Tissue plasminogen activator to treat impending pupillary block glaucoma in patients with acute fibrinous HLA-B27 positive iridocyclitis.
OBJECTIVE
To report the use of intracameral tissue plasminogen activator to dissolve fibrinous membranes and break posterior synechiae in patients with acute HLA-B27-positive iridocyclitis with impending pupillary block.


METHODS
Two patients with severe acute fibrinous iridocyclitis and seclusio pupillae were identified. Because of the concern of impending pupillary block, intracameral tissue plasminogen activator (12.5 microg in 0.1 ml, Activase; Genentech, Inc, South San Francisco, California) was injected with a 25-gauge needle through the corneal limbus.


RESULTS
Both patients showed complete dissolution of fibrin with disruption of posterior synechiae. There were no adverse events after injection. Neither patient required further invasive intervention, and both fully recovered with medical management.


CONCLUSIONS
Intracameral tissue plasminogen activator is a safe and effective agent for patients with severe acute iridocyclitis and pupillary seclusion. Patients with clinical signs suggestive of impending pupillary block glaucoma may be considered for tissue plasminogen activator injection to avoid the possible need for emergency surgical iridectomy and synechiolysis.
Skolnick
C A
CA
Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago College of Medicine, Chicago, IL 60612-7243, USA.
Fiscella
R G
RG
Tessler
H H
HH
Goldstein
D A
DA
D000208:Acute Disease; D000328:Adult; D005337:Fibrin / Q000187:drug effects; D005342:Fibrinolysis / Q000187:drug effects; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005901:Glaucoma / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D015796:HLA-B27 Antigen / Q000032:analysis*; D006801:Humans; D015863:Iridocyclitis / Q000097:blood / Q000150:complications*; D008297:Male; D011681:Pupil Disorders / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D015796:HLA-B27 Antigen; D005337:Fibrin; D010959:Tissue Plasminogen Activator