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Jerome Vincent Giovinazzo, Michael Jansen, Codrin Iacob, Richard B Rosen, Avnish Deobhakta; Obtaining Vitreous Samples in Acute Endophthalmitis: Comparing the Rate of Dry Taps Using a Needle vs Trocar Cannula. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3673.
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Acute endophthalmitis is a rare but vision threatening ophthalmic disease. Vitreous samples are routinely obtained at time of presentation at the bedside using a needle prior to injection of antibiotics. Obtaining a vitreous sample can be difficult if the vitreous has not liquefied. Our goal was to determine the rate of “dry taps” from fine needle aspiration and analyze whether a valved trocar could increase the probability of obtaining a sample.
A retrospective chart review was conducted from August 2016 until November 2017 reviewing patients diagnosed with endophthalmitis that underwent bedside vitreous tap and injections. 25 gauge needles attached to a 3cc syringe were used prior to August 2017 while valved trocars were introduced afterwards. The valved trocar is placed 4mm posterior to the limbus temporally. A similar gauged needle on a 3cc syringe is inserted through the trocar to obtain the vitreous sample. All bedside tap and injections and were performed by the retina service at The New York Eye and Ear Infirmary of Mount Sinai (NYEE). Statistical analysis was performed using a Fisher’s exact test.
38 tap and injections were performed on 33 patients. 26 tap and injections were performed using a 25 gauge needle. 9/26 (34.6%) were dry, and for those 9, aqueous needed to be sent. 12 tap and injections were performed with trocars, (two 25 gauge and ten 27 gauge) and 0/12 were dry. Differences between the two groups were statistically significant (P=0.0356). For 2/12 (16.7%) of trocar-assisted taps, multiple syringes were sent to pathology to ensure adequate sample was provided.
Vitreous samples in acute endophthalmitis are important for disease management and antibiotic choice. Dry vitreous taps are common, seen in 35% of cases during a one year period. Trocar placement increases the probability of obtaining an adequate vitreous sample. Having a trocar in place allows multiple attempts and repositioning of the patient, giving additional opportunities to obtain sufficient vitreous sample with minimal discomfort to the patient.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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