The Treatment of Total Hyphemia with Fibrinolysin (Plasmin)

Abstract

I. Introduction This paper reports observations on the use of fibrinolysin in the treatment of 2 eyes with total hyphemia. Total hyphemia exists when the anterior chamber is completely filled with a black, homogeneous-appearing blood clot. The prognosis is extremely poor. Absorption is almost invariably slow, and the incidence of secondary glaucoma with blood staining of the cornea is high. Lack of agreement as to the proper management of such eyes emphasizes the inadequacy of present day treatment. Conventional methods of therapy usually employ paracentesis in an attempt to avoid high intraocular pressure while the clot absorbs.¹ Rychener² advised paracentesis only after an elevation of pressure; while Fralick³ urged paracentesis early, before the pressure rises. Experience has shown that in the presence of a total hyphemia, the clot is extremely difficult to remove by any means. Differentiation of clotted blood from iris is often impossible, and attempted