t-PA前房注射治疗玻璃体切割联合眼内硅油充填术后眼内纤维蛋白渗出

目的评价前房内注射组织型纤溶酶原激活剂(tissueplasminogenactivator,t-PA)治疗玻璃体切割联合眼内硅油充填术后重度眼内纤维蛋白渗出的效果及安全性。方法对21例(21只眼)玻璃体切割联合眼内硅油充填术后眼内纤维蛋白渗出经常规方法治疗无效的病例,给予前房内注射t-PA12.5μg,观察其对眼内纤维蛋白形成的疗效。结果眼内一次注射t-PA12.5μg后,纤维蛋白渗出位于前房及瞳孔区者21例均完全溶解,所需时间0.5～2小时(平均1小时);12例下方虹膜根切孔膜闭者有8只眼根切孔膜溶解(占66.7%),根切孔保持通畅;注射后前房出血3例(占14.3%)。随访3～24个月(平均8个月)视网膜复位17例(占81.0%)。结论对玻璃体切割联合眼内硅油充填术后严重眼内纤维蛋白渗出经常规方法治疗无效的病例,前房内注射t-PA能够迅速溶解眼内纤维蛋白渗出,为一种安全有效的方法。     

t—PA治疗玻璃体切割术后眼内纤维蛋白渗出

眼内纤维蛋白渗出是导致玻璃体切割术失败并危及视力的主要并发症之一。目前，动物实验和临床研究证实，玻璃体切割术联合眼部应用组织型纤维蛋白溶酶原激活剂（ｔ－ＰＡ），可有效地预防和治疗眼内纤维蛋白渗出及纤维增殖膜形成。本就这一疗法的研究现状作一总结，认为：眼部应用ｔ－ＰＡ治疗玻璃体切割术后眼内纤维蛋白渗出具有效果可靠、安全、毒性低、副作用小、适应证广泛等优点，在预防和治疗各种原因引起的增殖性玻璃体视网     

玻璃体切割术联合组织型纤溶酶原激活物和速避凝治疗兔细菌性眼内炎所致纤维蛋白渗出

目的 探讨玻璃体切割联合组织型纤溶酶原激活物（r-tPA）和速避凝治疗细菌性眼内炎的效果。 方法 将40只青紫兰家兔随机分为实验组和对照组，每组各20只。向兔左眼玻璃体腔内注射105个/ml表皮葡萄球菌0.1 ml，经过8～14 h后，所有动物均接受玻璃体切割手术。手术中在实验组使用的平衡盐灌注液内加入速避凝，其终浓度为6 IU/ml；手术后运用裂隙灯和间接检眼镜观察眼内纤维蛋白渗出的程度。若实验组手术后1、3、7、14、21 d眼内存在纤维渗出，从手术后第1天开始向玻璃体腔内注射125 mg/ml的r-tPA 0.1 ml。 结果 手术后实验组兔眼瞳孔区及玻璃体腔内纤维渗出较对照组显著减轻。 结论 玻璃体切割术联合r-tPA和速避凝的应用，能减轻兔细菌性眼内炎的纤维化程度，改善预后。 (中华眼底病杂志, 2005, 21: 391-393)     

玻璃体腔组织纤溶酶原激活剂治疗玻璃体黄斑粘连

目的：评估仅玻璃体腔注射组织纤溶酶原激活剂(TPA)对玻璃体黄斑牵引以及玻璃体腔注射TPA和贝伐单抗对视网膜血管疾病的改善作用。

方法：前瞻性研究。对24例24眼患者进行干预性系统研究。其中5眼玻璃体黄斑牵引综合征(VMT),19眼视网膜血管疾病包括：糖尿病黄斑水肿(DME)眼,糖尿病性玻璃体出血(VH)眼,视网膜中央静脉阻塞(CRVO)和新生血管年龄相关性黄斑变性眼(AMD)。在注射前及注射1mo后分别进行视力,B超和OCT检查。3眼VMT接受玻璃体腔单次注射TPA50 μg,2眼接受100 μg 注射。19例视网膜血管疾病患者接受玻璃体腔组织纤溶酶原激活剂(50 μg)和贝伐单抗(1.25 mg)联合治疗。

