The use of subconjunctivally administered tissue plasminogen activator after trabeculectomy

Blockage of aqueous flow in the early postoperative period can be devastating to the success of trabeculectomy. We used tissue plasminogen activator (tPA) subconjunctivally in an attempt to release a trabeculectomy flap that appeared to be adherent to its scleral bed. No change was noted 90 minutes after injection, but a highly elevated bleb was present on the first postoperative day. Subconjunctivally administered tPA may be useful in releasing the fibrin "glue" in cases with adherent trabeculectomy flaps.