fibrin and Glaucoma

The mechanisms implicated in the clinical manifestations of zonular diseases, especially ectopia lentis, are reviewed.. The molecular mechanisms involve fibrillin in a large spectrum of heritable diseases characterized by zonular stretching. The usual complications are refractive errors, especially myopia, glaucoma (either primary open angle, secondary angle closure and pupil block by anterior displacement of the lens) and retinal detachment.. The genetics and molecular understanding provide information for genetic counseling. Treatment of myopia and glaucoma depend on the underlying mechanism, and lens surgery techniques are continuously improved.

Topics: Ectopia Lentis; Fibrin; Glaucoma; Humans; Marfan Syndrome; Refraction, Ocular; Refractive Errors

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 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

A prospective study of the peroperative behaviour of eyes with pseudoexfoliation syndrome (PEX) in cataract surgery was carried out between June 1989 and July 1990, including 164 eyes with PEX and 164 eyes in the control group. All eyes underwent either phakoemulsifikation or extracapsular extraction with implantation of a posterior chamber lens. Intraoperative the eyes with PEX fairly often failed to reach adequate mydriases (23%) compared with the control group (5.5%). The rate of postoperative fibrinoid reactions was almost the same in both groups (7.9% in eyes with PEX, 7.5% in the control group). Even though the cataract extraction and implantation of the IOL sometimes is slightly more difficult due to inadequate mydriasis, there is no evidence for an increased rate of severe intraoperative complications. The incidence of ruptures of the posterior capsule and vitreous loss was 1.2% and 0.6% respectively in eyes with PEX, the former is within our results of cataract surgery, delivered from a study of 6000 consecutive cases from 1982 to 1985 (0.73%).

Topics: Aged; Female; Fibrin; Foreign-Body Reaction; Glaucoma; Humans; Lens Capsule, Crystalline; Lenses, Intraocular; Male; Postoperative Complications; Prospective Studies; Risk Factors

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

In recent years microinvasive glaucoma surgery has risen in popularity. Among microinvasive glaucoma surgery options is the XEN gel stent (Allergan Plc, Dublin, Ireland), a 45 μm wide ab-interno microstent. It has proven effective in lowering intraocular pressure (IOP) with low complication rates. However, XEN gel stents can become obstructed and cause postoperative rise in IOP. The causes and predicting factors for such obstructions still requires further research.. We describe the case of a 69-year-old male patient, with traumatic glaucoma and chronic intraocular inflammation showed by laser flare photometry, following childhood trauma and anterior segment surgery. Uncontrollable IOP despite maximal antiglaucomatous therapy was managed with XEN-augmented Baerveldt surgery. Despite good initial filtration and IOP control, the XEN stent became obstructed and was surgically replaced. After a month, the new stent became obstructed and was replaced by a thicker-lumened Baerveldt tube. This restored good filtration, and adequate IOP was maintained postoperatively. Microscopic examination of the obstructed XEN stent showed a dense fibrin plug.. This case report shows that fibrin formation could be an important factor in XEN gel stent obstruction, even in initially successfully filtering stents. The association of fibrinogenesis and intraocular inflammation could add a note of caution to the use of XEN gel stents in complicated cataract surgery, or advocate for aggressive anti-inflammatory treatments postoperatively. This could lead to a refinement in success predictors and better patient selection for XEN surgery. Finally, this could open the way to new management options for persistent obstructions, including pharmaceutical fibrinolysis.

Topics: Aged; Chronic Disease; Device Removal; Fibrin; Fibrinolysis; Glaucoma; Glaucoma Drainage Implants; Humans; Inflammation; Intraocular Pressure; Male; Ophthalmologic Surgical Procedures; Prosthesis Failure; Prosthesis Implantation; Risk Factors; Stents; Tonometry, Ocular; Treatment Outcome

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

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

To report the use of intracameral tissue plasminogen activator to dissolve fibrinous membranes and break posterior synechiae in patients with acute HLA-B27-positive iridocyclitis with impending pupillary block.. Two patients with severe acute fibrinous iridocyclitis and seclusio pupillae were identified. Because of the concern of impending pupillary block, intracameral tissue plasminogen activator (12.5 microg in 0.1 ml, Activase; Genentech, Inc, South San Francisco, California) was injected with a 25-gauge needle through the corneal limbus.. Both patients showed complete dissolution of fibrin with disruption of posterior synechiae. There were no adverse events after injection. Neither patient required further invasive intervention, and both fully recovered with medical management.. Intracameral tissue plasminogen activator is a safe and effective agent for patients with severe acute iridocyclitis and pupillary seclusion. Patients with clinical signs suggestive of impending pupillary block glaucoma may be considered for tissue plasminogen activator injection to avoid the possible need for emergency surgical iridectomy and synechiolysis.

