Anterior Chamber Paracentesis in the Treatment of Acute Elevation of Intraocular Pressure

Abstract

Abstract: : Purpose: To evaluate the efficacy and safety of anterior chamber paracentesis in acute elevation of intraocular pressure (IOP). Methods: A prospective monocenter study was conducted on 20 eyes of 20 patients who presented with IOP > 50 mmHg. After appropriate aseptic techniques, corneal paracentesis was performed at the slit–lamp biomicroscope with a sterile surgical blade. IOP was measured by Goldmann applanation tonometry before, 10 minutes, 24 hours, 7 days and 30 days after paracentesis. Results: The patients treated were as follows: 15 cases of acute angle–closure attacks (one bilateral), one case of phacolytic glaucoma, and 3 cases of secondary angle–closure glaucoma. Intraocular pressure decreased from 53.4 ± 3.7 mm Hg to 23.3 ± 11.0 mm Hg at 10 minutes (p<0.0005), then to 17.4 ± 10.0 mm Hg at 24 hours (p<0.0005), and to 15.1 ± 9.2 mm Hg 7 days after paracentesis (p<0.0005). Paracentesis combined with antiglaucomatous medications provided immediate relief of symptoms in all cases, and the improvement of corneal edema in 17 cases out of 20. We noted one failure in a posterior block and in one neovascular glaucoma. An additional puncture was required in 3 patients. We successfully performed a laser peripheral iridotomy in 15 patients after paracentesis. An additional surgical treatment was required in 18 eyes. No complications directly related to paracentesis were observed. Conclusions: This preliminary study suggests that paracentesis is a safe and effective procedure for acute elevation of IOP. It is only and add–on therapy to classic treatments used in acute elevation of IOP. However such a technique has to be evaluated in larger series.

Keywords: anterior chamber • aqueous • intraocular pressure