Use of Intracameral Tissue Plasminogen Activator During Uveitic Cataract Surgery

ABSTRACT

Purpose

To report the outcomes of intracameral tissue plasminogen activator (tPA) use during uveitic cataract surgery.

Design

Retrospective case series from a single United States tertiary center of 36 eyes from 31 consecutive patients with established uveitis who received intraoperative intracameral tPA during cataract surgery between 2016 and 2020.

Results

Mean visual acuity (VA) improved from logMAR 1.0 ± 0.7 preoperatively to logMAR 0.7 ± 0.8 by POM12. VA improved from baseline postoperatively (POM1 p = 0.0002, POM6 p = 0.006 and POM12 p = 0.007). Minimal to no anterior chamber inflammation was achieved in 47.2% of the eyes by POW1 and 80.0% of the eyes by POM1. Mean clock-hours of posterior synechiae improved from 8.2 ± 3.8 preoperatively to 0.1 ± 0.6 by POM12. Six eyes developed hyphema and/or vitreous hemorrhage, four of which resolved spontaneously.

Conclusions

Adjunctive intracameral tPA during uveitic cataract surgery improves VA and intraocular inflammation, but risks postoperative hemorrhage. Intraoperative tPA as adjunctive anti-inflammatory therapy warrants randomized prospective studies.

KEYWORDS:

• Cataract surgery
• intraocular inflammation
• postoperative inflammation
• tissue plasminogen activator
• uveitis

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was supported in part by Unrestricted Grants from Research to Prevent Blindness, New York, NY, to the Department of Ophthalmology & Visual Sciences, University of Utah, and to the Flaum Eye Institute at the University of Rochester. WFH was supported by a Heed Ophthalmic Foundation Fellowship.