Use of intraocular human recombinant tissue plasminogen activator as an adjunct treatment of posterior synechiae in patients with uveitis.

PURPOSE: To evaluate the effect of intracameral injection of small doses of human recombinant tissue plasminogen activator (hr-tPA) as an adjunct to lysing extensive recent-onset posterior synechiae associated with uveitis in the setting of impending pupillary seclusion. METHODS: This is an interventional retrospective case series involving three patients. All patients received an intracameral injection of hr-tPA while on maximum antiinflammatory therapy. Two patients had unilateral acute anterior uveitis with extensive (270°-360°) recent-onset posterior synechiae, while 1 patient had chronic recurrent anterior uveitis complicated by recent and preexisting posterior synechiae. RESULTS: Two patients with acute uveitis had rapid and complete synechiolysis (360°) after an intracameral injection of hr-tPA within 24 hours. One patient with acute reactivation of recurrent uveitis had subtotal (270°) synechiolysis because of incomplete lysis of chronic synechiae. With resolution of inflammation, all patients regained their preuveitis visual acuity. No cataract or glaucoma was reported at 12-month follow-up. CONCLUSION: We evaluated the role of intracameral hr-tPA injections as an adjunct to maximum antiinflammatory therapy. We conclude that a low-dose (3 µg) low-volume (0.05 mL) intracameral injection of hr-tPA in patients with extensive recent-onset posterior synechiae associated with uveitis leads to rapid lysis of synechiae, reducing the risk of pupillary seclusion and associated glaucoma.