Intracameral recombinant tissue plasminogen activator (rtPA) as the primary treatment for secondary pupillary block
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 effectiv...
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| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Pusat Perubatan Universiti Kebangsaan Malaysia
2022
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| Online Access: | http://journalarticle.ukm.my/19680/1/24_ms0517_pdf_18838.pdf http://journalarticle.ukm.my/19680/ https://www.medicineandhealthukm.com/toc/17/1 |
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| Summary: | 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 onehour
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. |
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