Treatment approaches to postoperative fibrinoid syndrome after phacoemulsification

Abstract

BACKGROUND: Postoperative fibrinoid syndrome (PFS) is an early complication of phacoemulsification, manifested by fibrin deposition on the iris and the intraocular lens surface, which leads to visual acuity decrease.

AIM: To assess the rate and the treatment efficacy (by YAG laser, enzymatic, medicalmentous) in PFS after phacoemulsification.

MATERIALS AND METHODS: Retrospective analysis of 56,019 cataract surgery cases of 2017–2021. There were 49 patients with PFS divided into 3 groups according to treatment approaches: 1^st group — medicamentous treatment (MT) + YAG laser destruction of the fibrin film (n = 6); 2^nd — MT + prourokinase injection into the anterior chamber (n = 6); 3^rd — MT only (n = 37).

RESULTS: There was no difference between groups in best-corrected visual acuity (BCVA) before the PFS development. There was a more rapid increase in BCVA in the 1^st and the 2^nd groups compared with the 3^rd one on the third day (0.20 ± 0.09 and 0.21 ± 0.08 versus 0.09 ± 0.08 for groups respectively, p = 0.001) and on the fifth day of treatment (0.25 ± 0.10 and 0.27 ± 0.13 versus 0.16 ± 0.14, p = 0.029). Nevertheless, in one week, there was no difference in BCVA between groups. Unfortunately, BCVA did not return to baseline in any group.

CONCLUSION: The incidence of PFS after phacoemulsification is relatively low and amounts to 0.093%. The most rapid BCVA recovery was observed in the 1^st and the 2^nd groups.

Keywords

phacoemulsification / complication / iridocyclitis / intraocular lens / fibrin / vitreitis / endophthalmitis / inflammation / YAG laser / prourokinase

References

[1] Gndoyan IA. Use of the fibrinolytic drug trombovazim in the fibrinoid syndrome treatment after cataract extraction. Journal of Volgograd State Medical University. 2012;(2):28–32. (In Russ.)

[2] Гндоян И.А. Применение фибринолитического препарата «Тромбовазин» в лечении фибриноидного синдрома после экстракции катаракты // Вестник ВолгГМУ. 2012. № 2. С. 28–32.

[3] Boiko EhV, Danilichev VF, Kol’tsova SV. Ehksperimental’noe obosnovanie primeneniya rekombinantnoi prourokinazy i ee immobilizirovannykh form dlya lecheniya posleoperatsionnogo fibrinoidnogo sindroma v oftal’mologii. Byulleten’ eksperimental’noj biologii i mediciny. 1997;123(2):201–204. (In Russ.)

[4] Бойко Э.В., Даниличев В.Ф., Кольцова С.В. Экспериментальное обоснование применения рекомбинантной проурокиназы и её иммобилизированных форм для лечения послеоперационного фибриноидного синдрома в офтальмологии // Бюллетень экспериментальной биологии и медицины. 1997. Т. 123, № 2. С. 201–204.

[5] Novoderezhkin VV. Lazernaya korrektsiya fibrinoidnogo sindroma v posleoperatsionnom periode posle ehkstraktsii katarakty. Russian Journal of Clinical Ophthalmology. 2001;(3):114. (In Russ.)

[6] Новодережкин В.В. Лазерная коррекция фибриноидного синдрома в послеоперационном периоде после экстракции катаракты // РМЖ. Клиническая офтальмология. 2001. № 3. С. 114.

[7] Nishi O. Fibrinous membrane formation on the posterior chamber lens during the early postoperative period. J Cataract Refract Surg. 1988;14(1):73–77. DOI: 10.1016/s0886-3350(88)80068-3

[8] Nishi O. Fibrinous membrane formation on the posterior chamber lens during the early postoperative period // J Cataract Refract Surg. 1988. Vol. 14, No. 1. P. 73–77. DOI: 10.1016/s0886-3350(88)80068-3

[9] Ficker L, Meredith TA, Wilson LA, et al. Chronic bacterial endophthalmitis. Am J Ophthalmol. 1987;103(6):745–748. DOI: 10.1016/s0002-9394(14)74386-7

[10] Ficker L., Meredith T.A., Wilson L.A., et al. Chronic bacterial endophthalmitis // Am J Ophthalmol. 1987. Vol. 103, No. 6. P. 745–748. DOI: 10.1016/s0002-9394(14)74386-7

[11] Logai IM, Leus NF. Selektivnye ingibitory sinteza prostaglandinov. Oftal’mologicheskii zhurnal. 1999;(4):286–293. (In Russ.)

[12] Логай И.М., Леус Н.Ф. Селективные ингибиторы синтеза простагландинов // Офтальмологический журнал. 1999. № 4. С. 286–293.

