RESULTS AND COMPLICATIONS IN RTPA TREATME NT OF THE ANTERIOR SEGMENT OF THE EYE

Recombinant tissue plasminogen activator (rTPA) is commonly used in pa tients with myocardial infarction. Recently, it has also been applied intraocularly to dissolve postoperative fibrin with no serious complic ations being reported so far. In this study we describe our own experi ence with rTPA in 25 patients with persisting fibrinous membranes in t he anterior segment. rTPA (Actilyse, Dr. Karl Thomae GmbH) was given i n a single dose of 25 mu g and injected into the anterior chamber via a paracentesis. We did not encounter any complications during the inje ction of rTPA. In 21 eyes fibrin could be reduced significantly, albei t sometimes only slowly. In 13 patients,the membrane had dissolved alm ost completely by the following day. In contrast, no success was obser ved after glaucoma surgery (2 eyes) and in chronic iritis (1 eye), or when fibrin mixed with blood was treated (1 eye). There were two (cont rollable) post-operative hemorrhages (rTPA after vitrectomy, and for f ibrin/blood after cataract surgery). In addition, we noted 2 cases of irreversible superficial corneal clouding (rTPA after cataract surgery ). We conclude that injection of rTPA can be a useful addition to ster oid treatment in selective cases of persisting fibrin in the anterior segment. Long-standing membranes, however, are unlikely to be dissolve d. Care should also be taken and rTPA be avoided when there is evidenc e of recent bleeding. Most worrying to us were the corneal complicatio ns that we cannot explain to date. With regard to the definite time co rrelation we feel that rTPA or one of the solution components might be the cause of this unusual feature.