结果：纳入病例中男性10眼视网膜血管疾病和VMT患者平均年龄分别为56.8y 和60.4y。纳入病例中男性10眼(41.7%),女性14眼(58.3%)。22眼(91.7%)晶状体眼,2眼(8.3%)人工晶状体眼。VMT和视网膜血管疾病的玻璃体后部脱离(PVD)分别为0(0/5)和57.8%(11/19)(P=0.04)。在改善最佳矫正视力(BCVA)和降低黄斑中心凹厚度(CMT)方面,与无PVD眼相比,有PVD眼改善更多。

结论：在VMT患者中,单独玻璃体腔内注射TPA不能成功诱导玻璃体后部完全脱离。玻璃体腔联合注射TPA和贝伐单抗可引起视网膜血管疾病患者玻璃体后部脱离,提高最佳矫正视力以及降低黄斑中心凹厚度。     

组织型纤溶酶原激活剂（t-PA）对实验性前房纤维蛋白渗出的治疗观察

采用兔眼前房穿刺后注入含拘橼酸钠的自体血浆0．2ml的方法对14只兔(14只眼)建立了一定量、可重复的前房纤维蛋白渗出模型。24小时后将这些模型随机等分为两组，一组前房内注入t-PA(4μg)，另一组用等量生理盐水作对照。t-PA治疗组纤维蛋白凝块平均在5小时内溶解，而对照组需7日方彻底清除。经裂隙灯检查、眼压测量、角膜内皮显微镜及光镜观察未见毒性作用。     

组织纤维蛋白溶酶原激活剂联合透明质酸酶致玻璃体后脱离的实验研究

玻璃体后脱离（posterior vitreous detachment，PVD）直接影响玻璃体切割术的操作过程及手术效果，手术前通过非手术方法诱导PVD可缩短手术进程。本文采用组织纤维蛋白溶酶原激活剂（tissue plasminogen activator，t-PA）联合透明质酸酶诱导PVD，探索其在玻璃体切割术中的作用和安全性。     

组织型纤溶酶原激活剂治疗人工晶状体前膜

我们采用组织型纤溶酶原激活剂 (tissueplasminogenac tivator ,t PA)前房内注射 ,治疗人工晶状体前纤维素性渗出膜 ,收到了良好的临床效果 ,现报告如下。1　资料与方法1.1　一般资料　 12例患者中男 7例 ,女 5例 ,年龄 2 2～ 75岁 ,平均 (5 1.30± 2 3.5 5 )岁 ,外伤性白内障     

组织型纤溶酶原激活剂对实验性前房出血的治疗观察

组织型纤溶酶原激活剂对实验性前房出血的治疗观察赵培泉，王文吉，宋后燕，朱运松基因工程生产的组织型纤溶酶原激活剂（ｔ－ＰＡ）已被证实是一高效、特异的新型纤维蛋白溶解剂。我们通过实验拟观察ｔ－ＰＡ对实验性前房出血的治疗作用。１．材料与方法：取健康成年日本...     

组织型纤溶酶原激活剂对人视网膜色素上皮细胞的抑制

目的：探讨组织型纤溶酶原激活剂（tissue-type plasminogen activator,tPA)对人视网膜色素上皮（retinal pigment epithelial,RPE)细胞的作用。方法：运用活细胞计数法和甲基噻咪基四唑（methyl thiazolyl tetrazolium,MTT)比色实验观察分析tPA对人RPE细胞增殖的抑制作用,应用流式细胞仪（flow eytometry,FCM)分析人RPE细胞周期。结果：0．1－3μg/ml tPA对人RPE细胞有抑增殖作用,其效应与药物浓度和作用时间呈正向依赖关系（P＜0．01）;5μg/ml tpA对人RPE细胞有致死毒性作用。RCM显示tPA作用后S期细胞增加9．8％（P＜0．05）,G2M期减少6．6％（P＜0．05）。结论：tPA在一定时间和剂量范围内对人RPE细胞具有抑增殖作用,且不对细胞产生致死毒性;tPA主要延迟／阻滞人RPE细胞于S期。     

