Abstract
Purpose :
The development of exuberant fibrin in the anterior chamber (AC) can occur in uveitis. While reports of intracameral tPA have been shown to break fibrin, the benefit of synechiolysis and improved visual outcomes have not been reported. We performed a single center, retrospective case series to evaluate for this added benefit of tPA.
Methods :
This was an IRB approved review. The records of 21 patients who presented with a robust anterior segment fibrin reaction or 360 degrees of posterior synechiae that received tPA since April 2013 were reviewed. Data collected included: age, gender, ocular and surgical history, visual acuities (VA), intraocular pressure and ocular exam findings.
Results :
The mean age of patients was 52 years, with 10 M:11 F. All 21 patients had tPA (3mcg-12.5mcg/0.1mL) injected into the AC using a 30 g needle. 18 of 21 presented with a fibrin reaction. 6 of 21 presented with 360 degrees of synechiae, 10 with partial synechia, and 5 with no view of the iris. Varying grades of inflammation were present including hypopyon (4), 4+ (7), 3+ (4), 2+ (2), and 1+ (4) AC cell. On average, patients presented within 10 days from start of symptoms.
All patients were treated with topical steroids, with 9 patients receiving PO steroids as well. 15 patients had anterior uveitis secondary to HLA B27 (9), sarcoid (1), syphilis (1), or idiopathic disease (5). 6 patients had a panuveitis secondary to syphilis (1), TB (1), sarcoid (1), fungal (1), or idiopathic disease (2).
9 patients with anterior uveitis and 1 with panuveitis presented with 360 synechia or no clear view to the pupil. None of these patients remained with 360 synechia resulting in secondary angle closure or required surgical intervention up to 1 year following. All patients had rare or no cell/flare at 1 year.
Of the 15 patients with anterior uveitis, 8 presented with a VA worse than 20/100. 13 of the 15 patients had VA of 20/40 or better within 1 month.
Conclusions :
Fibrin reactions can occur in a variety of ocular conditions. While intracameral tPA can be used to often rapidly resolve fibrin, its use in conjunction with topical and oral steroids can provide significant benefit. These benefits include rapid improvement in VA, synechiolysis, and decreased rates of angle closure glaucoma and need for urgent surgical intervention.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.