fibrin and Cataract

To evaluate the postoperative effect of intracameral tPA (alteplase; Activase®, Genentech, San Francisco, CA), administered at immediate conclusion of phacoemulsification, on anterior chamber fibrin formation in dogs.. Forty-one dogs (82 eyes) undergoing bilateral phacoemulsification received 25 μg/0.1 mL intracameral tPA in one eye and 0.1 mL unmedicated aqueous vehicle in the contralateral eye immediately after corneal incision closure. Intraocular pressure (IOP) was measured, and severity of anterior chamber fibrin formation, aqueous flare, pigment precipitates on the intraocular lens (IOL) implant, posterior capsular opacification (PCO), and corneal edema were graded at approximately 1 week, 2-3 weeks, 4-6 weeks, 8-12 weeks, and greater than 3 months postoperatively.. Anterior chamber fibrin developed postoperatively in 68.3% of dogs (28/41) and 50% of eyes (41/82). In tPA-treated eyes, 53.7% (22/41) developed fibrin compared to 46.3% of control eyes (19/41). Some degree of postoperative ocular hypertension (POH) occurred in 53.7% of dogs (22/41) and 36.5% of eyes (30/82). In tPA-treated eyes, 34.1% (14/41) experienced POH compared to 39% of control eyes (16/41). Additional intracameral tPA injection was later required in 29.3% of both tPA-treated (12/41) and control eyes (12/41).. Administration of intracameral tPA at immediate conclusion of canine phacoemulsification had no clinically observable effect on anterior chamber fibrin incidence at any time point. tPA-treated eyes showed no prophylaxis against POH or secondary glaucoma compared to control eyes and received late postoperative tPA injections at the same frequency as control eyes.

Topics: Animals; Anterior Chamber; Cataract; Dog Diseases; Dogs; Female; Fibrin; Fibrinolytic Agents; Follow-Up Studies; Glaucoma; Lens Implantation, Intraocular; Male; Ocular Hypertension; Phacoemulsification; Postoperative Period; Random Allocation; Tissue Plasminogen Activator

To report the intra-and postoperative complications and visual acuity outcomes in pars plana vitrectomy (PPV), phacoemulsification and intraocular lens (IOL) implantation in patients with cataract and proliferative diabetic retinopathy (PDR). A comparison of the combined versus two-step surgical approach is given.. Retrospective uncontrolled interventional clinical trial. Forty-eight eyes of 48 consecutive patients with PDR were included. Twenty-eight (58.3%) eyes with combined surgery and 20 (41.7%) eyes with sequential surgery were analyzed.. Postoperative follow-up time was between 6 and 63 months (mean: 18 months). 1) Combined surgery: Preoperative best-corrected visual acuity (BCVA) ranged from 20/200 to hand motions, and postoperative BCVA ranged from 20/30 to hand motions. BCVA improved in 17 eyes (60.7%), while in 7 (25%) eyes there was no change (> or =2 ETDRS lines) in VA, and in 4 (14.3%) eyes BCVA decreased. Postoperative complications included vitreous hemorrhage (VH) in 10 (35.7%) eyes, and fibrinous exudation in 9 (32.1%) eyes. 2) Two-step surgery: Preoperative BCVA ranged from 10/200 to light perception, and from 20/40 to light perception in the postoperative period. Best-corrected visual acuity improved in 15 (75%) eyes, remained the same in 4 (20%) eyes, and decreased in 1 (5%) eye. Postoperative complications included fibrinous exudation in 6 (30%) eyes, and VH in 3 (15%) eyes.. Combined PPV, phacoemulsification and IOL implantation as well as the two-step procedure are safe and effective for the management of cataract in PDR. Sequential surgery could be advantageous to BCVA outcomes by minimizing postoperative VH, which is significantly more frequent after combined surgery.

Topics: Adult; Aged; Aged, 80 and over; Cataract; Diabetic Retinopathy; Exudates and Transudates; Female; Fibrin; Follow-Up Studies; Humans; Intraoperative Complications; Ischemia; Lens Implantation, Intraocular; Macula Lutea; Male; Middle Aged; Phacoemulsification; Postoperative Complications; Retinal Detachment; Retrospective Studies; Time Factors; Visual Acuity; Vitrectomy; Vitreoretinopathy, Proliferative; Vitreous Hemorrhage

