Treatment of post-traumatic trabecular mashwork thrombosis and secondary glaucoma with intracameral tissue plasminogen activator in previously unrecognized sickle cell anemia

Intracameral tissue plasminogen activator (t-PA) application in a child with previously unrecognized sickle cell anemia, post-traumatic hyphema, thrombosis in trabecular mashwork and consecutive acute glaucoma showed positive results. Thirteen year-old boy, son of African father and Caucasian mother, was admitted to hospital, with symptoms of acute glaucoma and partial hyphema after right eye trauma. Visual acuity of affected eye was 0.5 and intraocular pressure (IOP) 46 mm Hg. Despite a common therapy three days later clinical condition of patient's right eye was getting worst. Visual acuity was only hand motion (HM) and IOP 53 mmHg. At this point rose suspicion of sickle cell disease (SCD) and decision about injecting t-PA (20 microg) into anterior chamber was made. Cytological examination of aqueous humor revealed 10% sickled erythrocytes. Hemoglobin electrophoresis discovered hemoglobin S so that diagnosis of SCD was confirmed. Intraocular application of t-PA showed excellent results in post-traumatic hyphema with trabecular mashwork thrombosis in the patient with sickle cell anemia. Two-years follow up confirmed permanent normalisation of IOP and visual acuity. Successful outcome with anterior chamber paracentesis and intracameral injection of t-PA is promising novel approach, which we recommend in treatment of post-traumatic hyphema in SCD.