USE OF TISSUE PLASMINOGEN-ACTIVATOR FOR RAPID DISSOLUTION OF FIBRIN AND BLOOD-CLOTS IN THE EYE AFTER SURGERY FOR GLAUCOMA AND CATARACT IN HUMANS

We treated 10 patients with tissue plasminogen activator (tPA) for complications that threatened the successful outcome of anterior segment surgery for glaucoma and/or cataract, and that endangered the structural and functional integrity of the eye. Eight patients who had developed massive fibrin or blood clots in the anterior chamber each received 10-20 mug of tPA intracamerally, and two patients who had an extensive subconjunctival blood clot that blocked the filtration site received 25 or 30 mug of tPA subconjunctivally. The clots dissolved within 30 min to a few hours in all patients. Except in one patient who developed a 10% hyphema after the tPA injection, we observed no ocular complications in any of our patients during a follow-up period that ranged from 2-22 months. Our preliminary investigations show that intracameral injection of tPA is highly effective and safe for the rapid dissolution of fibrin and blood clots in the anterior chamber that obstruct the visual axis, obscure the view of the fundus, or cause failure of filtering blebs, and for lysis of synechiae of 2 to 3 days duration. Optimal results were obtained with intracameral injection of greater-than-or-equal-to 10 mug tPA at 4 to 1 0 days after surgery. However, tPA should be regarded as an acute therapy and adjunctive modality for the treatment of fibrin and blood clots in the anterior segment of the eye. To avoid possible drug-induced complications, we advocate titration of the dose and repeat injection rather than a single large bolus of the drug.