Promotion of glaucoma filter bleb with tissue plasminogen activator after sclerectomy under a clot

Since 1987 we have performed, with good results, glaucoma filtering surgery in which the limbo-scleral fistula was closed by an autogenic full blood clot (sclerectomy under a clot). In 8 patients with advanced stages of glaucoma simplex, 1-3 days after sclerectomy under a clot with rise IOP, 25 micrograms of tissue plasminogen activator (tPA) was injected subconjunctivally. Two weeks after surgery normalization of IOP below 15 mmHg and normal outflow facility in all tPA treated eyes were obtained. No increase in early post-operative complications, such as hemorrhage or corneal haze, was attributable to tPA use. In early period after sclerectomy under a clot, when blockage of outflow appears, the use of tPA can cause the re-creation of filtering tract.