组织纤溶酶原激活剂，肝素对晶体后囊膜混浊抑制作用的实验对比研究

目的：观察tPA(组织纤溶酶原激活剂）,肝素对兔眼PC－IOL（后房型人工晶体）植入术后晶体后囊膜混浊的抑制作用,方法：48只新西兰大白兔分为三组（对照组,tPA组和肝素组）,常规晶体囊外除及PC－IOL植入,术中分别应用0．2ml(tPA25ug)和肝素100U/ml灌注液,于术后1,3天和1,3月分别取后囊膜行纤维蛋白和后囊膜增厚程度检测,结果：tPA,肝素对后囊膜上的纤维蛋白反应在术后1,3天均有抑制作用,二组的后囊增厚程度在术后1月时均较对照组为轻,结论：tPA,肝素对术后早期后囊膜混浊有一定的抑制作用。     

Recombinant tissue plasminogen activator in cases with fibrin formation after cataract surgery: a prospective randomised multicentre study

AIMS—This study investigated the effect of tissue plasminogen activator (tPA) in patients with severe intracameral fibrin after extracapsular cataract extraction or phacoemulsification with posterior chamber intraocular lens implantation.
METHODS—A randomised prospective multicentre study was carried out in 86 patients with intraocular fibrin formation 2-8 days after cataract surgery. While the first group (n=41) received only anti-inflammatory drugs, a single anterior chamber injection of tPA (10 µg) as an additional treatment to the standard was given in the second group (n=44). On days 1, 2, 14, and 90 after randomisation, the visual acuities, slit lamp findings, and intraocular pressures were documented in standardised protocols. Efficacy of treatment was judged by the rate of fibrinolysis (primary objective), the frequency of synechiae, and central capsular fibrosis (secondary objectives).
RESULTS—The incidence and quantity of intraocular fibrin were significantly lower in the patients treated with tPA than in the control group (p<0.05). The frequencies of synechiae were reduced by tPA injection. The capsule fibrosis noted after 3 months was significantly lower in the tPA group (p=0.027). No ocular side effects were noted after the tPA injections.
CONCLUSIONS—Lysis of postcataract fibrin formation is accelerated and increased by a single intracameral injection of 10 µg tPA in addition to standard anti-inflammatory treatment. The findings suggest that the tPA injection reduces posterior capsule fibrosis, which still has to be addressed in larger study populations and with a long term follow up.

Keywords: tissue plasminogen activator; cataract surgery; fibrin; fibrinolysis     

t-PA抑制白内障术后眼内纤维膜形成的实验研究

目的：研究白内障手术注射t-PA抑制眼内纤维蛋白渗出及眼内纤维膜的形成。方法：成年青紫兰兔行晶体囊外摘除,部分后房型人工晶体植入,术后不同时间、不同浓度结膜下注射t-PA,分别于1、3、7、14、30天摘除眼球,病理常规切片,光镜观察。结果：注射t-PA后,眼内发生显著的病理形态变化,主要有四方面改变：减轻前房纤维蛋白及炎症细胞的渗出;减少虹膜、睫状体细胞的增生抑制眼内纤维膜的形成;减弱晶体囊膜增厚及皱褶的程度。结论：t-PA具有显著的抑制纤维蛋白渗出及眼内纤维膜形成的作用,不同浓度t-PA均有相同作用,以术后第7天效果明显。t-PA是治疗后发性白内障的安全、有效药物。     

t—PA前房注射治疗人工晶体植入术后纤维蛋白性膜

目的探讨组织型纤溶酶原激活剂（ｔｉｓｕｅｐｌａｓｍｉｎｏｇｅｎａｃｔｉｖａｔｏｒ,ｔＰＡ）治疗人工晶体植入术后晶体前机化膜的合理方法,并评价其临床效果。方法将４３例（５８只眼）各类白内障术后眼分为３组,分别于人工晶体植入术后不同时间,前房内注射ｔＰＡ,或联合ＹＡＧ激光治疗,对比观察各组疗效。第１组２６只眼,在手术结束时立即前房内注入４μｇｔＰＡ。第２组２２只眼,在术后５～７天前房内形成纤维蛋白膜时,于前房内注射４μｇｔＰＡ。第３组１０只眼,术后形成较厚的纤维蛋白膜,在术后５～９天时先用ＹＡＧ激光切开纤维膜,再向前房内注射４μｇｔＰＡ。结果第１组患者中,４只眼发生前房内出血,８只眼形成瞳孔区纤维蛋白膜,于术后３～５天时再次前房内注射ｔＰＡ后全部溶解。第２组患者中,２０只眼内的纤维蛋白膜２４小时内全部溶解,无前房出血。第３组患者,４～２４小时内瞳孔区的纤维蛋白膜全部吸收,无前房内出血。结论在术后约１周时,前房炎症稳定的情况下,小剂量ｔＰＡ前房内注射治疗晶体前纤维蛋白性机化膜十分有效,ＹＡＧ激光联合治疗的作用更加明显。     

