Background: The fibrinolytic drug rt-PA, which has been successfully used systemically to treat arterial and venous occlusions, is now available for local, intraocular injection. rt-PA converts plasminogen to plasmin, which in turn is able to lyse fibrin and fibrin clots. Intraocular surgery, trauma and inflammation may lead to intraocular accumulation of fibrin. Treatment of this type of complication with high-dose corticosteroids is protracted and often unsuccessful.
Patients: Eight patients (age 59-75 years) with fibrin formation following phacoemulsification and IOL implantation combined with trabeculectomy were treated by intraocular injection of 10 micrograms rt-PA. The intraocular status following the local fibrinolytic therapy was documented by biomicroscopy, photography and laser-flare Tyndallometry on days 1, 2 and 8.
Results: In all patients the fibrin clots dissolved completely. Neither relapses nor adverse affects were noted.
Conclusions: The intraocular application of rt-PA results in an efficient fibrinolytic effect, which prohibits potential complications of combined glaucoma and cataract surgery due to fibrin formation.