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. 2024 Jul;32(5):673-677.
doi: 10.1080/09273948.2023.2194410. Epub 2023 Apr 20.

Use of Intracameral Tissue Plasminogen Activator During Uveitic Cataract Surgery

Wen F Hu  1 , Tyler Etheridge  2 , Marissa B Larochelle  2
Affiliations

Use of Intracameral Tissue Plasminogen Activator During Uveitic Cataract Surgery

Wen F Hu et al. Ocul Immunol Inflamm. 2024 Jul.

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.

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Conflict of interest statement

Disclosure Statement

The authors report there are no competing interests to declare.

Figures

Figure 1.
Figure 1.. Preoperative and postoperative visual acuity.
(A) Mean logMAR best corrected visual acuity (BCVA) improved with time (mixed effects ANOVA, p=0.0002). BCVA at postoperative time points improved compared to preoperative baseline (multiple comparisons test POM1 p=0.0002, POM6 p=0.006 and POM12 p=0.007). Error bars represent standard error of the mean. (B) Distribution of pre-operative and postoperative BCVA.
Figure 2.
Figure 2.. Preoperative and postoperative intraocular pressure.
(A) Mean number of IOP-lowering agents increased transiently at POW1 but was not statistically significant (one way ANOVA, p=0.08). (B) Mean IOP (mmHg) did not vary by visit (mixed effects ANOVA, p=0.67. Error bars represent standard error of the mean.
Figure 3.
Figure 3.. Preoperative and postoperative inflammation.
(A) Anterior chamber (AC) cell grade categorized by a grade of 0 or 0.5 and ≥1 across visits. (B) Vitreous cell grade categorized by a grade of 0 or 0.5 and ≥1 by visit. (C) Average clock hours of posterior synechiae improved after surgery (mixed effects ANOVA, p<0.0001), at all post-operative time points compared to pre-operative baseline (multiple comparisons test p<0.0001 at POW1, POM1, POM6, POM12).
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