组织型纤溶酶原激活剂治疗急性纤维蛋白性HLA - B27阳性虹膜睫状体炎患者即将发生的瞳孔阻滞性青光眼。
Tissue plasminogen activator to treat impending pupillary block glaucoma in patients with acute fibrinous HLA-B27 positive iridocyclitis.
作者信息
Skolnick C A, Fiscella R G, Tessler H H, Goldstein D A
机构信息
Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago College of Medicine, Chicago, IL 60612-7243, USA.
出版信息
Am J Ophthalmol. 2000 Mar;129(3):363-6. doi: 10.1016/s0002-9394(99)00350-5.
PURPOSE
To report the use of intracameral tissue plasminogen activator to dissolve fibrinous membranes and break posterior synechiae in patients with acute HLA-B27-positive iridocyclitis with impending pupillary block.
METHODS
Two patients with severe acute fibrinous iridocyclitis and seclusio pupillae were identified. Because of the concern of impending pupillary block, intracameral tissue plasminogen activator (12.5 microg in 0.1 ml, Activase; Genentech, Inc, South San Francisco, California) was injected with a 25-gauge needle through the corneal limbus.
RESULTS
Both patients showed complete dissolution of fibrin with disruption of posterior synechiae. There were no adverse events after injection. Neither patient required further invasive intervention, and both fully recovered with medical management.
CONCLUSIONS
Intracameral tissue plasminogen activator is a safe and effective agent for patients with severe acute iridocyclitis and pupillary seclusion. Patients with clinical signs suggestive of impending pupillary block glaucoma may be considered for tissue plasminogen activator injection to avoid the possible need for emergency surgical iridectomy and synechiolysis.
目的
报告在前房内使用组织型纤溶酶原激活剂溶解纤维蛋白膜并解除急性HLA - B27阳性虹膜睫状体炎伴即将发生瞳孔阻滞患者的虹膜后粘连。
方法
确定了两名患有严重急性纤维蛋白性虹膜睫状体炎和瞳孔闭锁的患者。由于担心即将发生瞳孔阻滞，通过角膜缘用25号针头注射前房内组织型纤溶酶原激活剂（0.1 ml含12.5 μg，阿替普酶；基因泰克公司，加利福尼亚州南旧金山）。
结果
两名患者的纤维蛋白均完全溶解，虹膜后粘连解除。注射后无不良事件发生。两名患者均无需进一步的侵入性干预，经药物治疗后均完全康复。
结论
前房内组织型纤溶酶原激活剂对于严重急性虹膜睫状体炎和瞳孔闭锁患者是一种安全有效的药物。对于有即将发生瞳孔阻滞性青光眼临床体征的患者，可考虑注射组织型纤溶酶原激活剂，以避免可能需要的急诊手术虹膜切除术和粘连松解术。
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