BAND KERATOPATHY AFTER TISSUE-PLASMINOGEN ACTIVATOR TREATMENT OF POSTOPERATIVE FIBRIN REACTION

Background In recent years TPA (tissue-plasminogen activator) has been increasingly and successfully used for the treatment of severe, posto perative fibrin reaction in the anterior chamber. So far no serious si de effects of this treatment have been reported. Patients and methods Altogether, 32 patients received 0.2 mi solution with 20 mu g TPA intr acamerally. In 2 cases a dense corneal opacity was observed 12-24 hour s after the injection of TPA which was resistent to treatment with loc al dexamethasone and lubricants. Therefore it was removed by superfici al keratectomy. In one case the keratectomy specimen could be examined by light- and electronmicroscopy. Results In the keratectomy specimen a selective, fine-granular calcification of Bowmans membrane could be demonstrated. Conclusions The intracameral TPA treatment for postoper ative fibrin reaction can cause a rapid band keratopathy. Therefore th e application of TPA should be restricted to severe therapy-resistent cases of intracameral fibrin reaction. In cases with the development o f a band keratopathy EDTA treatment is recommended.