title: Use of tissue plasminogen activator to revive blebs following intraocular surgery.
abstract: BACKGROUND
  Tissue plasminogen activator (tPA) is a serine protease with thrombolytic-fibrinolytic activity. In the anterior segment of the eye, it has been used to lyse blood and fibrin clots immediately following trabeculectomy.
  
  
  OBJECTIVE
  To review our experience using tPA to revive previously functional but newly failing blebs following secondary surgical procedures (cataract extraction or penetrating keratoplasty).
  
  
  METHODS
  A retrospective medical record review of all eyes receiving tPA to revive a failing bleb after a later anterior segment surgery was performed. Blebs were functional for at least 9 months before tPA, 12.5 microg, was injected into the anterior chamber. Eyes had longer than 6 months of follow-up after tPA use.
  
  
  RESULTS
  Six eyes that had undergone phacoemulsification and 1 that had undergone penetrating keratoplasty were identified. Before the secondary surgery, blebs had been in place for 20.4 +/- 9.3 months, with an intraocular pressure of 10.7 +/- 3.6 mm Hg. New bleb failure in these eyes was observed following phacoemulsification or penetrating keratoplasty between postoperative days 4 and 14, with the intraocular pressure increasing to 27.7 +/- 9.5 mm Hg. One day after tPA use, the intraocular pressure had decreased to 11.0 +/- 3.7 mm Hg (P =.002). In 5 of the 7 patients, the bleb height improved following tPA use. The final intraocular pressure was 10.7 +/- 3.6 mm Hg at a follow-up of 13.4 +/- 6.4 months. (All data are given as mean +/- SD.)
  
  
  CONCLUSIONS
  Tissue plasminogen activator can be a useful adjunct for reviving newly failing blebs after other anterior segment surgery.
authors.affiliation: Department of Ophthalmology, University of Florida, JHMHC Box 100284, Gainesville, FL 32610-0284, USA. mfsmith@eye1.eye.ufl.edu
authors.forename: M F
authors.initials: MF
authors.lastname: Smith
authors.forename: J W
authors.initials: JW
authors.lastname: Doyle
mesh_terms: D000328:Adult; D000368:Aged; D000869:Anterior Eye Segment / Q000601:surgery; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005901:Glaucoma / Q000601:surgery; D006801:Humans; D007429:Intraocular Pressure; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification / Q000009:adverse effects*; D011183:Postoperative Complications / Q000188:drug therapy*; D012189:Retrospective Studies; D013524:Surgical Flaps; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014130:Trabeculectomy; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator