以TPA治療外傷性前房出血－病例報告

Treatment of Traumatic Hyphema by Intracameral Injection of Tissue Plasminogen Activator-One Case Report

劉秀雯(Shiow-Wen Liou) ； 邱正仁(Cheng-Jen Chiu)

《中華民國眼科醫學會雜誌》 38卷4期 (1999/12) Pp. 684-688

https://doi.org/10.30048/ACTASOS.199912.0016

摘要

目的：本文報告利用TPA治療外傷性前房出血且併發術後再出血的病患之病例
方法：病例報告
結果：病患四十歲男性，因車禍造成右眼外傷性前房出血，在他院接受了兩次前房沖吸治療：第一次手術後血塊未能清除，而第二次手術中發生再出血及術後眼壓升高現象。來本院求診時，右眼視力僅有辨別手動程度，前房有大量血塊及纖維膜增生，眼壓62mmHg。住院後接受兩次前房TPA(5μg)注射及沖吸治療，血塊很快有溶解的情形，而前房纖維膜逐漸消失，眼壓也回復到正常。出院後在門診追蹤中，右眼眼壓一直維持正常，角膜僅有一些血色素染色，右眼最佳矯正視力可達壹點零。
結論：外傷性前房出血是眼科急症之一，尤其是合併前房內纖維增生及眼壓升高時，更是難以處理。本院眼科利用TPA來治療一位複雜外傷性前房出血且發生術後再出血的病患，獲得良好成果，特提出報告並探討TPA在眼科上的應用。

並列摘要

Tissue plasminogen activator (TPA) is a serine protease that converts plasminogen to plasmin. Plasmin will bind to fibrin and result in fibrinolysis. We presented a forty-year-old male who had traumatic hyphema with dense blood clot, anterior chamber fibrin formation and glaucoma in the right eye. After twice unsuccessful anterior chamber irrigation/aspiration, intraoperative rebleeding developed after the second operation and post-operative intraocular pressure (IOP) elevation was noted. He was transferred to our hospital and intracameral injections of TPA (5(g) with irrigation/aspiration procedures were performed twice. Clotted blood resolved and IOP returned to normal. 3 years later, the best-corrected visual acuity was 1.0. The anterior chamber was quiet and IOP remained normal. This case demonstrated that intracameral injection of TPA might be a simple and effective method for intractable hyphema combined with fibrous membrane.

並列關鍵字

Tissue plasminogen activator ； Traumatic hyphema