Background The intraocular inoculation of alteplase helps to dissolve blood clots.
Purpose To evaluate the effectiveness and safety of the use of alteplase in a patient with massive SCH who had to undergo vitrectomy drainage.
Materials and methods A 50-year-old woman, diagnosed with glaucoma resistant to drug treatment, was admitted with an intraocular pressure of 50 mmHg. Her medical history included risk factors such as degenerative myopia, hypertension and eye inflammation. She has undergone trabeculectomy with mitomycin and after the surgery she developed an expulsive SCH. To manage the SCH, the ophthalmological unit decided to do a vitrectomy and drain the eye; to assist with this they wanted to inject intraocular alteplase 50 mcg/0.1 mL.
A literature search was conducted in PubMed (keywords: tissue plasminogen activator, suprachoroidal haemorrhage, vitrectomy) to explain the clinical use and the pharmaceutical product was made according to the standard operating procedure (SOP) established in the Pharmacy Service.
In the vertical laminar flow hood we reconstituted 20 mg of alteplase with 20 ml of sterile water for injection. 1 ml of this solution was added to 1 ml of 0.9% sodium chloride. The final concentration was 500 mcg/ml. 0.1 mL of this solution was transferred to a 0.5 ml sterile insulin syringe and sealed with a sterile cap and labelled recommending its immediate use to obtain a final concentration of 500 mcg/ml.
Results 16 days after the SCH occurred, drainage surgery was performed after a 50 mcg intraocular inoculation of alteplase in the operating theatre to remove the blood clot. During the subsequent follow-up, there was evidence of a satisfactory clinical evolution, although a retinal detachment in the right eye was detected and the patient needed a second operation. She was prescribed brinzolamide and timolol ophthalmic drops and five months later she had normal intraocular pressure and a good quality of vision.
Conclusions The intraocular alteplase inoculation helped to dissolve the blood clot and it permitted the massive haemorrhage to drain better, improving the patient’s vision and making the second operation for retinal detachment easier. There were no adverse reactions referable to the intraocular inoculation of alteplase.
No conflict of interest.
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