Treatment of failing glaucoma filtering cystic blebs with tissue plasminogen activator (tPA).

Abstract

Tissue plasminogen activator (tPA) is a clot-specific fibrinolytic agent shown to be effective in decreasing postsurgical fibrin formation and enhancing filtration after trabeculectomy. To evaluate the efficacy of tPA on blebs showing clinical evidence of failure, a retrospective analysis was performed on 20 eyes of 20 glaucoma patients with failing or failed cystic filtering bleb treated with tPA intrableb and/or intracameral injection. The average pre-tPA intraocular pressure (IOP) was 18.0 +/- 7.2 mmHg and post-tPA was 12.9 +/- 6.2 mmHg. Fifteen of 20 eyes (75%) were able to maintain their IOP at or below target level, in the follow-up period of 3 to 7 months. Eight of the 15 eyes with successful outcome were free of glaucoma medication. Patients experienced no pain or irritation during and after the injection of tPA. No adverse effects on visual acuity or major complications were encountered. Transient mild complications related to tPA injections were subconjunctival hemorrhage (2 eyes), hyphema (1 eye) and hypotony (6 eyes). The revision of failing cystic bleb by tPA intrableb and/or intracameral injection may be considered as a useful adjunct with low risk in management of failing cystic blebs. A well designed clinical trial would provide needed information pertaining to the nature of cystic bleb formation as well as the efficacy, safety and clinical implication on the tPA treatment.