Topical treatment of postvitrectomy fibrin formation with tissue plasminogen activator

Tissue plasminogen activator (tPA) is able to dissolve any fibrin material that forms in the anterior chamber or vitreous humor. This property has been reported by various experimental studies performed in rabbits.The authors demonstrate the tPA eye drops administered to patients with postoperative hyphema, which did not respond to traditional therapy, gave rapid clearance of the clot.Following its topical administration for the first time in patients, the harmless nature of the drug is emphasized as well as its efficacy. This study indicates the promising features of this drug which deserve further investigation.     

Submacular hemorrhage secondary to age-related macular degeneration managed with vitrectomy,subretinal injection of tissue plasminogen activator,hemorrhage displacement with liquid perfluorocarbon,gas tamponade,and face-down positioning

Purpose

To investigate the outcomes of vitrectomy, subretinal tissue plasminogen activator (tPA) injection, hemorrhage displacement with liquid perfluorocarbon, gas tamponade, and face-down positioning, in hemorrhagic neovascular age-related macular degeneration (AMD) patients.

t—PA治疗眼内出血的初步临床观察

目的 探讨组织型纤溶酶原激活剂的对眼内出血的治疗作用及并发症。方法 常规方法治疗无效的眼内出血者１４例,４例前房出血行前房注射。９例玻璃体出血行玻璃体注射。１例暴发性脉络膜上腔出血后脉络膜上腔注射。结果 追踪１－６月,平均２月,出血溶解１３例,视力提高１２例。     

t-PA治疗白内障术后前房内纤维素性渗出

目的：探讨前房内注射组织型纤溶酶原激活剂（tissue plasminogen activator,t-PA)治疗白内障摘出人工晶状体植入术后前房内纤维素性渗出的临床效果。方法：20例20眼在白内障摘出人工晶状体植入术后1－3周内形成纤维素渗出膜时，于前房内注射t-PA10μg。结果：注药后72h，18例前房内纤维素性渗出全部溶解吸收，2例部分溶解。无任何并发症出现。结论：前房内注射t-PA治疗白内障术后前房内纤维素性渗出是一安全、有效的方法。     

The use of tissue plasminogen activator in postvitrectomy cases

The study concerns 17 eyes which, following vitrectomy, were given an injection of 25 g of tissue plasminogen activator (tPA). Of these 17 cases, ten showed a severe fibrin formation in the anterior chamber, 3 cases showed vitreous hemorrhage (one of them with hyphema), 2 had fibrin formation and cellular proliferation, while in one case tPA was injected at the end of the vitrectomy because of perisilicone proliferation and in one case because of fibrin depositions on the intraocular lens.The tPA was injected into the anterior chamber (10 eyes) or into the vitreous cavity (7 eyes). The follow-up period ranged from 4 to 15 months (mean period 91/2 months). Fibrinolysis was noted in the 10 cases with fibrin formation in the anterior chamber. Fibrin dissolution was achieved within 3–4 hours. None of these cases presented a recurrence throughout the follow-up period. Positive results were observed also in the case with perisilicone proliferation. On the contrary in 3 cases with postvitrectomy hemorrhage the hemorrhage persisted unchanged. Also in 2 cases with fibrin formation and cellular proliferation on the anterior and posterior surface of the iris the tPA injection proved ineffective. Both cases developed traction retinal detachment (TRD) due to anterior proliferative vitreoretinopathy (PVR). In the case with fibrin depositions on the intraocular lens the situation remained unchanged. Any complications observed in our case proved to be mild and transitory.