Intraocular recombinant tissue-plasminogen activator fibrinolysis of fibrin formation after cataract surgery in children

Purpose: To evaluate the efficacy and safety of intracameral recombinant tissue plasminogen activator (rt-PA) application for fibrinolysis of fibrin formation;after cataract surgery in children. Setting: Johann Wolf gang Goethe-University, Department of Ophthalmology, Frankfurt am Main, Germany. Methods: This study comprised 11 eyes of 10 patients aged 3 to 13 years (mean 7.2 +/- 3.68 [SD]) who developed severe fibrin formation after cataract surgery and IOL implantation despite intensive topical steroid therapy. Under general anesthesia sia, fibrinolysis was performed with 10 mu g of rt-PA 7.18 +/- 2.04 days after intraocular surgery. Follow-up included slitlamp examination, tonometry, visual acuity testing, and ophthalmoscopy. Anterior chamber flare measurements could be performed in 6 eyes. Results: Complete resolution of fibrin formations occurred in 90% of the patients. in these cases, no recurrent fibrinous reaction or adverse effects were noted. In 2 eyes of the same patient with a history of juvenile rheumatoid arthritis and chronic uveitis, fibrin clot dissolution was incomplete. A recurrent fibrinous formation could be observed after 2 and 4 weeks, respectively. A beginning band keratopathy excluding the central and limbal cornea was noted after 6 and 8 weeks respectively. Conclusion: Intraocular application of rt-PA appears to be a safe and efficacious therapeutic approach in the management of severe fibrinous:reactions after pediatric cataract surgery.