[The use of tissue plasminogen activator in the post-operative treatment of fibrinoid uveitis]. / Utilizarea activatorului tisular al plasminogenului in tratamentul uveitelor fibrinoide postoperatorii.

PURPOSE: To evaluate the efficacy and safety of tissue plasminogen activator in management of postoperative fibrinous uveitis. MATERIAL AND METHOD: Prospective study, interventional case series including 13 patients who developed fibrinous membrane in anterior chamber; patients were operated for cataract (4 cases), for cataract and glaucoma (7 cases) and for corneoscleral lacerations (2 cases). Initial treatment consisted of corticosteroid administration (topically, subconjunctival +/- systemic) and mydriatic-cycloplegic drugs. Inadequate response imposed intracavitary administration of tissue plasminogen activator (25 microg/ml, 0.2 ml). The main outcomes were: complete resolution of fibrinous membrane, presence of adverse events and visual rehabilitation. RESULTS: Fibrinous membrane resorption starts in the next hours and complete resolution was proved in all cases after a mean time 53.55 +/- 37.65 (24-146) hours. In 12 patients we used only one administration of tissue plasminogen activator, but in one case we repeated it. It was not signaled any adverse event drug related. It was an important increase of visual acuity in all cases. CONCLUSION: Intracavitary administration of tissue plasminogen activator is a safe and efficient alternative in the management of postoperative fibrinous membrane.

[The influence of cataract surgery on the efficacy of trabeculectomy in patients with open-angle glaucoma]. / Influenta operatiei de cataracta asupra eficientei trabeculectomiei la pacientii cu glaucom cu unghi deschis.

PURPOSE: To study the influence of cataract surgery on the intraocular pressure decreasing effect of trabeculectomy in patients with open angle glaucoma. METHOD: Retrospective study that included two groups: --32 patients with open angle glaucoma, their intraocular pressure being controlled after filtering surgery; they were subject to cataract surgery at least 6 months after the trabeculectomy (the CT group)--44 patients with open angle glaucoma (primary or secondary) with intraocular pressure controlled after trabeculectomy (the T group). The evaluation included: preoperative intraocular pressure, early (at 2 months) and late (at 18 months) postoperative intraocular pressure, intra- and postoperative complications of the cataract surgery, the need for antiglaucoma medication. RESULTS: The cataract surgery in patients with trabeculectomy increases the intraocular pressure (initial mean IOP = 15.31 mmHg, final mean IOP = 18.53 mmHg, mean IOP = 3.22 mmHg). The intraocular pressure increase is more important after extracapsular extraction than after phacoemulsification (3.7 vs. 2.01 mmHg). Qualified therapeutical success was obtained in 81.25% of CT patients. In the T group the postoperative intraocular pressure maintained constant throughout the entire follow-up period. The number of additional antiglaucoma drugs was larger in the T group (0.7 versus 0.5). The patients that suffered intra and postoperative complications had increased intraocular pressure when compared to those without complications (mean IOP early = 3.1 mmHg, mean IOP late = 1.1 mmHg). CONCLUSIONS: Cataract surgery in patients with previous filtering surgery increases the intraocular pressure and the need for antiglaucoma drugs. The intraocular pressure rise was more important after extracapsular extraction than after phacoemulsification. Intra and postoperative complications result in a more important increase in intraocular pressure, in the first months after the cataract operation.