fibrin and Vitreous-Hemorrhage

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

The authors undertook a study to investigate the ability of systemic or heparin supplementation of the vitrectomy infusion solution to prevent formation of postoperative intraocular fibrin membranes. A total of 73 eyes were randomized; 26 served as the control group, 23 received 10,000 IU of intravenous bolus of heparin, and 12 eyes each underwent the vitrectomy with an infusion solution containing 10 or 5 IU/cc of heparin. Intraoperative bleeding, postoperative bleeding, and postoperative fibrin formation were graded. A 10-IU/cc heparin infusion resulted in a statistically significant reduction in postoperative fibrin formation (P = 0.04) but increased intraoperative bleeding (P = 0.02). A trend toward reduced postoperative fibrin formation was noted in the intravenous heparin and 5 IU/cc infusion groups.

Topics: Fibrin; Heparin; Humans; Infusions, Intravenous; Injections, Intravenous; Intraoperative Complications; Postoperative Complications; Prospective Studies; Random Allocation; Thrombosis; Vitrectomy; Vitreous Hemorrhage

Topics: Diabetes Mellitus, Type 2; Diabetic Retinopathy; Eye Diseases; Fibrin; Humans; Laser Coagulation; Macular Edema; Male; Middle Aged; Postoperative Complications; Tomography, Optical Coherence; Vitrectomy; Vitreous Body; Vitreous Hemorrhage

To determine the maximum tolerated dose (MTD) of enoxaparin, a low molecular weight heparin (LMWH) was used during repeat vitrectomy for rhegmatogenous retinal detachment with proliferative vitreoretinopathy (PVR) and severe diabetic retinopathy.. From 25 patients, 29 eyes undergoing repeat vitrectomy for PVR (CP3 or greater) or severe diabetic retinopathy were included in the study. Patients had previously undergone an average of 2.1 previous vitrectomies (range 1-5). Enoxaparin was added to the infusion fluid in an escalating dose from 0.1 IU/ml to 6.0 IU/ml as tolerated. Intraoperative bleeding, postoperative fibrin, hyphema and vitreous hemorrhage were graded in an unmasked fashion using previously described grading scales.. All patients completed the study, and the study was able to achieve the 6.0 IU/ml maximum dose on the dose escalation schedule. No patient experienced dose-limiting toxicity. Analysis showed no increase in intraoperative bleeding complications between low dose (1.0 IU/ml) enoxaparin (Mann-Whitney Test, P=0.029).. Enoxaparin dose escalation did not result in a dose-dependent increase in acute side effects. The establishment of a well-tolerated dose of enoxaparin during repeat vitrectomy for PVR and severe diabetic retinopathy (6.0 IU/ml) provides a foundation for future studies.

Topics: Diabetic Retinopathy; Enoxaparin; Female; Fibrin; Fibrinolytic Agents; Humans; Hyphema; Infusion Pumps; Intraoperative Complications; Male; Maximum Tolerated Dose; Middle Aged; Prospective Studies; Reoperation; Vitrectomy; Vitreoretinopathy, Proliferative; Vitreous Hemorrhage

The study concerns 17 eyes which, following vitrectomy, were given an injection of 25 micrograms of tissue plasminogen activator (tPA). Of these 17 cases, ten showed a severe fibrin formation in the anterior chamber, 3 cases showed vitreous hemorrhage (one of them with hyphema), 2 had fibrin formation and cellular proliferation, while in one case tPA was injected at the end of the vitrectomy because of perisilicone proliferation and in one case because of fibrin depositions on the intraocular lens. The tPA was injected into the anterior chamber (10 eyes) or into the vitreous cavity (7 eyes). The follow-up period ranged from 4 to 15 months (mean period 9 1/2 months). Fibrinolysis was noted in the 10 cases with fibrin formation in the anterior chamber. Fibrin dissolution was achieved within 3-4 hours. None of these cases presented a recurrence throughout the follow-up period. Positive results were observed also in the case with perisilicone proliferation. On the contrary in 3 cases with postvitrectomy hemorrhage the hemorrhage persisted unchanged. Also in 2 cases with fibrin formation and cellular proliferation on the anterior and posterior surface of the iris the tPA injection proved ineffective. Both cases developed traction retinal detachment (TRD) due to anterior proliferative vitreoretinopathy (PVR). In the case with fibrin depositions on the intraocular lens the situation remained unchanged. Any complications observed in our case proved to be mild and transitory.

