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D. Trivedi, P. I. Murray; Safety of Anterior Chamber Paracentesis Performed at the Slit Lamp. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3783.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the safety profile of anterior chamber (AC) paracentesis performed at the slit lamp as an out patient procedure.
Retrospective study of 560 uveitis patients who underwent AC paracentesis at the slit lamp for diagnostic or research purposes between January 1997 and June 2009. Patients with undilated and dilated pupils were included. Local research ethics committee approval and informed consent was obtained. After frequent instillation of topical local anaesthetic followed by povidone iodine antiseptic solution, the patient was positioned at the slit lamp, instructed to look straight ahead, and the upper lid and eyelashes held out of the way by an assistant. A lid speculum was not required. Out of 560 paracenteses performed, 510 were undertaken using a 27-gauge needle attached to an insulin syringe, and an aqueous pipette was used for the rest. The 27-gauge needle was inserted at the paralimbal clear cornea in a plane above and parallel to the iris with the bevel of the needle facing forward. The sampler or assistant pulled the plunger of the syringe to aspirate the aqueous. The aqueous pipette (DORC, The Netherlands designed by O’Rourke) consists of a short 30-gauge needle mounted inside plastic tubing, which in turn is connected to a soft polyethylene suction-infusion bulb. The bulb is squeezed to create a vacuum and the needle inserted at the limbus as describe above. When pressure of the bulb is released, aqueous spontaneously fills the pipette. The whole procedure takes less than five minutes. After sampling an antibiotic drop was prescribed for 3 days, and all patients were re-examined 20 minutes after the procedure and 1-2 weeks later.
Two patients had an inadvertent injection of air into the AC using the pipette, with spontaneous resolution and no adverse outcome. One patient had anterior lens capsule touch that was self-sealing and left a tiny localised opacity. This was due to eye movement because of language difficulties. One patient had an allergic reaction to povidone iodine. No patients had a hyphaema or endophthalmitis.
AC paracentesis can be performed safely as an out patient procedure at the slit lamp following adequate aseptic precaution, and appropriate counselling.
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