Intraocular tissue plasminogen activator during vitrectomy in the management of acute severe bacterial endophthalmitis.

PURPOSE: To describe a novel off-label use of tissue plasminogen activator (tPA) in the setting of severe endophthalmitis for improved surgical outcomes during pars plana vitrectomy.

METHODS

After a limited core vitrectomy is completed, 50mcg/0.1ml tPA is administered intravitreally and allowed to take effect with a 15-minute lights-out period. A fluid-fluid exchange is then carried out to lavage the inflammatory debris and tPA from the posterior segment.

RESULTS

This technique allows for significantly improved surgical visualization and complete removal of inflammatory debris in the anterior and posterior segment.

CONCLUSION

Increased clearance of intraocular inflammatory debris may reduce post-infection inflammatory sequalae such as posterior synechiae and preretinal membranes and achieve better surgical outcomes.