 50 Patienten.