Topics: Adolescent; Adult; Aged; Anterior Chamber; Female; Fibrin; Fibrinolysis; Follow-Up Studies; Humans; Injections; Male; Middle Aged; Postoperative Complications; Thrombosis; Tissue Plasminogen Activator; Vitrectomy; Vitreous Hemorrhage

We studied the inhibition of intraocular fibrin formation following infusion of 5 IU/mL of low-molecular-weight heparin sodium (Fragmin, KabiVitrum AB, Stockholm, Sweden) during lensectomy, vitrectomy, and retinotomy in the rabbit model. Surgery was performed on 18 eyes, with nine receiving low-molecular-weight heparin and nine serving as controls. Masked postoperative examinations assessed fibrin quantity, corneal clarity, media clarity, and amount of vitreous hemorrhage. Five (56%) of nine eyes receiving low-molecular-weight heparin did not show fibrin exudation development, with the remainder demonstrating a minimal fibrin response. Eight (89%) of nine control eyes demonstrated prominent fibrin exudation, with five (56%) showing development of a fibrin clot that obscured two or more quadrants of the posterior chamber. No significant difference in the degree of vitreous hemorrhage was noted between groups. Corneal clarity was improved in the heparin-treated group.

Topics: Animals; Cataract Extraction; Cornea; Fibrin; Heparin; Molecular Weight; Rabbits; Retina; Vitrectomy; Vitreous Hemorrhage

Tissue plasminogen activator is a potent thrombolytic agent that recently has been used to treat postvitrectomy fibrin formation. However, a recent report noted anterior and posterior segment bleeding following intracameral tissue plasminogen activator injection. In this study, we performed lensectomy and vitrectomy in 20 rabbits. A retinal blood vessel was incised to stimulate intraocular hemorrhage; bleeding was controlled and vitreous hemorrhage aspirated. Postoperatively, one eye received a 0.1-mL injection of tissue plasminogen activator (25 micrograms); the other received balanced salt solution. The eyes receiving tissue plasminogen activator had a 28% incidence of increased anterior chamber blood and a 61% incidence of increased intravitreal blood. There was no evidence of postinjection bleeding in eyes receiving balanced salt solution. Most cases of bleeding occurred within 24 hours of tissue plasminogen activator injection. Administration of tissue plasminogen activator in the setting of segmented blood vessels may lead to intraocular hemorrhage.

Topics: Animals; Fibrin; Hyphema; Lens, Crystalline; Postoperative Care; Rabbits; Random Allocation; Retinal Hemorrhage; Tissue Plasminogen Activator; Vitrectomy; Vitreous Hemorrhage

We injected 25 micrograms of recombinant tissue plasminogen activator into the anterior chamber or the vitreous cavity in seven aphakic patients for pupillary block caused by a complete fibrin pupillary membrane that formed after vitrectomy with fluid-gas exchange. Progressive fibrin deposition resulted in pupillary block by three days after vitrectomy surgery in six patients, and seven days after vitrectomy in one patient. The pupillary block was associated with increased intraocular pressure in six patients. Tissue plasminogen activator was injected via the corneoscleral limbus in five patients and via the pars plana in two patients. In all patients, injection of tissue plasminogen activator resulted in complete fibrinolysis of the fibrin pupillary membrane within four hours, associated with a deepening of the anterior chamber. In the six patients with increased intraocular pressure at the time of tissue plasminogen activator injection, dissolution of the fibrin membrane was associated with a decrease in pressure. In all patients, intraocular pressure had returned to normal by three days after the injection. No complications were associated with the injection.

Topics: Adult; Aged; Anterior Chamber; Female; Fibrin; Humans; Insufflation; Intraocular Pressure; Iris Diseases; Male; Middle Aged; Recombinant Proteins; Retinal Detachment; Tissue Plasminogen Activator; Vitrectomy; Vitreous Body; Vitreous Hemorrhage