Use of tissue plasminogen activator to revive blebs following intraocular surgery

Arch Ophthalmol. 2001 Jun;119(6):809-12. doi: 10.1001/archopht.119.6.809.


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.)

Conclusion: Tissue plasminogen activator can be a useful adjunct for reviving newly failing blebs after other anterior segment surgery.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anterior Eye Segment / surgery
  • Female
  • Fibrinolytic Agents / therapeutic use*
  • Glaucoma / surgery
  • Humans
  • Intraocular Pressure
  • Keratoplasty, Penetrating / adverse effects*
  • Male
  • Middle Aged
  • Phacoemulsification / adverse effects*
  • Postoperative Complications / drug therapy*
  • Retrospective Studies
  • Surgical Flaps
  • Thrombolytic Therapy*
  • Tissue Plasminogen Activator / therapeutic use*
  • Trabeculectomy
  • Treatment Outcome


  • Fibrinolytic Agents
  • Tissue Plasminogen Activator