Intracameral r-tPA for the management of severe fibrinous reactions in TASS after cataract surgery

Perach Osaadon, Nadav Belfair, Itay Lavy, Eyal Walter, Jaime Levy, Raimo Tuuminen, Asaf Achiron, Boris Knyazer

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Background: To describe the use of intracameral recombinant tissue plasminogen activator (r-tPA) in the treatment of severe fibrinous reactions in toxic anterior segment syndrome (TASS) after cataract surgery. Methods: A case series of 59 eyes of 59 patients with severe fibrinous anterior chamber reaction following cataract surgery who received intracameral r-tPA (25 µg/0.1 ml). The main outcome measures after intracameral r-tPA were the incidence of complete fibrinolysis, time of maximal effect, visual acuity, and complications. Results: Severe fibrinous reactions appeared 11.5 ± 5.3 days after cataract surgery. Fibrinolysis was observed 2.33 ± 2.70 days after rtPA use and 36 eyes (61%) exhibited resolution of the fibrin by the end of the first day following injection (p < 0.001). Transient corneal edema observed at 1-day after injection was the only complication reported during the injection of r-tPA or at follow-up. Eight eyes (13.6%) required a second r-tPA injection. Best-corrected visual acuity improved from 0.88 ± 0.67 logMAR units before rtPA injection to 0.48 ± 0.49 logMAR units at 1-month (p < 0.001). Conclusions: The application of r-tPA was a quick and efficacious therapeutic approach for the management of severe fibrinous reactions in TASS after cataract surgery. In a clinical setting, intracameral r-tPA may be useful when rapid visual recovery is needed.

Original languageEnglish
Pages (from-to)200-204
Number of pages5
JournalEuropean Journal of Ophthalmology
Volume32
Issue number1
DOIs
StatePublished - 1 Jan 2022
Externally publishedYes

Keywords

  • Lens/cataract
  • biochemistry/physiology
  • intraoperative complications of cataract surgery
  • phacoemulsification
  • postoperative anterior segment problems

ASJC Scopus subject areas

  • Ophthalmology

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