A novel use of tissue plasminogen activator in PreserFlo Microshunt obstructed by fibrin and/or blood

To report the novel use of tPA in PreserFlo MicroShunt obstructed by fibrin and/or blood. PreserFlo MicroShunts are used in the management of medically uncontrolled Primary Open Angle Glaucoma (POAG). Hyphaema is a common complication of glaucoma surgery. Intracameral blood and/or fibrin can obstruct the lumen of the shunt and compromise aqueous outflow, leading to an early post-operative pressure spike and surgical failure. Tissue plasminogen activator(tPA) is a serine protease inhibitor with fibrinolytic activity. The use of tPA has been reported in glaucoma valves and trabeculectomies. Here we report its use in three patients with the PreserFlo MicroShunt. The intracameral administration of tPA in three patients rapidly restored the patency of their shunts, reformed their conjunctival blebs and reduced their intraocular pressure(IOP). No serious adverse events were noted. Thus, intracameral tPA is safe, rapid and effective in restoring the patency of PreserFlo MicroShunt obstructed by blood clot and/or fibrin with a prompt lowering of IOP.