Purpose: The purpose of this paper is to report a patient who developed a traction retinal detachment (TRD) that was successfully treated with intravitreal tissue plasminogen activator (tPA) after refractory intravitreal dexamethasone for a severe post-vitrectomy fibrin response. Methods: Observational case report. Results: A 30-year-old male with uncontrolled diabetes developed fibrinoid syndrome in his right eye after pars plana vitrectomy for vitreous hemorrhage and TRD secondary to diabetic retinopathy. He was initially unsuccessfully treated with intravitreal dexamethasone on postoperative day (POD) 1 given worsening fibrin in the vitreous and progression to early TRD. As a result, tPA was administered on POD 2, which led to the resolution of the fibrinoid syndrome induced TRD. Conclusion: This case highlights the efficacy of tPA use in fibrinoid syndrome when refractory to corticosteroids. tPA was able to manage this complication quickly and non-surgically in the setting of severe pre-retinal membrane formation and potential for rapid formation of TRD.
Youn et al. (2026) studied this question.