r-tPA bei der Keratoplastik à chaud. Bericht über 50 Patienten

TY - JOUR

T1 - r-tPA bei der Keratoplastik à chaud. Bericht über 50 Patienten

AU - Bialasiewicz, A A

AU - Hassenstein, A

AU - Richard, G

PY - 1999/5/1

Y1 - 1999/5/1

N2 - BACKGROUND: Fibrinolytic treatment using recombinant plasminogen activator (r-tPA) has been reported in cataract surgery; however, reports are lacking with respect to complex surgical interventions including keratoplasty because of anterior segment infections.PATIENTS AND METHODS: This report deals with a prospective study comprising 50 patients (50 eyes) suffering from a serpent ulcer treated by keratoplasty à chaud. r-tPA (25 micrograms) was instilled intracamerally at the end of surgery in 25 eyes.RESULTS: The 25 eyes treated with r-tPA were subsequently less inflamed than the control population (decrease in inflammatory cells 1.5 days vs 7 days, fibrin reaction 1x vs 12x), had highly significantly better visual acuity and there was significantly reduced inpatient hospitalization (median 9.9 vs 19.3 days). No hemorrhages were observed in either population; medically treated infection recurrences (S. aureus, C. tropicalis, acanthameba) were observed in 3 and primary graft failure or rejection in both populations 3x.CONCLUSIONS: This study showed that perioperative application of r-tPA had a beneficial effect. This therapeutic avenue should be further evaluated in a randomized, double-masked multicenter study.

AB - BACKGROUND: Fibrinolytic treatment using recombinant plasminogen activator (r-tPA) has been reported in cataract surgery; however, reports are lacking with respect to complex surgical interventions including keratoplasty because of anterior segment infections.PATIENTS AND METHODS: This report deals with a prospective study comprising 50 patients (50 eyes) suffering from a serpent ulcer treated by keratoplasty à chaud. r-tPA (25 micrograms) was instilled intracamerally at the end of surgery in 25 eyes.RESULTS: The 25 eyes treated with r-tPA were subsequently less inflamed than the control population (decrease in inflammatory cells 1.5 days vs 7 days, fibrin reaction 1x vs 12x), had highly significantly better visual acuity and there was significantly reduced inpatient hospitalization (median 9.9 vs 19.3 days). No hemorrhages were observed in either population; medically treated infection recurrences (S. aureus, C. tropicalis, acanthameba) were observed in 3 and primary graft failure or rejection in both populations 3x.CONCLUSIONS: This study showed that perioperative application of r-tPA had a beneficial effect. This therapeutic avenue should be further evaluated in a randomized, double-masked multicenter study.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Corneal Transplantation

KW - Corneal Ulcer

KW - Female

KW - Humans

KW - Instillation, Drug

KW - Male

KW - Middle Aged

KW - Postoperative Complications

KW - Prospective Studies

KW - Recombinant Proteins

KW - Thrombolytic Therapy

KW - Tissue Plasminogen Activator

M3 - SCORING: Zeitschriftenaufsatz

C2 - 10414124

VL - 96

SP - 335

EP - 341

JO - OPHTHALMOLOGE

JF - OPHTHALMOLOGE

SN - 0941-293X

IS - 5

ER -