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V. Hershberger, A.H. Kaufman; Fibrinolysis of Post-cataract Fibrin Membranes Associated with Usage of Iris Retractors in Cataract Surgery: Role of Intracameral Tissue Plasminogen Activator . Invest. Ophthalmol. Vis. Sci. 2003;44(13):2418.
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Purpose: 1) To evaluate the incidence of fibrinous effusion following iris retractor usage in cataract surgery in patients with a history of iritis and posterior synechiae, and 2) To evaluate the efficacy and safety of intracameral tissue plasminogen activator (r-tPA) in the treatment of post-cataract fibrinous effusion in these patients. Methods: A retrospective analysis of 10 eyes of 10 patients aged 35 years to 85 years, with a history of iritis and posterior synechiae who underwent clear cornea cataract surgery and implantation of an acrylic intraocular lens between July 2002 and November 2002. Preoperatively, all eyes were quiescent for greater than 90 days. Posterior synechiae ranging from mild (< 90o) to severe (360o) were present in all eyes. Two patients received preoperative subtenon triamcinolone (10mg) approximately two weeks prior to surgery. All eyes underwent phacoemulsification with intraocular lens implantation. All eyes required iris retractors during the surgery. Seven patients (70%) required intraoperative stripping of dense pupillary membranes. All patients received intensive (hourly) steroids in the post-operative course. Results: Fibrin formation was observed in 7 of the 10 eyes (70%). Two patients who received subtenon triamcinolone preoperatively did not develop a fibrinous effusion, and neither did one patient with very mild posterior synechiae. All 7 patients with fibrinous effusion received 10ug of tPA intracamerally. Complete resolution of the fibrin was observed after 24 hours in 5 of 7 eyes (71%). Recurrent fibrin was seen in 2 of 7 eyes (29%). The mean number of injections required to achieve complete fibrinolysis was 1.1. Intracameral tPA was administered ranging from post-operative day 2 to day 6. The mean duration of follow-up was 11 weeks. No hyphema, keratopathy, or toxic intraocular side-effect was observed during this study. Conclusions: Intracameral tPA is safe and effective in the treatment of significant post-operative fibrinous effusions associated with iris retractor usage in cataract patients with a history of iritis. Preoperative subtenon steroids may decrease the risk of fibrinous effusions in such patients. To our knowledge this is the first report describing the use of post-operative tPA to treat fibrinous effusions associated with usage of iris retractors.
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