Pediatrik Travmatik Katarakt Olgusunda Dirençli Fibrin Membran ile Mücadele

Öz

Korneal penetrasyona bağlı gelişen pediatrik travmatik katarakt olgusunda görülen, medikal tedavi ile gerilemeyen dirençli fibrin reaksiyonda tPA uygulaması sonrası fibrin reaksiyonun kaybolduğunu göstermek.Beş yaş altı aylık erkek çocuk düşme sonrası sol gözünü demire çarpma öyküsüyle dış merkezden sol korneal penetrasyon ön tanısıyla kliniğimize sevk edildi.Yapılan muayenesinde sol göz görme keskinliği GK persepsiyon pozitif P+ , göz içi basıncı GİB palpasyon ile hipoton idi. Ön segment muayenesinde kornea saat 5-8 arası limbustan limbusa yay şeklinde uzanan korneal penetrasyonu, iris prolapsusu, ön kamara sığlığı, travmatik kataraktı ve lens ön kapsül perforasyonu mevcuttu. Hastanın penetrasyon ve katarakt cerrahisi sonrası GİB’ının yüksek seyretmesi, fibrin membranının gelişmesi ve medikal tedaviye ek Nd:yag lazer membranotomiye cevap vermemesi üzerine ön kamaradan fibrin temizliği yapıldı. Ayrıca ön kamaraya 25 µg/0,1 ml tPA uygulandı. Postoperatif muayenesinde fibrin membranının tamamen gerilediği, GK’inin 0,2, GİB’ının palpasyon ile normoton olduğu izlendi.Komplikasyonsuz katarakt cerrahisi sonrası az sayıda olguda ön kamarada fibrin membran gelişebilmektedir. Seçilmiş olgularda dirençli fibrin membranda intrakameral tPA uygulanabilmekte, tedavi edici olmakta ve yan etki oranının da düşük olması nedeniyle güvenle kullanılabilmektedir

Anahtar Kelimeler

• Fibrin membran, tPA, Pediatrik travmatik katarakt

Pediatrik Travmatik Katarakt Olgusunda Dirençli Fibrin Membran ile Mücadele Treatment of Resistant Fibrinous Membrane in Pediatric Traumatic Cataract

Abstract

We present a case of pediatric traumatic cataract due to corneal penetration in which fibrin reaction resistant to medical treatment resolved after tPA administration.A 5-year 6-month-old boy, with a history of left eye trauma by a metal object, was referred to our clinic with the diagnosis of a left corneal penetration.Left eye visual acuity VA testing was perception positive P + and the eye was hypotonic on palpation. Anterior segment examination revealed corneal penetration extending from 5 o'clock to 8 o'clock with an interlimbal arc shape, iris prolapse, anterior chamber shallowing, traumatic cataract, and anterior capsular perforation of the lens. Following surgery for the penetration and cataract, sustained high intraocular pressure IOP levels and fibrinous membrane development were observed. The membrane did not respond to Nd: YAG laser membranotomy in addition to medical treatment and fibrin cleansing was subsequently performed from the anterior chamber. We also administered tPA 25 μg / 0.1 ml into the anterior chamber. On postoperative examination, the fibrin membrane had completely resolved. The VA was 0.2, and the eye was normotonic.Fibrinous membranes can sometime develop in the anterior chamber following uncomplicated cataract surgery. Intracameral tPA can be administered in selected cases for the resistant fibrin membrane and can provide a successful outcome. It can also be used safely as adverse effects are uncommon

Keywords

• Fibrinous membrane, tPA, Pediatric traumatic cataract

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