How do you approach the use of tPA in patients undergoing PPV for endophthalmitis when dense fibrin or membranes are present preoperatively?  

I have never used it if planning to go to the OR for endophthalmitis. I remove any anterior segment membranes surgically with forceps or the cutter to facilitate my view of the posterior segment. I do know some retina specialists who use it in non-surgical endophthalmitis patients to accelerate the ...