fibrin and Uveitis

To evaluate the efficacy and safety of tissue plasminogen activator in management of postoperative fibrinous uveitis.. 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.. 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.. Intracavitary administration of tissue plasminogen activator is a safe and efficient alternative in the management of postoperative fibrinous membrane.

Topics: Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Algorithms; Cataract Extraction; Drug Therapy, Combination; Eye Diseases; Female; Fibrin; Fibrinolytic Agents; Humans; Injections, Intralesional; Male; Middle Aged; Postoperative Complications; Prospective Studies; Tissue Plasminogen Activator; Uveitis; Visual Acuity

The causes of fibrinous uveitis after cataract surgery are unclear, but surface modification of polymethylmethacrylate (PMMA) is known to influence post-operative inflammation. One hundred twenty-five patients were entered into a prospective investigation designed to assess the effect of intraoperative surface modification of PMMA, by coating with a 2% hydroxypropyl methylcellulose solution, on the incidence of fibrinous uveitis after extracapsular cataract surgery and lens implantation.. Of the 125 patients entered into this prospective study, 90 received pretreatment with a 1% indomethacin solution.. Fibrinous uveitis developed in 18(33%) of 54 eyes with dry lens implantation and in 1 (3%) of 36 eyes with coated lens implantation (P less than 0.005). Thirty-five eyes were not pretreated with indomethacin, and fibrin formation occurred in 6 (30%) of 20 dry implanted eyes and in 0 of 15 eyes with coated lens implantation (S = 0.02).. Intraoperative modification of the PMMA surface of an intraocular lens during implantation significantly reduces the severity of postoperative inflammation, as manifest by the incidence of fibrinous uveitis.

Topics: Adult; Aged; Aged, 80 and over; Cataract Extraction; Female; Fibrin; Humans; Hypromellose Derivatives; Incidence; Indomethacin; Lenses, Intraocular; Male; Methylcellulose; Methylmethacrylate; Methylmethacrylates; Middle Aged; Prospective Studies; Surface Properties; Uveitis; Visual Acuity

We report the results of 150 capsular bag implantations of the IOGEL PC-12 hydrogel lens. Mean follow-up was seven months. Following capsulorhexis and phacoemulsification, a Faulkner folder was used to insert the lens through a 3.5 mm to 4.0 mm scleral tunnel incision. Initially, a number of surgical complications were encountered. Because of increasing experience and modified instrumentation and technique, these did not occur in the later cases. Visual results were good, all eyes gaining a best case visual acuity of 20/40 or better and 97% achieving 20/25 or better. Morphological results were satisfactory. Generally the lenses remained centered and at a distance from the iris. Retention of viscoelastic substance or debris between the lens and the posterior capsule, occasionally observed at the start of the series, has been avoided by retrolental aspiration. Persistent pigment dispersion, which was observed when the lens had been implanted in the sulcus, was not seen. Tolerance of the lens material was generally satisfactory. There were six cases (4%) of fibrinoid uveitis, which is a relatively high incidence. From our experience and results we conclude that this implantation procedure allowed controlled insertion and placement of the IOGEL lens, provided that adequate instrumentation and technique was used; visual performance was comparable to that of poly(methyl methacrylate) lenses; capsular bag fixation furnished satisfactory morphological results, provided an adequately shaped capsulorhexis was performed.

Topics: Aged; Elasticity; Evaluation Studies as Topic; Fibrin; Follow-Up Studies; Humans; Lens Capsule, Crystalline; Lenses, Intraocular; Methacrylates; Middle Aged; Prognosis; Surgical Procedures, Operative; Uveitis; Visual Acuity

Certain types of intermediary uveitis are accompanied by proliferative vitreoretinopathy and retinal detachment. As a rule both complications are confined to the fundus periphery; they often occur simultaneously but they are not always related to one another. Exudate plaques and/or neovascularizations at the base of the vitreous are the precursors of peripheral proliferative vitreoretinopathy. Clinical findings and their therapeutic consequences are discussed.

Topics: Fibrin; Humans; Retina; Retinal Detachment; Retinal Vessels; Uveitis; Vitreous Body

Topics: Animals; Dose-Response Relationship, Drug; Electrophoresis, Polyacrylamide Gel; Endopeptidases; Fibrin; Fibrin Fibrinogen Degradation Products; Fibrinolysin; Fibrinolysis; Immunodiffusion; Rabbits; Time Factors; Urokinase-Type Plasminogen Activator; Uveitis; Vitreous Body

Acute anterior immunogenic uveitis of varying degree was induced in rabbits by the injection of human serum albumin into the vitreous body. After fixation and drying by the critical point method, the lens, the zonules, the vitreous and, in some specimens, coagulated exudate were removed by careful dissection. The surface of the ciliary body and the posterior surface of the iris were examined by scanning electron microscopy. In moderate uveitis, the ciliary body was covered by a thin layer of leucocytes enmeshed in fibrin strands. Scattered deposits of fibrin and a few leucocytes were also found in the iris. In severe uveitis, the processes of the ciliary body had nearly disappeared because of oedema and exudate, which also contained erythrocytes. The numerous leucocytes had marked excrescences formed by folds of the cell membrane. Fibrin seemed to play a role in the attachment of the leucocytes on the surface of the ciliary body.

Topics: Acute Disease; Animals; Ciliary Body; Fibrin; Iris; Leukocytes; Microscopy, Electron, Scanning; Rabbits; Serum Albumin; Uveitis

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