Medical College of Wisconsin
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Intracameral tissue plasminogen activator after glaucoma surgery. Indications, effectiveness, and complications. Ophthalmology 1996 Feb;103(2):274-82

Date

02/01/1996

Pubmed ID

8594514

DOI

10.1016/s0161-6420(96)30704-5

Scopus ID

2-s2.0-0030024511 (requires institutional sign-in at Scopus site)   57 Citations

Abstract

PURPOSE: To describe the authors' clinical experience with intracameral tissue plasminogen activator (tPA) after glaucoma surgery.

METHODS: Retrospective review of medical records of all patients who received intracameral tPA after glaucoma surgery at the Doheny Eye Institute from November 4, 1992, to June 14, 1994. There were 20 tPA administrations (18 eyes of 17 patients) in doses ranging from 6 to 25 microgram. Indication for tPA administration was decreased bleb function secondary to blood/fibrin clot in aqueous outflow pathway.

RESULTS: Tissue plasminogen activator was given after trabeculectomy (5 drug administrations) and combined cataract extraction/trabeculectomy procedures (9 drug administrations), with increased filtration in 12 (86%). There were five (36%) instances of hyphema and three (21%) of hypotony. All hyphemas occurred after doses of 25 microgram. Final IOP of 18 mmHg or lower and 6 mmHg or higher was achieved in 11 (92%) of 12 patients after a mean follow-up interval of 4.2+/-4.7 months. The six remaining tPA irrigations were done in five patients after glaucoma drainage implant surgery (n=4) or surgical/needle revision of a filtering bleb (n=2).

CONCLUSIONS: Aqueous outflow obstruction from blood/fibrin clot after glaucoma surgery may be treated effectively with intracameral tPA in doses of 6 to 25 microgram. The authors recommend using a dose of less than or equal to 6 to 12.5 microgram to minimize risk of hyphema.

Author List

Lundy DC, Sidoti P, Winarko T, Minckler D, Heuer DK

Author

Dale Heuer MD Emeritus Professor in the Ophthalmology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Aged, 80 and over
Anterior Chamber
Aqueous Humor
Cataract Extraction
Child
Female
Fibrinolysis
Glaucoma
Humans
Male
Middle Aged
Molteno Implants
Plasminogen Activators
Postoperative Complications
Retrospective Studies
Thrombolytic Therapy
Tissue Plasminogen Activator
Trabeculectomy