To evaluate the efficacy and safety of intracameral recombinant tissueplasminogen activator (rt-PA) application for fibrinolysis of fibrin formation after cataract surgery in children. Johann Wolfgang Goethe-University, Department of Ophthalmology; Frankfurt am Main, Germany. This study comprised 11 eyes of 10 patients aged 3 to 13 years (mean7.2 ± 3.68 SD) who developed severe fibrin formation after cataract surgery and IOL implantation despite intensive topical steroid therapy. Under general anesthesia, fibrinolysis was performed with 10 μg of rt-PA 7.18 ± 2.04 days after intraocular surgery. Follow-up included slitlamp examination, tonometry, visual acuity testing, and ophthalmoscopy. Anterior chamber flare measurements could be performed in 6 eyes. Complete resolution of fibrin formations occurred in 90% of the patients. Inthese cases, no recurrent fibrinous reaction or adverse effects were noted. In 2 eyes of the same patient with a history of juvenile rheumatoid arthritis and chronic uveitis, fibrin clot dissolution was incomplete. A recurrent fibrinous formation could be observed after 2 and 4 weeks, respectively. A beginning band kenatopathy excluding the central and limbal cornea, was noted after 6 and 8 weeks, respectively. Intraocular application of rt-PA 'appears to be a safe and efficacious therapeutic approach in the management of severe fibrinous reactions after pediatric cataract surgery.