INTRACAMERAL TISSUE-PLASMINOGEN ACTIVATOR AFTER GLAUCOMA SURGERY - INDICATIONS, EFFECTIVENESS, AND COMPLICATIONS

Purpose: To describe the authors' clinical experience with intracamera l tissue plasminogen activator (tPA) after glaucoma surgery. Methods: Retrospective review of medical records of all patients who received i ntracameral tPA after glaucoma surgery at the Doheny Eye Institute fro m November 4, 1992, to June 14, 1994. There were 20 tPA administration s (18 eyes of 17 patients) in doses ranging from 6 to 25 mu g. Indicat ion for tPA administration was decreased bleb function secondary to bl ood/fibrin clot in aqueous outflow pathway. Results: Tissue plasminoge n activator was given after trabeculectomy (5 drug administrations) an d combined cataract extraction/trabeculectomy procedures (9 drug admin istrations), with increased filtration in 12 (86%). There were five (3 6%) instances of hyphema and three (21%) of hypotony, All hyphemas occ urred after doses of 25 mu g. Final IOP of 18 mmHg or lower and 6 mmHg or higher was achieved in 11 (92%) of 12 patients after a mean follow -up interval of 4.2 +/- 4.7 months. The six remaining tPA irrigations were done in five patients after glaucoma drainage implant surgery (n = 4) or surgical/needle revision of a filtering bleb (n = 2). Conclusi ons: Aqueous outflow obstruction from blood/fibrin clot after glaucoma surgery may be treated effectively with intracameral tPA in doses of 6 to 25 mu g. The authors recommend using a dose of less than or equal to 6 to 12.5 mu g to minimize the risk of hyphema.