To evaluate the effect of intraocular infusion of dalteparin, a low-molecular-weight heparin (LMWH) administered in the infusion fluid to prevent early postoperative fibrin formation in combined phacoemulsification-trabeculectomy surgery (phacotrabeculectomy).. Farabi Eye Hospital, Tehran, Iran.. Standard combined phacotrabeculectomy was performed prospectively in a masked fashion in 60 eyes; 35 eyes received 5 IU/mL LMWH in the infusate and 25 eyes served as controls. Masked postoperative examinations assessed visual acuity, intraocular pressure (IOP), anterior chamber cell and flare, and fibrin formation with slitlamp examinations 1, 3, 7, 30, and 90 days after surgery.. The rate of intraocular fibrin/membrane formation was significantly lower in the LMWH group than in the control group at each follow-up (P<.001, Student t test) . The amount of IOP was lower in LMWH group at each follow up (P<.01, Student t test). Final visual acuity was better in LMWH group (P = .03, Student t test). The frequency of synechia formation was lower in the LMWH group on day 90 (P = .002, chi-square test).. Infusion of dalteparin, a LMWH, may be an effective inhibitor of postoperative fibrin formation in phacotrabeculectomy surgery. It may reduce the frequency of synechia formation and improve visual acuity. It may not be associated with increased risk for intraoperative or postoperative complications at the tested dose. This drug may be a useful adjunct in combined surgery.

Topics: Aged; Cataract; Dalteparin; Double-Blind Method; Female; Fibrin; Fibrinolytic Agents; Glaucoma; Humans; Infusions, Parenteral; Intraocular Pressure; Lens Implantation, Intraocular; Male; Phacoemulsification; Postoperative Complications; Prospective Studies; Trabeculectomy; Visual Acuity

To evaluate the efficacy of intracameral recombinant tissue plasminogen activator (r-TPA) in prevention of fibrinous effusion after lensectomy, anterior vitrectomy, and posterior chamber intraocular lens (PCIOL) implantation in patients with congenital cataract.. The study was done as a double masked randomised clinical trial between April 2002 and November 2003 in Farabi Eye Hospital. 34 eyes of 26 patients with congenital cataract were included in the study and randomised into two groups (18 cases and 16 controls). Mean age was 8.1 years (3--14 years). Each eye underwent lensectomy and anterior vitrectomy with PCIOL implantation. At the end of surgery 20 microg r-TPA was injected intra-camerally in the case group. The control group received only balanced salt solution. All patients received periocular, systemic, and topical steroids after surgery. Patients underwent follow up examinations for 3 months.. The incidence of intraocular fibrin membrane formation was significantly lower in the case group on days 1, 3, 7, 14 (p=0.02, p=0.01, p=0.01, and p=0.01, respectively, chi(2) test), but there was no significant difference on days 30 and 90. The frequency of pigmented intraocular lens precipitates was significantly lower in the case group at the end of the third month (p<0.001, chi(2) test). No gross ocular side effects were noted after r-TPA injection.. It seems that prophylactic intracameral r-TPA is effective in prevention of fibrinous effusion at least in the first 2 weeks after cataract extraction in the paediatric age group and decreases the incidence of pigmented IOL precipitates.

Topics: Adolescent; Cataract; Cataract Extraction; Child; Child, Preschool; Double-Blind Method; Exudates and Transudates; Female; Fibrin; Fibrinolytic Agents; Humans; Male; Recombinant Proteins; Tissue Plasminogen Activator

Fibrin membrane pupillary-block glaucoma is an uncommon complication after phacoemulsification cataract surgery. We present a case treated successfully by pharmacological dilation of the pupil. Previous case reports have recommended the use of Nd:YAG peripheral iridotomy, Nd:YAG membranotomy and intracameral tissue plasminogen activator.The patient presented with intraocular pressure (IOP) of 45 mmHg 2 days after uneventful phacoemulsification cataract surgery. Anterior segment optical coherence tomography revealed that a fibrinous membrane-filled space had formed between the pupillary plane and the implanted intraocular lens.The diagnosis of fibrin membrane pupillary-block glaucoma was made. Initial treatment consisted of IOP-lowering medication and topical pupillary dilation (atropine 1%, phenylephrine hydrochloride 10% and tropicamide 1%). Within 30 min, the dilation broke the pupillary block and the IOP was 15 mmHg. The inflammation was treated with topical dexamethasone, nepafenac and tobramycin. Within a month, the patient reached a visual acuity of 1.0.

