Intracameral r-tPA for the management of severe fibrinous reactions in TASS after cataract surgery

Eur J Ophthalmol. 2022 Jan;32(1):200-204. doi: 10.1177/11206721211002064. Epub 2021 Mar 15.


Background: To describe the use of intracameral recombinant tissue plasminogen activator (r-tPA) in the treatment of severe fibrinous reactions in toxic anterior segment syndrome (TASS) after cataract surgery.

Methods: A case series of 59 eyes of 59 patients with severe fibrinous anterior chamber reaction following cataract surgery who received intracameral r-tPA (25 µg/0.1 ml). The main outcome measures after intracameral r-tPA were the incidence of complete fibrinolysis, time of maximal effect, visual acuity, and complications.

Results: Severe fibrinous reactions appeared 11.5 ± 5.3 days after cataract surgery. Fibrinolysis was observed 2.33 ± 2.70 days after rtPA use and 36 eyes (61%) exhibited resolution of the fibrin by the end of the first day following injection (p < 0.001). Transient corneal edema observed at 1-day after injection was the only complication reported during the injection of r-tPA or at follow-up. Eight eyes (13.6%) required a second r-tPA injection. Best-corrected visual acuity improved from 0.88 ± 0.67 logMAR units before rtPA injection to 0.48 ± 0.49 logMAR units at 1-month (p < 0.001).

Conclusions: The application of r-tPA was a quick and efficacious therapeutic approach for the management of severe fibrinous reactions in TASS after cataract surgery. In a clinical setting, intracameral r-tPA may be useful when rapid visual recovery is needed.

Keywords: Lens/cataract; biochemistry/physiology; intraoperative complications of cataract surgery; phacoemulsification; postoperative anterior segment problems.

MeSH terms

  • Anterior Chamber
  • Cataract Extraction* / adverse effects
  • Cataract*
  • Eye Diseases / drug therapy*
  • Eye Diseases / etiology
  • Fibrinolytic Agents / therapeutic use
  • Humans
  • Postoperative Complications / drug therapy
  • Recombinant Proteins / therapeutic use
  • Tissue Plasminogen Activator / therapeutic use*


  • Fibrinolytic Agents
  • Recombinant Proteins
  • Tissue Plasminogen Activator