TOPICAL TISSUE-PLASMINOGEN ACTIVATOR APPEARS INEFFECTIVE FOR THE CLEARANCE OF INTRAOCULAR FIBRIN

BACKGROUND AND OBJECTIVE: To determine the efficacy of topical tissue plasminogen activator (tPA) for the resolution of postoperative or inf lammatory intraocular fibrinous exudates. PATIENTS AND METHODS: Each t reatment consisted of drops of 1 mg/ml tPA given 9 times 5 minutes apa rt. Records were reviewed and the results at 24 and 48 hours were reco rded. Sixty-two patients had a total of 94 treatments. RESULTS: Fibrin exudates following intraocular surgery in 34 patients were treated 44 times. In 6 patients there was a positive result. Fibrin associated w ith intraocular infection was treated in 9 patients. None showed clear improvement. Nineteen patients had a total of 34 treatments for poorl y controlled intraocular pressure (IOP) after glaucoma surgery. Five p atients showed adequate control of the IOP, 12 did not change, and 2 h ad a questionable improvement. Eleven patients had adequate IOP - cont rol after additional treatment. Seven required suture lysis, 2 ab inte rno bleb revision, and 2 YAG capsulotomy or iridotomy to reduce the IO P to an acceptable level. CONCLUSIONS: Within the limits of this retro spective study and taking into account that fibrin may resolve spontan eously, it appears that topical tPA drops are not effective for the li quefaction of intraocular fibrin after surgery or in association with intraocular inflammation. They did not improve IOP control after glauc oma surgery.