t-PA前房注射治疗玻璃体切割联合眼内硅油充填术后眼内纤维蛋白渗出

Treatment of intraocular fibrin formation with tissue plasmingen activator after vitrectomy combined with silicone oil tamponade

目的评价前房内注射组织型纤溶酶原激活剂(tissueplasminogenactivator,t-PA)治疗玻璃体切割联合眼内硅油充填术后重度眼内纤维蛋白渗出的效果及安全性。方法对21例(21只眼)玻璃体切割联合眼内硅油充填术后眼内纤维蛋白渗出经常规方法治疗无效的病例,给予前房内注射t-PA12.5μg,观察其对眼内纤维蛋白形成的疗效。结果眼内一次注射t-PA12.5μg后,纤维蛋白渗出位于前房及瞳孔区者21例均完全溶解,所需时间0.5～2小时(平均1小时);12例下方虹膜根切孔膜闭者有8只眼根切孔膜溶解(占66.7%),根切孔保持通畅;注射后前房出血3例(占14.3%)。随访3～24个月(平均8个月)视网膜复位17例(占81.0%)。结论对玻璃体切割联合眼内硅油充填术后严重眼内纤维蛋白渗出经常规方法治疗无效的病例,前房内注射t-PA能够迅速溶解眼内纤维蛋白渗出,为一种安全有效的方法。

Objective To evaluate the effects and safety of the injection of tissue plasminogen activator （t-PA） into the anterior chamber in the treatment of severe intraocular fibrin formation after vitrectomy combined with silicone oil tamponade, Methods The t-PA （12.5μg） was injected into the anterior chamber in 21 cases with severe intraocular fibrin formation after vitrectomy combined with silicone oil tamponade which had been all unresponsive to conventional therapy. The effects in the treatment of severe intraocular fibrin formation was observed. Results All 21 cases had lysis of fibrin which in the papillary area and in the anterior chamber, and the complete dissolution with one injection was achieved within 0.5 to 2.0 hours with a mean of 1 hour. 8 of 12 eyes with inferior peripheral iridectomy closed by fibrin had lysis of fibrin and maintained a patent inferior peripheral iridectomy. In 3 of 21 cases, a small hyphema developed after the t-PA injection. The follow- up periods ranged from 3 to 24 months （mean period, 8 months）. At the final follow-up exanination, the retina was reattached in 17 of the 21 eyes （81.0%）. Conclusions Anterior chamber injection of t-PA is an effective and safe method in the treatment of severe intraocular fibrin formation after vitrectomy combined with silicone oil tamponade.