3 research outputs found
Intracameral recombinant tissue plasminogen activator (rtPA) as the primary treatment for secondary pupillary block
Alteplase is a recombinant form of human tissue plasminogen activator (tPA) that
converts plasminogen to plasmin essential for fibrinolysis. It is commonly used to
treat embolic or thrombotic disorders such as ischemic stroke. Despite its rarity
use in ophthalmology, we are reporting the effectiveness of recombinant tissue
plasminogen activator (rtPA) in treating an eye with secondary pupillary block
as a consequence of severe endophthalmitis. A patient presented with acute
endophthalmitis after a complicated cataract extraction. Examination showed
severe anterior chamber reaction leading to seclusion pupillae, iris bombe and
presence of iridocorneal touch 360-degree. Following intracameral alteplase 2.5
microgram in 0.1 ml given, iris bombe was observed to resolve completely onehour
later. Anterior chamber was also significantly deeper and slightly larger pupil
compared to before rtPA injection. Due to clearer view of anterior segment, pars
planar vitrectomy and extraction of intraocular lens could be performed with
significant visual improvement after surgery. Our findings suggest that usage of
rtPA, which is alteplase, was effective in treating secondary pupillary block due to
intense anterior segment inflammation in endophthalmitis cases. Thus it is useful
in replacing the conventional use of laser peripheral iridotomy in treating pupillary
block, as the latter potentially aggravates the pre-existing inflammatory condition
Bilateral retinal vasculitis: a presumed case of ocular TB without inflammation.
A 17-year-old male student of Indonesian parentage presented with two weeks history of progressive painless bilateral visual deterioration. There was no contact with tuberculosis (TB)-infected patients and parents claimed that all immunization including BCG was completed. However, BCG scar was not apparent. Visual acuity was 6/36 and 6/60 in the right and left eyes respectively. The anterior and vitreous chambers were quiet. Funduscopic examination revealed retinal vasculitis with perivascular exudates, branch vein occlusion, neovascularization and macular oedema. Fluorescein angiography confirmed large areas of capillary non-perfusion and leaking new vessels. Mantoux test was positive and full regime anti-TB therapy was instituted. HIV screening was negative. Three days later, an immunosuppressive dose of oral steroid was started. Both eyes received intensive laser photocoagulation.
Interestingly, there was no development of vitritis throughout