外伤性白内障术后t-PA防治前房渗出的研究

A clinical study of prevention and treatment of anterior chamber fibrin exudation following traumatic cataract surgery with t-PA.

目的 探讨t PA防治外伤性白内障术后前房渗出的效果及对眼组织的毒性。方法 将 78眼外伤性白内障分 3组 ,60眼随机分观察组和对照组各 3 0眼 ,观察组人工晶状体植入术后前房注射t PA 10 μg(0 1ml) ,对照组注射生理盐水。观察两组前房渗出发生率等。治疗组 18眼为术后出现前房渗出者 ,14眼前房注射t PA 10 μg ,观察治疗效果。 结果 观察组 1眼轻度前房渗出 ,对照组 8眼为中、重度渗出 (P <0 0 5 )。治疗组 14眼注射t PA 48小时渗出完全吸收。 4眼未注射t PA者 2眼 8天渗出完全吸收 ,2眼人工晶状体前膜形成。结论 t PA前房注射对外伤性白内障术后前房渗出有预防作用 。

Objective To investigate the efficacy and toxicity of anterior chamber injection of tissue plasminogen activator (t PA) for the prevention and treatment of intraocular fibrin exudates after traumatic cataract extraction and IOL implantation.Methods 78 case (78 eyes) of traumatic cataract were divided into three groups,60 eyes were divided into study group and control group at random.After surgery,10 μg of t PA or 0 1 ml of physologic solution was injected into the anterior chamber in the study group or in the control group separately.The rate of anterior chamber fibrin exudates in both groups were observed.Intraocular pressure corneal thickness and electroretinograph (ERG) were measured.In treatment group,18 eyes with anterior chamber fibrin formation after sugery,14 eyes were treated with t PA 10 μg injected into the anterior chamber.The clearance of fibrin were observed.Results The mild fibrin was found in 1 patient's anterior chamber in the study group.The moderate and severe fibrin were found in 8 patient's anterior chamber in the control group ( P <0 05).Postoperative IOP in both groups were higher than preoperative IOP ( P >0 1).No statistical difference of the corneal thickness was observed in the two groups each time ( P >0 1).ERG in study group showed no difference in a or b wave amplitudes and a or b wave implicit times each time ( P >0 05).After the t PA was injected into the anterior chamber in 14 cases with fibrin in treatment group,complete dissolution within 48 hours.In 4 cases without t PA injected,complete dissolution of anterior chamber fibrin in 2 cases was not seen until 8 days later.The pupillary fibrin membrane developed in another 2 cases.Conclusion t PA injection could prevent intraocular fibrin follwing traumatic cataract extraction and IOL implantation.t PA leads to rapid dissolution of fibrin following traumatic cataract surgery.t PA 10 μg injected into anteior chamber does not bring toxicity to corneal endothelium cells and retina.