Abstract
Purpose: :
In this case series, we evaluate the efficiency and safety of anterior chamber injections of human recombinant tissue plasminogen activator (hr-tPA) as a treatment modality for lysing recent-onset, extensive posterior synechiae due to acute anterior uveitis.
Methods: :
Patients (n=3) with unilateral, acute anterior uveitis complicated by extensive (270º-360º), recent-onset posterior synechiae were included. Each patient was treated with an intracameral injection of hr-tPA in combination with a posterior sub-tenon’s injection of triamcinolone acetonide. Main outcome treatment measures were the extent of posterior synechiolysis, pupillary dilation and visual acuity recovery.
Results: :
Two patients with initial onset uveitis had rapid and complete synechiolysis (360º) following a single hr-tPA injection, while the third patient with recurrent uveitis and some preexisting, old posterior synechiae had sub-total synechiolysis with greater than 300º of pupillary margin free of synechiae. All three patients regained their pre-uveitis visual acuity without any adverse effects such as cataract or glaucoma at the end of the follow-up. Mean follow-up was 6 months. None of them required any further interventions.
Conclusions: :
Low-dose (3 µg), low-volume (0.05 ml) intracameral hr-tPA injection using a 30 G needle is a safe and effective approach in lysing recent-onset, extensive posterior synechiae due to anterior uveitis. In addition, we utilized a therapeutic paradigm comprising a combination of intracameral hr-tPA and posterior sub-tenon’s injection of triamcinolone acetonide suspension (40 mg) for the management of severe, anterior uveitis poorly responsive to topical therapy, particularly in the setting of an impending pupillary seclusion.
Keywords: uveitis-clinical/animal model • inflammation • injection