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S. M. Pfahler, B. M. Glaser; A High Yield In-office Technique for Acquiring Vitreous Samples. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4996.
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Recently, the development of reverse phase protein microarray technology has allowed clinicians to analyze the proteome of vitreous samples from patients with a wide-array of vitreo-retinal pathology1. The Diagnostic Vitreous Proteome (DVP) has the potential to allow clinicians to monitor and design treatments based upon a patients’ individual proteome. In order for DVP to fulfill its potential, a high-yield, in-office vitreous sampling must be established. We report an efficient, high yield in-office technique to acquire small volumes of vitreous fluid.
The vitreous sample was obtained by using a standard technique on all patients obtained as follows: Topical anesthesia was obtained by instillation of topical lidocaine gel 2% followed by placement of a soaked cotton-tip applicator (lidocaine 2% solution) in the inferior temporal quadrant. Using sterile gloves a sterile lid speculum was placed followed by a drop of betadine 5% . Immediately following, a specialized needle was placed via pars plana approach into the mid-vitreous cavity and vitreous fluid was aspirated. Following removal of the needle, the thirty gauge needle with appropriate medication was injected in the same location. Intraocular pressure was only measured if a vitreous sample was not obtained ("dry sample"). After injection the patient was discharged with post-injection warning signs and instructions to use a fourth generation flouroquinolone antibiotic drop (moxifloxacin or gatifloxicin) four times a day for five days.
A total of 550 positive diagnostic vitreous samples were collected from 578 attempts in 157 eyes of 144 patients. There were 49 males and 95 female participants. The average age of the subjects was 77.3 (range 33-98). There were 86 phakic eyes and 71 pseudophakic eyes.
High yield vitreous sampling can be obtained in an office based setting in a high percentage of patients. Larger studies will need to be completed to further assess the efficacy of this technique.
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