[13] Müller-Jensen K, Rörig M, Hagele J, Zimmermann H. Effect of cataract technique and duration of surgery on fibrin reaction after IOL implantation. Ophthalmologe. 1997;94(1):38–40. DOI: 10.1007/s003470050081

[14] Müller-Jensen K., Rörig M., Hagele J., Zimmermann H. Effect of cataract technique and duration of surgery on fibrin reaction after IOL implantation // Ophthalmologe. 1997. Vol. 94, No. 1. P. 38–40. DOI: 10.1007/s003470050081

[15] Boiko EhV, Danilichev VF, Sazhin TG. Ehnzimoterapiya fibrinoidnogo sindroma. Fyodorov Journal of Ophthalmic Surgery. 2005;(3):25–29. (In Russ.)

[16] Бойко Э.В., Даниличев В.Ф., Сажин Т.Г. Энзимотерапия фибриноидного синдрома // Офтальмохирургия. 2005. № 3. С. 25–29.

[17] Apple DJ, Solomon KD, Tetz MR, et al. Posterior capsule opacification. Surv Ophthalmol. 1992;37(2):73–116. DOI: 10.1016/0039-6257(92)90073-3

[18] Apple D.J., Solomon K.D., Tetz M.R., et al. Posterior capsule opacification // Surv Ophthalmol. 1992. Vol. 37, No. 2. P. 73–116. DOI: 10.1016/0039-6257(92)90073-3

[19] Singh S, Pardhan S, Kulothungan V, et al. The prevalence and risk factors for cataract in rural and urban India. Indian J Ophthalmol. 2019;67(4):477–483. DOI: 10.4103/ijo.IJO_1127_17

[20] Singh S., Pardhan S., Kulothungan V., et al. The prevalence and risk factors for cataract in rural and urban India // Indian J Ophthalmol. 2019. Vol. 67, No. 4. P. 477–483. DOI: 10.4103/ijo.IJO_1127_17

[21] Avetisov KS. Acoustic density of cataracts. The Russian annals of ophthalmology. 2015;131(2):38–44. (In Russ.) DOI: 10.17116/oftalma2015131238-44

[22] Аветисов К.С. Акустическая плотность хрусталика при катаракте // Вестник офтальмологии. 2015. Т. 131, № 2. С. 38–44. DOI: 10.17116/oftalma2015131238-44

[23] Potyomkin VV, Ageeva EV. Zonular instability in patients with pseudoexfoliative syndrome: the analysis of 1000 consecutive phacoemulsifications. Ophthalmology Journal. 2018;11(1):41–46. (In Russ.) DOI: 10.17816/OV11141-46

[24] Потемкин В.В., Агеева Е.В. Нестабильность связочного аппарата хрусталика у пациентов с псевдоэксфолиативным синдромом: анализ 1000 последовательных факоэмульсификаций // Офтальмологические ведомости. 2018. Т. 11, № 1. С. 41–46. DOI: 10.17816/OV11141-46

[25] Potyomkin VV, Goltsman EV. Cataract surgery in pseudoexfoliation syndrome. Ophthalmology Journal. 2020;13(1):37–42. (In Russ.) DOI: 10.17816/OV25739

[26] Потемкин В.В., Гольцман Е.В. Хирургия катаракты при псевдоэксфолиативном синдроме // Офтальмологические ведомости. 2020. Т. 13, № 1. С. 37–42. DOI: 10.17816/OV25739

[27] Dedov II, Shestakova MV, Galstyan GR. The prevalence of type 2 diabetes mellitus in the adult population of Russia (NATION study). Diabetes mellitus. 2016;19(2):104–112. (In Russ.) DOI: 10.14341/DM2004116-17

[28] Дедов И.И., Шестакова М.В., Галстян Г.Р. Распространённость сахарного диабета 2 типа у взрослого населения России (исследование NATION) // Сахарный диабет. 2016. Т. 19, № 2. С. 104–112. DOI: 10.14341/DM2004116-17

[29] Sheng Y, Sun W, Gu Y, et al. Endophthalmitis after cataract surgery in China, 1995–2009. J Cataract Refract Surg. 2011;37(9): 1715–1722. DOI: 10.1016/j.jcrs.2011.06.019

[30] Sheng Y., Sun W., Gu Y., et al. Endophthalmitis after cataract surgery in China, 1995–2009 // J Cataract Refract Surg. 2011. Vol. 37, No. 9. P. 1715–1722. DOI: 10.1016/j.jcrs.2011.06.019

[31] Oswal KS, Sivaraj RR, Murray PI, Stavrou P. Clinical course and visual outcome in patients with diabetes mellitus and uveitis. BMC Res Notes. 2013;29(6):167. DOI: 10.1186/1756-0500-6-167

[32] Oswal K.S., Sivaraj R.R., Murray P.I., Stavrou P. Clinical course and visual outcome in patients with diabetes mellitus and uveitis // BMC Res Notes. 2013. Vol. 29, No. 6. ID 167. DOI: 10.1186/1756-0500-6-167

