섬유성막에 의한 아메드밸브의 막힘에서 조직형 플라스미노겐활성제를 앞방 내로 주입한 1예

Intracameral Tissue Plasminogen Activator Injection in Fibrinous Membrane Block of Ahmed Valve

Purpose: To report a case of intracameral tissue plasminogen activator (t-PA) injection in a patient with blocked Ahmed valve by fibrinous membrane. Case summary: A 57-year-old female patient visited our clinic with visual disturbance and ocular pain in the left eye. She had Ahmed valve implantation in her left eye due to proliferative diabetic retinopathy and neovascular glaucoma 3 years ago. Best corrected visual acuity of left eye was hand motion and intraocular pressure (IOP) was 40 mmHg. The patient was diagnosed as mature cataract, vitreous hemorrhage and neovascularization glaucoma and pars plana vitrectomy, phacoemulsification of the lens and second Ahmed valve implantation were performed. Two days after surgery, thick fibrinous membrane was found in the anterior chamber and it blocked silicone tube of Ahmed valve. The measured IOP was 54 mmHg and did not respond to anti-glaucoma medication. On next day, t-PA (20 µg/0.05 mL) was injected into the anterior chamber. Some portion of the fibrous membrane was dissolved only 4 hours after the intracameral t-PA injection. A little fibrinous membrane was remaining 1 day after the injection. The silicone tip was released from the fibrinous membrane and the IOP was returned to normal. The fibrinous membrane disappeared completely in the next day. Conclusions: When fibrinous membrane blocks the silicone tube of Ahmed valve, which increase IOP, intracameral t-PA injection can be a fast and effective way to lysis the fibrinous membrane and lower the IOP to normal level.