Intraocular Lens Opacification with Recombinant Tissue Plasminogen Activator after Cataract Surgery

1. Dipak Parmar¹
2. Simon Fung²
3. Dawn Sim²
4. Niaz Islam³
5. Hadi Zambarakji¹

¹Whipps Cross University Hospital, London, UK
²Moorfields Eye Hospital, London, UK
³Queen's Hospital, Essex, UK

Purpose
To report 8 cases of intraocular lens (IOL) opacification following treatment of fibrinous uveitis with recombinant tissue plasminogen activator (r-tPA) after cataract surgery.

Methods
Prospective clinicopathological case-series reporting 8 eyes of 8 patients who received recombinant tissue plasminogen activator (r-tPA) for fibrinous uveitis after phacoemulsification cataract surgery.

Results
All patients underwent uncomplicated cataract surgery and IOL implantation in the capsular bag. Fibrinous membranes developed between 1 to 4 weeks of surgery and were treated with intracameral r-tPA. Resolution of fibrin plaques occurred in all cases within 24 hours. IOL opacification was noted between 5 months to 7 years after r-tPA treatment with reduced visual acuity. Uneventful IOL exchange was carried out in 5 patients with a mean final BCVA of 6/12. Light microscopic evaluation of the IOL optics revealed diffuse fine granular deposits on the anterior surface that stained positive for calcium (von-Kossa, Alizarin red).

Conclusions
Intracameral injections of r-tPA, though rapidly effective in the treatment of fibrinous membranes, may cause IOL opacification.