fibrin and Glaucoma--Neovascular

To report the use of intracameral urokinase for dissolving fibrin or blood clots after glaucoma surgery.. Four eyes of four patients who had undergone glaucoma surgery developed an anterior chamber fibrin or blood clot and increased intraocular pressure. Urokinase was injected into the anterior chamber in each patient to dissolve the clot.. In all cases, urokinase injection resulted in reduction of intraocular pressure. No adverse effects of urokinase injection were detected during the short follow-up period.. Urokinase may be a safe, inexpensive, and convenient alternative to tissue plasminogen activator for dissolving fibrin or blood clots after glaucoma surgery. Additional studies are warranted to evaluate the long-term safety of intracameral injection.

Topics: Aged; Anterior Chamber; Fibrin; Fibrinolysis; Glaucoma, Neovascular; Humans; Hyphema; Injections; Intraocular Pressure; Male; Middle Aged; Plasminogen Activators; Thrombolytic Therapy; Urokinase-Type Plasminogen Activator

Transscleral cyclophotocoagulation was performed with a neodymium: YAG laser on five patients 24-72 hr before enucleation for a blind, painful eye. The thermal mode at 20 ms and a maximum offset between aiming and therapeutic beams were kept constant. Variable parameters evaluated were energy levels between 2 and 8 J and distance from the limbus of 0.5-3.0 mm. Because of the underlying distortion in three of the eyes, meaningful interpretation by light microscopic evaluation was possible only in the other two. This suggested that the early histologic hallmark of the procedure is similar to that previously observed in human autopsy eyes with ciliary epithelial damage and elevation from underlying tissue. In addition, fibrin and scant inflammatory cells were seen in the space between ciliary epithelium and stroma. Minimal damage was observed in the ciliary muscle. These findings suggest that direct damage to the ciliary epithelium is the most likely mechanism of reduced aqueous production by this cyclodestructive procedure. The findings also support the concept that an anterior placement of approximately 1.0-1.5 mm posterior to the limbus is most likely to damage the ciliary epithelium of the pars plicata.

Topics: Ciliary Body; Diabetic Retinopathy; Epithelium; Eye Enucleation; Fibrin; Glaucoma, Neovascular; Glaucoma, Open-Angle; Humans; Inflammation; Leukocytes; Light Coagulation; Sclera