Intracameral Recombinant Tissue Plasminogen Activator (rtPA) as the Primary Treatment for Secondary Pupillary Block
RTPA for Secondary Pupillary Block
Vol. 17 No. 1 : 2022 (302-307)
Abstract
Alteplase is a recombinant form of human tissue plasminogen activator (tPA) that converts plasminogen to plasmin essential for fibrinolysis. It is commonly used to treat embolic or thrombotic disorders such as ischemic stroke. Despite its rarity use in ophthalmology, we are reporting the effectiveness of recombinant tissue plasminogen activator (rtPA) in treating an eye with secondary pupillary block as a consequence of severe endophthalmitis. A patient presented with acute endophthalmitis after a complicated cataract extraction. Examination showed severe anterior chamber reaction leading to seclusion pupillae, iris bombe and presence of iridocorneal touch 360-degree. Following intracameral alteplase 2.5 microgram in 0.1 ml given, iris bombe was observed to resolve completely one-hour later. Anterior chamber was also significantly deeper and slightly larger pupil compared to before rtPA injection. Due to clearer view of anterior segment, pars planar vitrectomy and extraction of intraocular lens could be performed with significant visual improvement after surgery. Our findings suggest that usage of rtPA, which is alteplase, was effective in treating secondary pupillary block due to intense anterior segment inflammation in endophthalmitis cases. Thus it is useful in replacing the conventional use of laser peripheral iridotomy in treating pupillary block, as the latter potentially aggravates the pre-existing inflammatory condition.
Keywords :
anterior chamber,
endophthalmitis,
Tissue plasminogen activator,
Correspondance Address
Safinaz Mohd Khialdin. Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-9145 5555 Email: drsafinaz_1978@yahoo.com.my
References
Akcetin, T.A., Eltutar, K., Dincer, N., Ozdemir, F. 2015. Fibrin membrane pupillary-block glaucoma after uneventful cataract surgery treated with intracameral tissue plasminogen activator: a case report. Istanbul Med J 16(1): 42-4.
Damji, K.F., O’Connor, M.D., Hill, V. 2001. Tissue plasminogen activator for treatment of fibrin in endophthalmitis. Can J Ophthalmol 36(5): 269-71.
Dotan, A., Kaiserman, I., Kremer, I., Ehrlich, R., Bahar, I. 2014. Intracameral recombinant tissue plasminogen activator (r-TPA) for refractory toxic anterior segment syndrome. Br J Ophthalmol 98(2): 252-5.
Durand, M.L. 2013. Endophthalmitis. Clin Microbiol Infect 19(3): 227-34.
Erol, N., Özer, A., Topbas, S., Yildirim, N., Yurdakul, S. 2003. Treatment of intracameral fibrinous membranes with tissue plasminogen activator. Ophthalmic Surg Lasers Imaging 34(6): 451-6.
Georgiadis, N., Boboridis, K., Halvatzis, N., Ziakas, N., Moschou, V. 2003. Low-dose tissue plasminogen activator in the management of anterior chamber fibrin formation. J Cataract Refract Surg 29(4): 729-32.
Heiligenhaus, A., Steinmetz, B., Lapuente, R., Krallmann, P., Althaus, C., Steinkamp, W.K., Dick, B. 1998. Recombinant tissue plasminogen activator in cases with fibrin formation after cataract surgery: a prospective randomised multicentre study. Br J Ophthalmol 82(7): 810-5.
Patrick, S., Hui-Tze, C., Wan-Hazabbah, W.H., Zunaina, E., Azhany, Y., Liza-Sharmini, A.T. 2018. Use of recombinant tissue plasminogen activator for treatment of recalcitrant anterior uveitis: a case series. J Taibah Univ Med Sci 13(5): 483-7.
Riaz, Y., Mehta, J.S., Fernando, A., Ferguson, V. 2006. Recombinant tissue plasminogen activator (r-TPA) in fibrin dissolution due to postoperative endophthalmitis. Ann Acad Med Singapore 35(10): 723-5.
Wedrich, A., Menapace, R., Ries, E., Polzer, I. 1997. Intracameral tissue plasminogen activator to treat severe fibrinous effusion after cataract surgery. J Cataract Refract Surg 23(6): 873-7.
Wu, T.T., Wang, H.H. 2009. Intracameral recombinant tissue plasminogen activator for the treatment of severe fibrin reaction in endophthalmitis. Eye 23(1): 101-7.
Yoshino, H., Seki, M., Ueda, J., Yoshino, T., Fukuchi, T., Abe, H. 2012. Fibrin membrane pupillary-block glaucoma after uneventful cataract surgery treated with intracameral tissue plasminogen activator: a case report. BMC Ophthalmol 12: 3.
