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

Abstract

To investigate the safety and diagnostic utility of anterior chamber (AC) paracentesis in patients with ocular inflammation at the University of California, San Francisco (UCSF). This was a 2-part study including a cross-sectional survey study to assess practice patterns on AC paracentesis and a retrospective diagnostic and safety study of all outpatient AC paracentesis performed between April 2012 and March 2023 at UCSF. The participants of the practice patterns survey study were ophthalmologists in the Proctor Foundation listserv. All patients who underwent at least 1 outpatient AC paracentesis at UCSF from 2012 to 2023 were included in the retrospective diagnostic and safety investigation. For the diagnostic and safety study, the main outcomes included the frequency of adverse events and positive results for pathogens on various aqueous fluid testing. In our survey study, most providers had fellowship training in cornea and/or uveitis (68%) and performed AC paracentesis with the patient at the slit lamp (75%). Our retrospective diagnostic and safety study included 386 patients (51.3% female, mean age 56.7 years) and 528 AC paracentesis. Complications occurred in 5.7% of AC paracentesis. The overall PCR-positivity was 24.2% (97/401) and highest for cytomegalovirus (56/386; 14.5%). On multivariable analysis, topical corticosteroids increased the odds of PCR-positivity for viral pathogens (P = .01-.02). High AC cell levels were also associated with increased odds of PCR-positivity for HSV/VZV (P = .01). Results of our study demonstrated the safety and diagnostic utility of AC paracentesis. This procedure facilitated the diagnosis of infectious causes of uveitis in almost 25% of cases.