Topics: Acute Disease; Adult; Fibrin; Fibrinolysis; Fibrinolytic Agents; Glaucoma; HLA-B27 Antigen; Humans; Iridocyclitis; Male; Pupil Disorders; Tissue Plasminogen Activator

Topics: Aged; Female; Fibrin; Fibrinolysis; Fibrinolytic Agents; Glaucoma; Humans; Injections; Postoperative Complications; Thrombolytic Therapy; Tissue Plasminogen Activator; Trabeculectomy

I report the use of tissue plasminogen activator to open blocked silicone tubes of Baerveldt glaucoma implants in two cases. A dose of 25 micrograms was used in both cases; lysis of fibrin clots occurred within 15 to 45 minutes.

Topics: Aged; Aged, 80 and over; Anterior Chamber; Blood Coagulation; Female; Fibrin; Fibrinolysis; Glaucoma; Humans; Male; Postoperative Complications; Prostheses and Implants; Recombinant Proteins; Silicone Elastomers; Tissue Plasminogen Activator

Topics: Aged; Aged, 80 and over; Blood Coagulation; Female; Fibrin; Filtration; Glaucoma; Humans; Postoperative Complications; 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

We have localized fibrin/fibrinogen in experimental glaucoma filtration surgery wounds in non-human primates by light and transmission electron microscopy. Fibrin/fibrinogen was abundant two days after surgery, but was virtually undetectable by seven days postoperatively. We have confirmed the identity of fibrin/fibrinogen on the ultrastructural level by immunoelectron microscopy employing antibodies directed against fibrinogen. Fibrin clot formation may play an important role in the wound healing response that causes glaucoma filtration surgery to fail.

Topics: Animals; Blood Coagulation; Fibrin; Fibrinogen; Glaucoma; Histocytochemistry; Macaca fascicularis; Microscopy, Electron; Postoperative Period; Wound Healing

Topics: Adult; Aged; Aged, 80 and over; Anterior Chamber; Cataract Extraction; Exudates and Transudates; Female; Fibrin; Glaucoma; Humans; Male; Middle Aged; Postoperative Complications; Trabeculectomy

After pars plana vitrectomy and fluid-gas exchange, two patients developed fibrin membranes across the pupillary space resulting in pupillary block and subsequent glaucoma. In one case the angle was closed; in the second case the angle was open because of gas in the anterior chamber. In both cases the argon laser made permanent openings in the fibrin pupillary membrane that relieved the pupillary block.

Topics: Adult; Aged; Exudates and Transudates; Female; Fibrin; Gases; Glaucoma; Humans; Injections; Iris Diseases; Laser Therapy; Male; Vitrectomy; Vitreous Body

Two hundred eighty consecutive vitrectomies in diabetic patients were studied retrospectively. In 15 eyes, interlacing fibrin-like strands appeared on the surface of the retina and behind the iris plane from two to 14 days postoperatively. One or two days later, a gelatinous mass formed in the center of the vitreous activity, leading to the development of tractional retinal detachment and rubeosis iridis with neovascular glaucoma. Large doses of systemic and topical corticosteroids reversed the fulminating course of this complication in six of 15 eyes. The combination of lens surgery or scleral buckling procedure with vitrectomy, and the presence of retinal detachment preoperatively seemed to predispose to this complication. It is possible that multiple surgical procedures performed during the same operation cause an increase in vascular permeability resulting in the formation of a gelatinous, fibrin-like material in the diabetic eye.

Topics: Adult; Aged; Diabetic Retinopathy; Eye Diseases; Female; Fibrin; Glaucoma; Humans; Intraocular Pressure; Iris Diseases; Male; Middle Aged; Postoperative Complications; Retinal Detachment; Retrospective Studies; Syndrome; Vitreous Body

Topics: Adult; Female; Fibrin; Glaucoma; Humans; Trabecular Meshwork

Topics: Anterior Chamber; Basement Membrane; Blood Platelets; Capillaries; Cell Nucleolus; Cell Nucleus; Choroid Neoplasms; Ciliary Body; Collagen; Cytoplasm; Cytoplasmic Granules; Endoplasmic Reticulum; Epithelium; Fibrin; Fibroblasts; Glaucoma; Humans; Hyalin; Macrophages; Melanoma; Microscopy, Electron; Microsurgery; Mitochondria; Mitosis; Osmium; Staining and Labeling

Topics: Animals; Behcet Syndrome; Collagen; Collagen Diseases; Cornea; Eye; Eye Diseases; Fibrin; Fibrinogen; Fluorescent Antibody Technique; Glaucoma; Humans; Rabbits; Uveitis