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Pediatrik Travmatik Katarakt Olgusunda Dirençli Fibrin Membran ile Mücadele

Yıl 2018, Cilt: 4 Sayı: 2, 182 - 186, 01.01.2018

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

Kaynakça

  • Miyake K, Maekubo K, Miyake Y, Nishi O. Pupillary fibrin mem brane. A frequent early complication after posterior chamber lens implantation in Japan. Ophthalmology 1989;96(88):1228-33.
  • Menapace R, Amon M, Radax U. Evaluation of 200 consecu tive IOGEL 1103 capsular-bag lenses implanted through a small incision. J Cataract Refract Surg 1992;18(3):252-64.
  • Lesser GR, Osher RH, Whipple D, Abrams GW, Cionni RJ. Treatment of anterior chamber fibrin following cataract surgery with tissue plasminogen activator. Journal of Cataract and Refractive Surgery 1993;19(2):301-5.
  • Willams GA, Lambrou FH, Jaffe GA. Treatment of postvit rectomy fibrin formation with intraocular tissue plasminogen activator. Arch Ophthalmol 1988;106: 1055-8.
  • Yoshino H, Seki M, Ueda J,Yoshino T, Fukuchi T, Abe H. Fibrin membrane pupillary-block glaucoma after uneventful cataract surgery treated with intracameral tissue plasminogen activator: A case report. BMC Ophthalmol 2012;12:3.
  • Khor WB, Perera S, Jap A, Ho CL, Hoh ST. Anterior segment imaging in the management of postoperative fibrin pupillary-block glau coma. J Cataract Refract Surg 2009;35:1307-12.
  • Tripathi RC, Park JK, Tripathi BJ, Millard CB. Tissue plasminogen activator in human aqueous humor and its possible therapeutic significance. Am J Ophthalmol 1988;106(6):719-22.
  • Yoshitomi F, Utsumi E, Hayashi M, Futenma M, Yamada R, Yamada S. Postoperative fluctuation of tissue plasminogen activator (t-PA) in aqueous humor of pseudophakes. J Cataract Refract Surg 1991;17(5):543-6.
  • Zalta AH, Sweeney CP, Zalta AK, Kaufman AH. Intracameral tissue plasminogen activator use in a large series of eyes with valved glaucoma drainage implants. Arch Ophthalmol 2002; 120:1487-93.
  • Lundy DC, Sidoti P, Winarko T, Minckler D, Heuer DK. Intracameral tissue plasminogen activator after glaucoma surgery. Indications, effectiveness, and complications. Ophthalmology 1996; 103(2): 274-82.
  • Hattenbach LO, Klais C, Koch FH, Gümbel HO. Intravitreous injection of tissue plasminogen activator and gas in the treatment of submacular hemorrhage under various conditions. Ophthalmology 2001; 108(8):1485- 92.
  • Moon J1, Chung S, Myong Y, Chung S, Park C, Baek N, Rhee S. Treatment of postcataract fibrinous membranes with tissue plasminogen activator. Ophthalmology 1992;99(8):1256-9.
  • Mehta JS, Adams GG. Recombinant tissue plasminogen activator following pediatric cataract surgery. Br J Ophthalmol 2000;84:983-6.
  • Snyder RW, Lambrou FH, Williams GA. Intraocular fibrinolysis with recombinant human tissue plasminogen activator; experimental treatment in a rabbit model. Arch Ophthalmol 1987;105:1277-80.
  • Jaffe GJ, Lewis H, Han DP, Williams GA, Abrams GW. Treatment of postvitrectomy fibrin pupillary block with tissue plasminogen activator. Am J Ophthalmol 1989; 108: 170-5.
  • Norris JW, Chirls IA, Santry JG, Norris JW III. Severe fibrinous reaction after cataract and intraocular lens implantation surgery requiring neodymium: YAG laser therapy. J Cataract Refract Surg 1990; 16: 637-9.
  • Heiligenhaus A, Steinmetz B, Lapuente R, Krallmann P, Althaus C, Steinkamp WK, Dick B. Recombinant tissue plasminogen activator in cases with fibrin formation after cataract surgery: A prospective randomized multicentre study. Br J Ophthalmol 1998, 82: 810-5.
  • Rehfeldt K, Hoh H. Therapeutic and prophylactic application of TPA (recombinant tissue plasminogen activator) into the anterior chamber of the eye. Ophthalmologe 1999;96: 587-93.