[33] Christopher KL, Hood CT, Mian SI, et al. Endophthalmitis in advanced microbial keratitis: risk factors and examination findings. Cornea. 2020;39(9):1096–1101. DOI: 10.1097/ICO.0000000000002349

[34] Christopher K.L., Hood C.T., Mian S.I., et al. Endophthalmitis in advanced microbial keratitis: risk factors and examination findings // Cornea. 2020. Vol. 39, No. 9. P. 1096–1101. DOI: 10.1097/ICO.0000000000002349

[35] Norris JW, Chirls IA, Santry JG, et al. Severe fibrinous reaction after cataract and intraocular lens implantation surgery requiring neodymium: YAG laser therapy. J Cataract Refract Surg. 1990;16(5):637–639. DOI: 10.1016/s0886-3350(13)80784-5

[36] Norris J.W., Chirls I.A., Santry J.G., et al. Severe fibrinous reaction after cataract and intraocular lens implantation surgery requiring neodymium: YAG laser therapy // J Cataract Refract Surg. 1990. Vol. 16, No. 5. P. 637–639. DOI: 10.1016/s0886-3350(13)80784-5

[37] Boiko EV, Danilichev VF, Sazhin TG, et al. Comparison of the pharmacokinetics of recombinant prourokinase in non-invasive methods of administration (drops, electrophoresis, therapeutic contact lenses). Russian journal of clinical ophthalmology. 2017;18(4):213–218. (In Russ.) DOI: 10.21689/2311-7729-2017-17-4-213-218

[38] Бойко Э.В., Даниличев В.Ф., Сажин Т.Г., и др. Сравнение фармакокинетики рекомбинантной проурокиназы при неинвазивных методах введения (инстилляции, электрофорез, лечебные контактные линзы) // РМЖ. Клиническая офтальмология. 2017. Т. 18, № 4. С. 213–218. DOI: 10.21689/2311-7729-2017-17-4-213-218

[39] Suvorov AS, Sazhin TG. Enzymotherapy of toxic anterior segment syndrome after phacoemulsification. Ophthalmology Journal. 2017;10(2):87–93. (In Russ.) DOI: 10.17816/OV10287-9

[40] Суворов А.С., Сажин Т.Г. Энзимотерапия токсического синдрома переднего сегмента после факоэмульсификации // Офтальмологические ведомости. 2017. Т. 10, № 2. С. 87–93. DOI: 10.17816/OV10287-9

[41] Osaadon P, Osaadon P, Lavy I, et al. Intracameral r-tPA for the management of severe fibrinous reactions in TASS after cataract surgery. Eur J Ophthalmol. 2022;32(1):200–204. DOI: 10.1177/11206721211002064

[42] Osaadon P., Osaadon P., Lavy I., et al. Intracameral r-tPA for the management of severe fibrinous reactions in TASS after cataract surgery // Eur J Ophthalmol. 2022. Vol. 32, No. 1. P. 200–204. DOI: 10.1177/11206721211002064

[43] Wedrich A, Menapace R, Mühlbauer-Ries E. The use of recombinant tissue plasminogen activator for intracameral fibrinolysis following cataract surgery. Int Ophthalmol. 1994;18(5):277–280. DOI: 10.1007/BF00917830

[44] Wedrich A., Menapace R., Mühlbauer-Ries E. The use of recombinant tissue plasminogen activator for intracameral fibrinolysis following cataract surgery // Int Ophthalmol. 1994. Vol. 18, No. 5. P. 277–280. DOI: 10.1007/BF00917830

[45] Heiligenhaus A, Steinmetz B, Lapuente R, et al. Recombinant tissue plasminogen activator in cases with fibrin formation after cataract surgery: a prospective randomised multicentre study. Br J Ophthalmol. 1998;82(7):810–815. DOI: 10.1136/bjo.82.7.810

[46] Heiligenhaus A., Steinmetz B., Lapuente R., et al. Recombinant tissue plasminogen activator in cases with fibrin formation after cataract surgery: a prospective randomised multicentre study // Br J Ophthalmol. 1998. Vol. 82, No. 7. P. 810–815. DOI: 10.1136/bjo.82.7.810

[47] Ben Simon GJ, Kenet G, Spierer A. Fibrinoid reaction after lens extraction in rabbit eyes. J Cataract Refract Surg. 2012;38(5): 890–893. DOI: 10.1016/j.jcrs.2011.12.026

[48] Ben Simon G.J., Kenet G., Spierer A. Fibrinoid reaction after lens extraction in rabbit eyes // J Cataract Refract Surg. 2012. Vol. 38, No. 5. P. 890–893. DOI: 10.1016/j.jcrs.2011.12.026

RIGHTS & PERMISSIONS

Belov D.F., Petukhov V.P.