[Treatment of intraocular fibrin formation with tissue plasminogen activator after vitrectomy]

Twenty two eyes of 22 cases with severe intraocular fibrin formation after vitrectomy who had been all unresponsive to conventional therapy were treated with tissue plasminogen activator (t-PA), including complicated retinal detachment (14 eyes), intraocular foreign body (3 eyes), vitreous hemorrhage (2 eyes), traumatic cataract (2 eyes) and endophthalmitis (1 eye). The fibrin formation appeared 1-5 days with a mean of 2 days after operation. Of these 22 eyes, fibrin was seen in the pupillary area in 11, in the anterior chamber in 10 eyes and in the vitreous cavity in 1 eye. The initial injection of t-PA was given between the 5th and 15th (mean, 8.6 days) postoperative days after vitrectomy. The t-PA (5-30 micrograms) was injected into the anterior chamber in 21 cases and into the vitreous cavity in 1 case (25 micrograms). Once injection resulted in complete fibrinolysis in 19 of 22 eyes and partial fibrinolysis in 3 eyes, and the complete dissolution with one injection was achieved within 0.5-2.5 hours with a mean of 1 hour. 1 eye required repeated t-PA injection for recurrent fibrin formation and the repeated injection resulted in complete fibrinolysis in this case. The follow-up periods ranged from 1 to 20 months (mean period, 10 months). At the final follow-up examination, the retina was totally attached in 16 of 22 eyes and partially attached and detached in 6. Visual acuity improved in 13 eyes. Complications of t-PA injection included hyphema, elevated intraocular pressure (IOP) and hyphema with elevated IOP in 1 case respectively. Factors affecting the therapeutic effect of t-PA and methods preventing the complications of t-PA injection were discussed.