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Ruben Kuruvilla, Priya D. Sahu, Jessica Ackert, Naomi Goldberg; Yield of In-Office Anterior Chamber and Vitreous Taps in Diagnosis and Management of Uveitis Patients. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3207.
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There are cases where the etiology of intraocular inflammation is uncertain which can lead to difficulty in identifying the optimal treatment course. We aimed to determine the diagnostic value of in-office anterior chamber and vitreous taps.
We retrospectively reviewed cases in our uveitis clinic from 2010 to 2011 and identified patients via a search based on procedure codes for either an anterior chamber or vitreous tap. Patients who were immediately post-operative from a surgical intervention, an intravitreal injection, or suspected of having an endogenous endophthalmitis were excluded.
Our search resulted in 5 diagnostic procedures performed on 4 eyes. One procedure was an anterior chamber tap; the remaining 4 were vitreous taps. In all cases the etiology of the inflammation was suspected to be infectious in origin, but atypical in appearance. Specimens were sent for gram stain, culture, and PCR to assess for VZV, HSV, toxoplasmosis, and CMV. The aqueous tap was negative for evidence of infection and the patient subsequently responded to oral prednisone and immunomodulatory therapy. There were 4 vitreous taps performed with a positive result in 2 of the 4 cases. One negative result was positive on a repeat vitreous tap. The second negative tap was found to have a positive peripheral RPR and the inflammation responded to treatment with IV Penicillin. There were no adverse events from the procedures. The sensitivity was 66.6% and specificity 100%. The overall positive predictive value was 100% and negative predictive value was 66.6%.
Outpatient anterior chamber and vitreous taps can be a quick, safe, and effective way to assist diagnostic and therapeutic decision-making in patients with intraocular inflammation, especially when an infectious etiology is suspected.
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