Anterior chamber paracentesis for increased intraocular pressure with intravitreal injections: systematic review and...

Intravitreal injections (IVIs) can cause a transient asymptomatic spike in intraocular pressure (IOP), which may cause irreversible damage to the patient's optic nerve. Anterior chamber paracentesis (ACP) is a well-established method to lower IOP. We aim to systematically review the literature, assessing the safety and efficacy of ACP for increased IOP with IVI of antivascular endothelial growth factor medications.

The following databases were used: MEDLINE, EMBASE, and CINAHL. Articles were included if they had human participants and discussed the use of ACP for increased IOP during IVIs. Key terms searched were anterior chamber paracentesis, intravitreal injections, and intraocular pressure.

Our search captured 236 articles, and ultimately 13 studies were included in our review. Six studies were included in our meta-analysis of studies that reported the IOP after 30 minutes post-ACP. Ten included studies reported that ACP is a safe and effective procedure that lowers the IOP of patients during the IVI process. The overall pooled effect size is significant for IOP measurements 30 minutes after ACP is -1.54 with a 95% CI of -2.20 to -0.88 mm Hg, 5 minutes after ACP is -2.37 with a 95% CI of -2.77 to -1.97 mm Hg and 2 minutes after ACP is -5.09 with a 95% CI of -8.48 to -1.70 mm Hg.

In conclusion, performing an ACP is a safe and effective way to reduce the transient spike in IOP after IVIs. However, this procedure is not without the potential for complications.