Topics: Cataract; Dilatation; Fibrin; Glaucoma; Humans; Intraocular Pressure; Phacoemulsification; Pupil Disorders; Tissue Plasminogen Activator

Topics: Cataract; Cataract Extraction; Diabetes Mellitus; Fibrin; Humans; Pupil Disorders

To describe the occurrence and associated factors for "fibrin web" (FW) formation following phacoemulsification in dogs.. A retrospective review of medical records of all dogs undergoing phacoemulsification (MU-Veterinary Health Center, 2014-2018) was conducted to associate FW formation with signalment, systemic co-morbidities, cataract stage, surgeon (resident vs faculty), phacoemulsification time, IOL, and intracameral injections including viscoelastic type. Both univariate and multivariate statistical analyses were performed to evaluate associations among variables with FW formation.. Data from 398 eyes on 201 dogs were included; 4 left eyes (4 dogs) developed presumptive endophthalmitis and were excluded from further analysis. Forty-eight eyes did not have cataract surgery. Hence, 350 eyes on 201 dogs were included in the analyses. Among these, 84 eyes (59 dogs) developed a FW. Univariate analyses showed that the odds of FW increased with age and phacoemulsification time. Additionally, FW web was associated lens type, lens brand, and viscoelastic type. Multivariate analyses showed that when comparing lens types in combination with a particular viscoelastic, viscoelastic impacted the estimated prevalence of FW formation the most. In contrast, when the data were analyzed by lens brand, lens brand impacted prevalence more than viscoelastic type. Diabetes mellitus was not associated with FW formation.. Based on the available data, intraocular lens implantation, viscoelastic type, dog age, and phacoemulsification time were associated with FW formation. Diabetes mellitus, gender, cataract stage, surgeon, intracameral injections other than viscoeleastic, and intra- and postoperative complications were not associated with FW formation.

Topics: Animals; Cataract; Dogs; Female; Fibrin; Male; Phacoemulsification; Retrospective Studies; Uveitis, Anterior

Topics: Anterior Chamber; Cataract; Fibrin; Fibrinolysis; Glaucoma; Humans; Plasminogen Activators; Postoperative Complications; Tissue Plasminogen Activator

The aim of the study is to determine the influence of some selected immunological factors upon the pathogenesis of senile cataract and cataract in diabetic people. Immunofluorescent pictures of opacities lenses in senile cataract patients and in diabetic cataract patients were compared. The fluorescent microscopic examination of these preparations revealed green colored concrements. The concrements thus observed proved the presence of a given class immunoglobulin in the lenticular nucleus sections. In all preparations (100%), the presence of IgG was found. None concrements' of C4 and the fibrin were spotted in the observed preparations.

Topics: Cataract; Complement C4; Diabetes Complications; Fibrin; Fluorescent Antibody Technique; Humans; Immunoglobulin G; Lens, Crystalline; Middle Aged

To investigate the efficacy of tissue plasminogen activator (tPA) in the treatment of severe fibrinous anterior chamber reactions after intraocular surgery.. Ophthalmology Department, AHEPA University Hospital, Thessaloniki, Greece.. The study comprised routine surgical and postoperative cases selected in a nonrandomized fashion. Low-dose tPA infusion (0.2 mL of 125 microg/mL) was administered through a side-port in the anterior chamber in 25 patients with recent or long-standing fibrin formation after cataract extraction (n = 13), trabeculectomy (n = 5), combined procedure (n = 5), or penetrating keratoplasty (n = 2). Patients were treated 4 to 25 days postoperatively (mean 7 days).. Fibrin lysis was observed 2 to 12 hours after tPA infusion. No hemorrhage or other complications occurred, and no further treatment was necessary in any patient. Three cases of delayed partial fibrin lysis resolved with intense topical steroid treatment. There were no recurrences over the 3-month follow-up.. Low-dose tPA was an effective and safe method for the management of anterior chamber fibrin formation. Treatment was well tolerated and gave excellent results with no complications.

Topics: Adult; Aged; Aged, 80 and over; Anterior Chamber; Cataract; Female; Fibrin; Fibrinolysis; Glaucoma; Humans; Male; Middle Aged; Phacoemulsification; Plasminogen Activators; Postoperative Complications; Safety; Thrombolytic Therapy; Tissue Plasminogen Activator; Trabeculectomy

We evaluated the biocompatibility of three kinds of intraocular lenses: heparin-surface-modified, surface-passivated, and regular poly(methyl methacrylate). Each lens type was implanted in 30 eyes. The cases were followed for one year. Biocompatibility was assessed by the degree of postoperative inflammation and capsule opacification. There was no significant difference between the surface-passivated and regular groups on both indices, but there was less postoperative inflammation in the heparin-surface-modified group. The incidence of posterior capsule opacification was greater in the heparin-surface-modified group than in the surface-passivated and regular groups, but the difference was not statistically significant.

