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Bert Glaser, Stephanie Ecker, Joshua Hines, Ann Igbre; A Prospective Study of In-Office Diagnostic Vitreous Sampling in Patients with Vitreoretinal Pathology, 2007-2011. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2464.
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This prospective study has been compiled to demonstrate that in-office vitreous sampling can be done safely and efficiently in patients with a variety of retinal pathologies.
Briefly, a vitreous aspiration was performed before an injection of Anti-VEGF or of corticosteroid for treatment of retinal disease. Each sample was taken using a standard technique, which includes 1) application of 2% topical liodcaine gel followed by placement of a soaked cotton-tip applicator with 4% Lidocaine solution (in the inferior temporal quadrant; 2) a Sterile Lid Speculum was placed followed by a drop of betadine 5%; 3) next, a 25 gauge, 5/8 inch Terumo Needle was placed via pars plana approach into the mid-vitreous cavity and 0.05 mL to 0.10mL of vitreous fluid was aspirated into a 1mL syringe. After removal of the needle the intravitreal injection is directed via or close to the same spot. After the injection the patient is discharged with post-injection warnings typical of patients following intra-vitreal injections.
As of December 31, 2011, a total of 830 patients were enrolled in the Western IRB approved Vitreous Proteomics study at our institute. A total of 3,741 attempts were made to acquire a vitreous sample, resulting in 3,245 samples, yielding an 86.7% rate of success over a 4 year period. The majority of the vitreoretinal diagnoses were AMD, DR and RVO, but there were 93 patients with other retinal diseases that were also sampled in this study. Out of the 830 patients in the study, there have been 24 (2.89%) patients that had a complication. The majority of the complications (79.16%, n=19) were mild vitreous hemorrhages, present at the one month follow-up visit. All vitreous hemorrhages resolved without sequelae. The other 5 adverse events consisted of a corneal abrasion (n=1), endophthalmitis (n=1), pseudo-endophthalmitis (n=2) and scleritis (n=1). There were no cases identified of acute posterior vitreous detachment, retinal tears or retinal detachments.
This proves that in-office vitreous sampling of 50-100 µl is a safe and reproducible procedure. The low rate of adverse events and the 4 year duration of this study give solid evidence that vitreous sampling is in fact a safe in-office procedure.
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