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L. E. Lerner, A. Jayaprakash Patil, M. C. Kenney, D. Minckler; Rapid Lysis of Posterior Synechiae Due to Uveitis Using a Combination of Intraocular tPA and Posterior Sub-Tenon’s Triamcinolone Acetonide. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4997.
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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.
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.
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.
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.
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