Intraocular tissue plasminogen activator during vitrectomy in the management of acute severe bacterial endophthalmitis

Purpose: To describe a novel off-label use of tissue plasminogen activator (tPA) in the setting of severe endophthalmitis for improved surgical outcomes during pars plana vitrectomy. Methods: After a limited core vitrectomy is completed, 50mcg/0.1ml tPA is administered intravitreally and allowed to take effect with a 15-minute lights-out period. A fluid-fluid exchange is then carried out to lavage the inflammatory debris and tPA from the posterior segment. Results: This technique allows for significantly improved surgical visualization and complete removal of inflammatory debris in the anterior and posterior segment. Conclusion: Increased clearance of intraocular inflammatory debris may reduce post-infection inflammatory sequalae such as posterior synechiae and preretinal membranes and achieve better surgical outcomes.