Practice Patterns, Diagnostic Utility, and Safety of Anterior Chamber Paracentesis.

Purpose: To investigate the safety and diagnostic utility of anterior chamber (AC) paracentesis in patients with ocular inflammation at the University of California, San Francisco (UCSF).

Design: This was a 2-part study including a cross-sectional survey study to assess practice patterns on AC paracentesis and a retrospective diagnostic and safety study of all outpatient AC paracentesis performed between April 2012 and March 2023 at UCSF.

Participants: The participants of the practice patterns survey study were ophthalmologists in the Proctor Foundation listserv. All patients who underwent at least 1 outpatient AC paracentesis at UCSF from 2012 to 2023 were included in the retrospective diagnostic and safety investigation.

Main Outcomes And Measures: For the diagnostic and safety study, the main outcomes included the frequency of adverse events and positive results for pathogens on various aqueous fluid testing.

Results: In our survey study, most providers had fellowship training in cornea and/or uveitis (68%) and performed AC paracentesis with the patient at the slit lamp (75%). Our retrospective diagnostic and safety study included 386 patients (51.3% female, mean age 56.7 years) and 528 AC paracentesis. Complications occurred in 5.7% of AC paracentesis. The overall PCR-positivity was 24.2% (97/401) and highest for cytomegalovirus (56/386; 14.5%). On multivariable analysis, topical corticosteroids increased the odds of PCR-positivity for viral pathogens (P = .01-.02). High AC cell levels were also associated with increased odds of PCR-positivity for HSV/VZV (P = .01).

Conclusions: Results of our study demonstrated the safety and diagnostic utility of AC paracentesis. This procedure facilitated the diagnosis of infectious causes of uveitis in almost 25% of cases.