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Tyler Etheridge, Wen Fan Hu, Marissa Larochelle; Intracameral Tissue Plasminogen Activator in Uveitic Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2022;63(7):3214 – A0440.
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© ARVO (1962-2015); The Authors (2016-present)
Tissue plasminogen activator (tPA) has been used as an adjunct to control intraocular inflammation after cataract surgery, with limited data on its use at the time of cataract surgery. We report the operative outcomes of intracameral tPA administered at the time of cataract surgery in eyes with uveitis, which are most at risk for post-operative inflammation.
A retrospective chart review identified patients with uveitis who received intracameral tPA at the time of cataract surgery between 2015 and 2021. Patients were excluded if they did not have a history of uveitis or if the surgery was not a primary cataract extraction. Surgeries were performed by four surgeons at one institution.
Thirty-six eyes from 31 patients were identified. Mean ± standard deviation age was 36.3 ± 19.9 years. Anterior (66.7%) and idiopathic (41.7%) uveitis were most common. Eyes were absent of active intraocular inflammation for 5.8 ± 4.7 months prior to surgery. >90% had at least one coexisting ocular disease, including cystoid macular edema (50.0%), glaucoma (19.4%), steroid response (13.9%), epiretinal membrane (19.4%), and retinal detachment (5.6%). Anterior or posterior synechiae was present in 97.2% and intraoperative synechiolysis was performed in 94.4%. 52.8% were combined with planned pars plana vitrectomy. Acrylic (100%) single-piece (88.9%) lens placed in the capsular bag (94.4%) was most common. tPA dose of 12.5 μg (50.0%) or 25 μg (50.0%) was injected intracamerally at the surgeon’s discretion. Thirty-four cases (94.4%) were uncomplicated. There was one anterior (2.8%) and one posterior capsular (2.8%) tear. LogMAR best corrected visual acuity (BCVA) improved from 1.0 ± 0.7 pre-operatively to 0.7 ± 0.7 post-operatively. 46.2% achieved BCVA ≤0.3 logMAR at 12 months, and only five (19.2%) remained at BCVA ≥1.3 logMAR. Improvement in BCVA was significant across all post-operative time points (p=0.0002). By month 1, 80.0% achieved anterior chamber cell grade of ≤0.5. Two eyes required repeat intracameral tPA injection at week 1 for fibrin formation. Posterior synechiae improved from 8.2 ± 3.8 clock hours pre-operatively to 0.1 ± 0.6 clock hours by month 12. Six eyes (16.7%) experienced hyphema; five (83.3%) resolved spontaneously.
Intracameral tPA administered at the time of cataract surgery in patients with uveitis appears to be effective in controlling acute post-operative inflammation.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.
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