Ophthalmology Department, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel.
Eur J Ophthalmol. 2022 Jan;32(1):200-204. doi: 10.1177/11206721211002064. Epub 2021 Mar 15.
To describe the use of intracameral recombinant tissue plasminogen activator (r-tPA) in the treatment of severe fibrinous reactions in toxic anterior segment syndrome (TASS) after cataract surgery.
A case series of 59 eyes of 59 patients with severe fibrinous anterior chamber reaction following cataract surgery who received intracameral r-tPA (25 µg/0.1 ml). The main outcome measures after intracameral r-tPA were the incidence of complete fibrinolysis, time of maximal effect, visual acuity, and complications.
Severe fibrinous reactions appeared 11.5 ± 5.3 days after cataract surgery. Fibrinolysis was observed 2.33 ± 2.70 days after rtPA use and 36 eyes (61%) exhibited resolution of the fibrin by the end of the first day following injection ( < 0.001). Transient corneal edema observed at 1-day after injection was the only complication reported during the injection of r-tPA or at follow-up. Eight eyes (13.6%) required a second r-tPA injection. Best-corrected visual acuity improved from 0.88 ± 0.67 logMAR units before rtPA injection to 0.48 ± 0.49 logMAR units at 1-month ( < 0.001).
The application of r-tPA was a quick and efficacious therapeutic approach for the management of severe fibrinous reactions in TASS after cataract surgery. In a clinical setting, intracameral r-tPA may be useful when rapid visual recovery is needed.
描述在白内障手术后毒性前节综合征（TASS）中使用玻璃体内重组组织纤溶酶原激活剂（r-tPA）治疗严重纤维蛋白性前房反应。
对 59 例 59 眼白内障手术后发生严重纤维蛋白性前房反应的患者进行了 r-tPA （25μg/0.1ml）玻璃体内注射的病例系列研究。玻璃体内注射 r-tPA 后的主要观察指标为完全纤维蛋白溶解的发生率、最大作用时间、视力和并发症。
严重的纤维蛋白反应在白内障手术后 11.5±5.3 天出现。在 r-tPA 使用后 2.33±2.70 天观察到纤维蛋白溶解，36 只眼（61%）在注射后第一天结束时纤维蛋白溶解（ < 0.001）。注射后 1 天观察到短暂性角膜水肿是唯一报告的 r-tPA 注射或随访期间的并发症。8 只眼（13.6%）需要再次 r-tPA 注射。最佳矫正视力从 r-tPA 注射前的 0.88±0.67 logMAR 单位提高到 1 个月时的 0.48±0.49 logMAR 单位（ < 0.001）。
r-tPA 的应用是治疗白内障手术后 TASS 严重纤维蛋白性反应的一种快速有效的治疗方法。在临床环境中，当需要快速视力恢复时，玻璃体内 r-tPA 可能是有用的。
