RECOMBINANT TISSUE-PLASMINOGEN ACTIVATOR IN CASES WITH FIBRIN FORMATION AFTER CATARACT-SURGERY - A PROSPECTIVE RANDOMIZED MULTICENTER STUDY

Aims-This study investigated the effect of tissue plasminogen activato r (tPA) in patients with severe intracameral fibrin after extracapsula r cataract extraction or phacoemulsification with posterior chamber in traocular lens implantation. Methods-A randomised prospective multicen tre study was carried out in 86 patients with intraocular fibrin forma tion 2-8 days after cataract surgery. While the first group (n=41) rec eived only antiinflammatory drugs, a single anterior chamber injection of tPA (10 mu g) as an additional treatment to the standard was given in the second group (n=44). On days 1, 2, 14, and 90 after randomisat ion, the visual acuities, slit lamp findings, and intraocular pressure s were documented in standardised protocols. Efficacy of treatment was judged by the rate of fibrinolysis (primary objective), the frequency of synechiae, and central capsular fibrosis (secondary objectives). R esults-The incidence and quantity of intraocular fibrin were significa ntly lower in the patients treated with tPA than in the control group (p<0.05). The frequencies of synechiae were reduced by tPA injection. The capsule fibrosis noted after 3 months was significantly lower in t he tPA group (p=0.027). No ocular side effects were noted after the tP A injections. Conclusions-Lysis of postcataract fibrin formation is ac celerated and increased by a single intracameral injection of 10 mu g tPA in addition to standard antiinflammatory treatment. The findings s uggest that the tPA injection reduces posterior capsule fibrosis, whic h still has to be addressed in larger study populations and with a lon g term follow up.