Practice Patterns, Diagnostic Utility, and Safety of Anterior Chamber Paracentesis

Area of Science:

• Ophthalmology
• Infectious Diseases
• Medical Diagnostics

Background:

• Ocular inflammation, particularly uveitis, often requires accurate diagnosis to guide treatment.
• Anterior chamber (AC) paracentesis is a procedure to collect aqueous humor for diagnostic testing.
• Understanding the safety and diagnostic yield of AC paracentesis is crucial for clinical practice.

Purpose of the Study:

• To evaluate the safety and diagnostic utility of AC paracentesis in patients with ocular inflammation.
• To assess practice patterns of AC paracentesis among ophthalmologists.
• To determine the frequency of adverse events and pathogen detection rates from aqueous fluid analysis.

Main Methods:

• A two-part study was conducted: a cross-sectional survey of ophthalmologists and a retrospective analysis of AC paracentesis procedures.
• The survey assessed practice patterns, while the retrospective study reviewed data from April 2012 to March 2023 at UCSF.
• Outcomes included complication rates and PCR positivity for various pathogens in aqueous humor.

Main Results:

• AC paracentesis was performed on 386 patients (528 procedures) with a complication rate of 5.7%.
• Overall PCR positivity was 24.2%, with cytomegalovirus being the most common pathogen detected (14.5%).
• Topical corticosteroids and high AC cell levels were associated with increased PCR positivity for viral pathogens.

Conclusions:

• Anterior chamber paracentesis is a safe procedure with significant diagnostic value in managing ocular inflammation.
• The study confirmed the utility of AC paracentesis in diagnosing infectious etiologies of uveitis, aiding in targeted therapy.