Topics: Aged; Aqueous Humor; Biocompatible Materials; Cataract; Cataract Extraction; Evaluation Studies as Topic; Fibrin; Follow-Up Studies; Heparin; Humans; Lens Capsule, Crystalline; Lenses, Intraocular; Macular Edema; Methylmethacrylate; Methylmethacrylates; Middle Aged; Prosthesis Design

Effects of anticoagulant or fibrinolytic therapy on anterior chamber fibrin following cataract surgery was evaluated. In one series of experiment, various amounts of antithrombin III (ATIII), an anticoagulant, were injected into the anterior chamber of the rabbit eye immediately after phacoemulsification of the lens. In another series, various amounts of tissue plasminogen activator (TPA), a fibrinolytic agent, were injected into the anterior chamber 24 hours after phacoemulsification when it was filled with fibrin. The extent of the fibrin clot was graded using a slit lamp microscope, and the aqueous flare intensity was determined with a laser cell-flare meter for 2 weeks after operation. The eyes treated with TPA was also examined with light and electron microscopy. ATIII showed an inhibitory effect on fibrin formation, but complete inhibition was not obtained even with the highest concentration used. In contrast, the fibrin clot was completely resolved even with the lowest dose of TPA used, while no side effect such as inflammation or bleeding was seen. Histological examinations revealed no pathological changes in eyes treated with TPA. TPA may be a promising agent for fibrin resolution after cataract surgery.

Topics: Animals; Anterior Chamber; Antithrombin III; Cataract; Cataract Extraction; Fibrin; Rabbits; Thrombolytic Therapy; Tissue Plasminogen Activator

Deposition of a fibrin-like material leading to a membrane in the pupillary opening is described in glaucoma patients following extracapsular cataract extraction and intraocular lens implantation. The fibrinoid reaction was observed in 4 out of 57 eyes (7%), all operated on within two years by the same surgeon (CTL). The fibrinoid reaction appeared 2 to 15 days postoperatively in glaucoma patients on whom iridoplasty or synechiolysis had been performed during surgery. It seems advisable to give such patients long-acting subconjunctival steroids at the end of the operation.

Topics: Aged; Aged, 80 and over; Cataract; Female; Fibrin; Glaucoma; Humans; Lenses, Intraocular; Male; Membranes; Middle Aged; Pupil; Retrospective Studies; Risk Factors; Visual Acuity

I observed transient membrane formation consisting primarily of fibrin on the anterior surface of the IOL in 45 (7.6%) of the 596 eyes that received posterior chamber lens implantation during the past year. The onset of the condition was generally five to six days after surgery. This membrane characteristically developed between the margins of the anterior capsule, and therefore might be the result of lens-induced uveitis from the proliferation of lens epithelial cells under the anterior capsule.

Topics: Adult; Aged; Cataract; Cornea; Diabetes Complications; Female; Fibrin; Humans; Lenses, Intraocular; Male; Membranes; Postoperative Complications; Steroids

A primate model was used to compare a silicone intraocular lens (Elastic Lens, STAAR Surgical) and a conventional polymethylmethacrylate/polypropylene lens. Tolerance and stability of silicone lenses within the eye were tested.

Topics: Animals; Anterior Chamber; Cataract; Cornea; Endothelium; Fibrin; Lens Capsule, Crystalline; Lenses, Intraocular; Macaca fascicularis; Melanins; Methylmethacrylates; Polypropylenes; Postoperative Complications; Prosthesis Design; Silicones

Subtotal open-sky vitrectomy can be used to improve visual function in some eyes for which closed vitrectomy is useless. Open-sky vitrectomy allows easier access for surgical instruments, especially to anterior fundus structures. The technique also improves the visibility of intraocular structures. The surgical procedure, which uses special instruments and high-molecular-weight hyaluronic acid, is divided into four stages: preparation, operating inside the vitreous cavity, wound closure, and retinal reattachment. In 290 consecutive operations for which complete follow-up data are available, retinal reattachment was achieved in 61 eyes (21%). The greatest number of successes (16 of 30 cases [53%]) was achieved in severe tractional retinal detachments. Such results are encouraging because these eyes were considered inoperable by other techniques. Open-sky vitreous surgery is performed through a corneal incision, but a scleral incision over the pars plana may become the method of choice in selected cases. The development of a preretinal fibrin membrane, as a result of either a closed vitrectomy or an open-sky procedure, may be a major cause of postoperative failure. Hypotony during surgery is probably the main precipitating factor of intraocular fibrin membrane formation.

Topics: Adolescent; Adult; Cataract; Child; Child, Preschool; Eye Diseases; Eye Foreign Bodies; Eye Injuries; Female; Fibrin; Humans; Lens Subluxation; Male; Middle Aged; Retinal Detachment; Scleral Buckling; Vitreous Body

Topics: Adhesives; Cataract; Cornea; Eye; Fibrin; Humans; Thrombin

Topics: Cataract; Cornea; Eye; Fibrin; Humans; Ophthalmology