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Piotr Fryczkowski (Warsaw, Poland)

Advantages:

In several cases after successful vitrectomy we observe endless fibrin membranes formation on the anterior or posterior surfaces of the artificial lenses with pupillary block and/or iris bombe. Patients’ vision in these cases is very poor because of the obstacle of the light pathway, and the possibility of developing secondary glaucoma. Laser capsulotomy is ineffective because of fibrin reaction, which is still present and active after several weeks or month after vitrectomy. Those patients were losing vision due to secondary cataract with secondary glaucoma.

Methods:

Four eyes after vitrectomy, with low endothelium count, after 2 or 3 YAG posterior capsulotomies. During the injection of 3 µg/0,1 ml of tissue plasminogen activator (tPA) we actively remove fibrin membranes from the anterior or posterior surface of the artificial lens with needle. After this maneuver we re-inject tPA. The latest time for the injection of tPA was 26 month after vitrectomy.

Effectiveness / Safety:

We didn’t observe any toxic effects on the retina or cornea after this technique during 6-month follow up time. No fibrin formation was present after 6 month. In all cases IOP remained normal and stable without treatment.

Take home message:

Although tPA is most effective 20 days post surgery, we can preserve and improve vision in patients with postvitrectomy fibrin membranes by using tPA injection combined with mechanical removal of the membranes.