Low-Dose Tissue Plasminogen Activator

LETTERS Figure 1. (Iester) Retinal nerve fiber layer thickness changes after Figure 2. (Iester) Retinal nerve fiber layer thickness changes after compression in each subject. 1 month in each subject. Low-Dose Tissue Plasminogen Activator I Figure 3. (Iester) Retinal nerve fiber layer thickness changes after compression in each subject, eliminating only 1 subject. n their article on tissue plasminogen activator (tPA) in managing anterior chamber fibrin formation,1 Georgiadis et al. report that tPA was effective in controlling severe fibrinoid inflammation after cataract surgery. I would like to point out several relevant points. First, 125 ␮g/mL was used in their study for safety, while we found that even less (25 ␮g/mL) was effective. Second, there is a small incidence of recurrence of inflammation that may require reinjection, so continued vigilance is necessary. Finally, a thorough reference search is always appreciated by authors, since we published a study on this topic in 1993.2 ROBERT H. OSHER, MD Cincinnati, Ohio, USA References Figure 4. (Iester) Retinal nerve fiber layer thickness changes after 1 month in each subject, eliminating only 1 subject. 2. Hoh T, Ishikawa H, Greenfield DS, et al. Peripapillary nerve fiber layer thickness measurement reproducibility using scanning laser polarimetry. J Glaucoma 1998; 7:12–15 3. Waldock A, Potts MJ, Sparrow JM, Karwatowski WSS. Clinical evaluation of scanning laser polarimetry: I. Intraoperator reproducibility and design of a blood vessel removal algorithm. Br J Ophthalmol 1998; 82:252–259 2258 1. Georgiadis N, Boboridis K, Halvatzis N, et al. Lowdose tissue plasminogen activator in the management of anterior chamber fibrin formation. J Cataract Refract Surg 2003; 29:729–732 2. Lesser GR, Osher RH, Whipple D, et al. Treatment of anterior chamber fibrin following cataract surgery with tissue plasminogen activator. J Cataract Refract Surg 1993; 19:301–305 Reply: In response to Dr. Osher’s interesting comments, I would like to point out that the intent of our study was to use the same relatively low tPA dose in a consecutive series of patients with severe anterior chamber fibrinous reaction not amenable to intensive topical and systemic antiinflammatory treatment. We have observed a range of fibrinolytic reactions from immediate fibrin lysis to delayed (48 hours) fibrin dissolution with an adjunctive steroid regimen, which is comparable to results J CATARACT REFRACT SURG—VOL 29, DECEMBER 2003