[Therapeutic and prophylactic application of TPA (recombinant tissue plasminogen activator) into the anterior chamber of the eye].
BACKGROUND
In therapy-resistant fibrin reactions within the anterior chamber, especially following combined cataract and glaucoma surgery, injection of TPA is indicated. We report our results.


METHODS
From August 1994 to August 1998 we applied TPA 185 times into anterior chambers. A total of 123 injections were for therapeutic reasons (if local therapy with eyedrops showed no fibrinolytic effect), 32 for prophylactic reasons at the end of operations with intensive manipulation of the iris and following postoperative fibrin risk, and 30 applications for nonfunctional filtering blebs following glaucoma surgery. We applied 10 microg/0.1 ml.


RESULTS
On the first day after therapeutic application of TPA, the fibrin was completely dissolved in 61 % of the eyes, and in 36.6 % of the eyes partial fibrinolysis occurred (total 97.6 %). Only 2.4 % of the eyes showed no fibrinolysis. Seventy-five percent of the eyes showed no fibrin reaction within the anterior chamber after prophylactic application of TPA. In all eyes (100 %) we would have expected fibrin reactions. Application of TPA for a filtering blebs disorder after glaucoma surgery resulted in restoration of the filtering bleb function in two-thirds of the eyes.


RESULTS
After 185 applications of TPA into the anterior chamber we saw ten occurrences anterior chamber bleeding (5.4 %). In six eyes (3.2 %) we saw transcient clouding of the corneal endothelium and/or corneal stroma. These complications were reversible, except for irreversible endothelial decompensation in one eye with Fuchs' corneal dystrophy.


CONCLUSIONS
TPA is effective for treating fibrin formation within the anterior chamber and maintaining the function of the filtering bleb. To confirm and quantify the efficiency of prophylactic use, a controlled prospective study is recommended.
Rehfeldt
K
K
Augenklinik, Klinikum Neubrandenburg, Akademisches Lehrkrankenhaus der Ernst-Moritz-Arndt-Universität Greifswald.
Höh
H
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000867:Anterior Chamber / Q000187:drug effects*; D002387:Cataract Extraction; D002648:Child; D005260:Female; D005337:Fibrin / Q000378:metabolism; D018463:Filtering Surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions; D011182:Postoperative Care; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
D009883:Ophthalmic Solutions; D011994:Recombinant Proteins; D005337:Fibrin; D010959:Tissue Plasminogen Activator