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

Yıl 2018, Cilt: 4 Sayı: 2, 182 - 186, 01.01.2018

Öz

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

Kaynakça

  • Miyake K, Maekubo K, Miyake Y, Nishi O. Pupillary fibrin mem brane. A frequent early complication after posterior chamber lens implantation in Japan. Ophthalmology 1989;96(88):1228-33.
  • Menapace R, Amon M, Radax U. Evaluation of 200 consecu tive IOGEL 1103 capsular-bag lenses implanted through a small incision. J Cataract Refract Surg 1992;18(3):252-64.
  • Lesser GR, Osher RH, Whipple D, Abrams GW, Cionni RJ. Treatment of anterior chamber fibrin following cataract surgery with tissue plasminogen activator. Journal of Cataract and Refractive Surgery 1993;19(2):301-5.
  • Willams GA, Lambrou FH, Jaffe GA. Treatment of postvit rectomy fibrin formation with intraocular tissue plasminogen activator. Arch Ophthalmol 1988;106: 1055-8.
  • Yoshino H, Seki M, Ueda J,Yoshino T, Fukuchi T, Abe H. Fibrin membrane pupillary-block glaucoma after uneventful cataract surgery treated with intracameral tissue plasminogen activator: A case report. BMC Ophthalmol 2012;12:3.
  • Khor WB, Perera S, Jap A, Ho CL, Hoh ST. Anterior segment imaging in the management of postoperative fibrin pupillary-block glau coma. J Cataract Refract Surg 2009;35:1307-12.
  • Tripathi RC, Park JK, Tripathi BJ, Millard CB. Tissue plasminogen activator in human aqueous humor and its possible therapeutic significance. Am J Ophthalmol 1988;106(6):719-22.
  • Yoshitomi F, Utsumi E, Hayashi M, Futenma M, Yamada R, Yamada S. Postoperative fluctuation of tissue plasminogen activator (t-PA) in aqueous humor of pseudophakes. J Cataract Refract Surg 1991;17(5):543-6.
  • Zalta AH, Sweeney CP, Zalta AK, Kaufman AH. Intracameral tissue plasminogen activator use in a large series of eyes with valved glaucoma drainage implants. Arch Ophthalmol 2002; 120:1487-93.
  • Lundy DC, Sidoti P, Winarko T, Minckler D, Heuer DK. Intracameral tissue plasminogen activator after glaucoma surgery. Indications, effectiveness, and complications. Ophthalmology 1996; 103(2): 274-82.
  • Hattenbach LO, Klais C, Koch FH, Gümbel HO. Intravitreous injection of tissue plasminogen activator and gas in the treatment of submacular hemorrhage under various conditions. Ophthalmology 2001; 108(8):1485- 92.
  • Moon J1, Chung S, Myong Y, Chung S, Park C, Baek N, Rhee S. Treatment of postcataract fibrinous membranes with tissue plasminogen activator. Ophthalmology 1992;99(8):1256-9.
  • Mehta JS, Adams GG. Recombinant tissue plasminogen activator following pediatric cataract surgery. Br J Ophthalmol 2000;84:983-6.
  • Snyder RW, Lambrou FH, Williams GA. Intraocular fibrinolysis with recombinant human tissue plasminogen activator; experimental treatment in a rabbit model. Arch Ophthalmol 1987;105:1277-80.
  • Jaffe GJ, Lewis H, Han DP, Williams GA, Abrams GW. Treatment of postvitrectomy fibrin pupillary block with tissue plasminogen activator. Am J Ophthalmol 1989; 108: 170-5.
  • Norris JW, Chirls IA, Santry JG, Norris JW III. Severe fibrinous reaction after cataract and intraocular lens implantation surgery requiring neodymium: YAG laser therapy. J Cataract Refract Surg 1990; 16: 637-9.
  • Heiligenhaus A, Steinmetz B, Lapuente R, Krallmann P, Althaus C, Steinkamp WK, Dick B. Recombinant tissue plasminogen activator in cases with fibrin formation after cataract surgery: A prospective randomized multicentre study. Br J Ophthalmol 1998, 82: 810-5.
  • Rehfeldt K, Hoh H. Therapeutic and prophylactic application of TPA (recombinant tissue plasminogen activator) into the anterior chamber of the eye. Ophthalmologe 1999;96: 587-93.
Toplam 18 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Araştırma Makalesi
Yazarlar

Yusuf Ayaz Bu kişi benim

Elif Betül Türkoğlu Bu kişi benim

Yayımlanma Tarihi 1 Ocak 2018
Yayımlandığı Sayı Yıl 2018 Cilt: 4 Sayı: 2

Kaynak Göster

APA Ayaz, Y., & Türkoğlu, E. B. (2018). Pediatrik Travmatik Katarakt Olgusunda Dirençli Fibrin Membran ile Mücadele. Akdeniz Tıp Dergisi, 4(2), 182-186.