Comparing the safety and efficacy of intracameral tissue plasminogen activator (t-PA) in trabeculectomy with MMC Vs standard trabeculectomy with MMC only.

Objective: To find out the harmlessness and effectiveness of intra-cameral tissue plasminogen activator (t-PA) in trabeculectomy for patients with primary open angle glaucoma (POAG). Study Design: Quasi-experimental Trial. Setting: Eye B Department, of Khyber Teaching Hospital, Peshawar. Period: Jan. 2021 and Dec. 2021. Material & Methods: Patients with POAG, who were operated for trabeculectomy (trab.)  Two groups were created out of study population i.e. Trab-MMC (Trab. With MMC done) and Trab-MMC/t-PA (Trab. With MMC + intra-cameral t-PA done). Success was defined as eyes having pressure (IOP) within the range of 8-20mmHg with at-least 25% reduction from pre-op IOP achieved with or without IOP lowering drugs. Results: Out of 20 participants (08 women and 12 men) 10 were allocated to each gp. Pre-op IOP was 28 ± 4.6 mmHg and 27 ± 4.8 mmHg, which dropped to 12.6 ± 3.8 mmHg and 11.1 ± 1.6 mmHg at 1st yr. post-op (p < 0.05) for both gps respectively. Surgical success was attained in 66% of Trab-MMC as compared to 86 % Trab-MMC/t-PA at 1st yr. (p = 0.44). Success with medication was 86 % compared to 100 % at 1st yr. respectively (p = 0.28). We didn’t observe any adverse effects with the use of intra-cameral t-PA. Conclusion: Adjunctive use of intra-cameral t-PA in trabeculectomy with MMC can result in improved outcome as compared to procedure without it. No side effects were noted with intra-cameral use of t-PA.