AS-OCT of cyclitic membrane pre and post treatment with rtPA in the anterior chamber

Abstract

We present the case of a 40-year-old male, who presented to the ophthalmology emergency department with pain and visual loss in his left eye 10 days after an intravitreal injection of a split medication. At the exploration, we found an intense corneal edema in the left eye with endothelial dusting and ciliary hyperemia. LE fundus was impracticable due to anterior chamber opacity. Because of the corneal edema, we performed an anterior segment optical coherence tomography (AS- OCT), visualizing a cyclitic membrane with pupillary block and inflammatory cells in the anterior chamber. There are different treatments to lyse the cyclitic membrane; in this case, we managed the cyclitic membrane with 0,05 ml of intracameral recombinant tissue plasminogen activator (rtPA), a highly potent fibrinolytic protein. We disinfected the eyelids and the conjunctival sac with Povidone Iodine solution, applied topical anesthesia with double anesthetic, and injected 0,05 mL rtPA solution into the anterior chamber using an insulin syringe with a 30-gauge needle. Intracameral rtPA was prepared under sterile conditions using 50 mg vials of rtPA diluted with 50 mL of sterile water to create a 1 mg/ mL solution. Four hours after rtPA treatment, the cyclitic membrane lysed, obtaining pupillary mydriasis. The AS OCT before and after the treatment with intracameral rtPA was of high utility as it allowed the visualization of the cyclitic membrane and its removal.

Keywords: AS-OCT; cyclitic membrane; intracameral rtPA; pupillary block.

Fig. 1

AS-OCT pre-rtPA treatment. Pupillary cyclitic membrane is observed, as well as the inflammation in the anterior chamber and a secondary pupillary block

Fig. 2

AS-OCT four hours post-rtPA treatment. After 4 hours of administering 0.05 mL of rtPA in the anterior chamber, the cyclitic membrane disappeared, with greater pupillary mydriasis