TISSUE-PLASMINOGEN ACTIVATOR FOR PRESERVING INFERIOR PERIPHERAL IRIDECTOMY PATENCY IN EYES WITH SILICONE OIL

Purpose: An inferior peripheral iridectomy (IPI) was used to prevent f orward migration of silicone oil in vitrectomized eyes; however, in ap proximately one third of eyes, the IPI closed spontaneously. Occlusion of the IPI by fibrin is believed to be an early event in permanent IP I closure by scar tissue. The authors determined whether intraocular t issue plasminogen activator (tPA) would restore and maintain IPI paten cy in eyes that had early occlusion of the IPI by fibrin. Methods: Bet ween November 1993 and January 1995, 12 patients who underwent vitrect omy with silicone tamponade and IPI for complicated retinal detachment received an anterior chamber injection of tPA (6.25 or 12.5 mu g) for occlusion of the IPI by fibrin. Results: All 12 patients had lysis of fibrin and maintained a patent IPI at the last follow-up (124 +/- 95 days). One patient required multiple tPA injections for recurrent fibr in formation. In another patient, a small hyphema developed after the tPA injection, which did not occlude the IPI. When compared with the n atural course in a very similar group of patients previously reported, tPA had a statistically significant beneficial effect in the maintena nce of IPI patency (P = 0.040). Conclusions: Intraocular tPA can be sa fely used to lyse postoperative fibrin occluding the IPI in eyes with silicone oil tamponade. Early lysis of this fibrin maintains IPI paten cy.