Tissue Plasminogen Activator For Fibrinoid Reaction Post Complex Dmek
Published 2022
- 40th Congress of the ESCRS
Reference: PO038
| Type: Case report
| DOI:
10.82333/7yjg-pt58
Authors:
Michael Mimouni* 1
, Tanya Trinh 2
, Eyal Cohen 2
, Larissa Gouvea 2
, Sara AlShaker 2
, Clara Chan 2
, David Rootman 2
1Department of Ophthalmology,Rambam Health Care Campus,Haifa,Israel, 2Department of Ophthalmology,University of Toronto,Toronto,Canada
To describe successful treatment of fibrinoid reaction post complex Descemet Membrane Endothelial Keratoplasty (DMEK) using tissue plasminogen activator (tPA).
This case series included three patients that developed a fibrinoid reaction post complex DMEK. All three cases were treated with an intracameral injection of a small air bubble as well as tPA (25 micrograms in 0.1ml) and laid in supine position for one hour.
All three patients demonstrated complete resolution of the fibrin and reattachment of the DMEK graft at the two hour and one day post injection visit. At one week and one month visits all patients remained attached and had a subsequent improvement in vision. At the three month visit endothelial cell counts remained viable for all three patients. The results of the first case are presented in detail here. A 60 year old female presented with a fibrinoid reaction and a 30% inferior DMEK detachment secondary to iridocorneal fibrin strands one day post iris hook aided intraocular lens exchange combined with DMEK. She did not respond to hourly Durezol. She subsequently underwent an intracameral injection of a small air bubble as well as tPA (25 micrograms in 0.1ml) and laid in supine position. After two hours the fibrin dissolved. The following day there were no signs of fibrin or synechia and the DMEK was attached. At three months her visual acuity was 20/30 with a compact cornea and an endothelial cell count of 1,532 cells/mm2.
This preliminary report indicates that intracameral tPA may be an effective treatment for fibrinoid reaction post DMEK. A small air bubble may be inserted prior to the injection with the goal of protecting the endothelial cells from the potential toxic effects of tPA.