Intracameral recombinant tissue plasminogen activator (r-tPA) for refractory toxic anterior segment syndrome.

AIMS: To investigate the therapeutic effect of recombinant tissue plasminogen activator (r-tPA) in patients with refractory toxic anterior chamber segment syndrome after cataract surgery with posterior chamber intraocular lens implantation.

METHODS

This prospective cohort study was performed from May 2010 to November 2011 at a tertiary university-based medical centre. Forty patients (40 eyes) with an anterior chamber fibrin reaction after cataract surgery were treated with intracameral injection of r-tPA (25 µg/0.1 mL) following failure to respond to conventional treatment with intensive topical and subconjunctival steroids. Outcome measures were best-corrected visual acuity, clearance/recurrence of the fibrin reaction and complications. Corneal endothelial cell counts were evaluated before and after r-tPA injection (n=6).

RESULTS

Intracameral r-tPA injection was administered 10-49 days after cataract surgery; mean was 20.3±9.6 days after surgery. At 1 day after treatment, complete clearance of the fibrin reaction was observed in 32 patients (80%) and partial clearance in 8 (20%). At the 1-month evaluation, the reaction had completely resolved in 95% of patients. Mean visual acuity improved from 0.61±0.38 logMAR before treatment to 0.45±0.37 logMAR 1 month later (p=0.06). There were no statistically significant differences in improvement in visual acuity and fibrinolysis rate by time of r-tPA injection after surgery (10-15 days, n=16 vs 16-49 days, n=24). There were no cases of increased intraocular pressure or endophthalmitis following the procedure.

CONCLUSIONS

Intracameral injection of 25 µg r-tPA is safe and effective for the treatment of refractory fibrin reaction after cataract surgery.