r-tPA in keratoplasty a chaud: report based on 50 patients

Background: Fibrinolytic treatment using recombinant plasminogen activator (r-tPA) has been reported in cataract surgery; however, reports are lacking with respect to complex surgical interventions including keratoplasty beca use of anterior segment infections. Patients and methods: This report deals with a prospective study comprising 50 patients (50 eyes) suffering from a serpent ulcer treated by keratoplas ty a chaud. r-tPA (25 mu g) was instilled intracamerally at the end of surg ery in 25 eyes. Results: The 25 eyes treated with r-tPA were subsequently less inflamed tha n the control population (decrease in inflammatory cells 1.5 days vs 7 days , fibrin reaction Ix vs 12x), had highly significantly better visual acuity and there was significantly reduced inpatient hospitalization (median 9.9 vs 19.3 days). No hemorrhages were observed in either population; medically treated infection recurrences (S. aureus, C, tropicalis, acanthameba) were observed in 3 and primary graft failure or rejection in both populations 3 x. Conclusions: This study showed that perioperative application of r-tPA had a beneficial effect. This therapeutic avenue should be further evaluated in a randomized, doublemasked multicenter study.