Anterior chamber paracentesis in patients with acute elevation of intraocular pressure

Arnavielle, S.; Creuzot‐Garcher, Catherine; Bron, Alain M.

doi:10.1007/s00417-006-0465-5

Cited by 27 publications

(19 citation statements)

References 23 publications

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“…This finding confirms that immediate ACP should be combined with conventional treatments [9]. The benefit of rapid IOP control is to limit the extent of potentially irreversible ocular tissue injuries.…”

Section: Discussionsupporting

confidence: 71%

“…Several previous reports describe different surgical techniques to perform ACP. Most studies used an ophthalmic surgical knife to enter directly into the anterior chamber, with a resulting release of aqueous humor through the wound [9,11,12].…”

Section: Discussionmentioning

confidence: 99%

“…Systemic anti-glaucoma medication is associated with several known side effects, as well as some contraindications in specific conditions. Previous studies have reported Anterior Chamber Paracentesis (ACP) as a method for managing acute and otherwise unmanageable increases in IOP [8][9][10]. Lam, et al reported the effectiveness of immediate ACP with a sterile 15 degree slit knife combined with systemic and topical anti-glaucoma medications [11].…”

Section: Introductionmentioning

confidence: 99%

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Immediate Anterior Chamber Paracentesis with a 30-Gauge Needle for Acute Primary Angle Closure

Kitnarong¹,

Boonyaleepun²,

Sakiyalak³

et al. 2017

J Clin Exp Ophthalmol

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Background: Primary angle-closure glaucoma (PACG) is more common among Asians than among Caucasians. Acute primary angle closure (APAC) is a serious associated complication in PACG patients. When conventional treatment fails, Anterior Chamber Paracentesis (ACP) can be performed to decrease IOP. Although slit knives are commonly used for performing ACP, other techniques can also be used to perform this procedure.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Immediate Anterior Chamber Paracentesis with a 30-Gauge Needle for Acute Primary Angle Closure

Kitnarong¹,

Boonyaleepun²,

Sakiyalak³

et al. 2017

J Clin Exp Ophthalmol

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“…Some ophthalmologists perform anterior chamber paracentesis after injection [29,30] while administering IOP-lowering agents for prevention of an increase in IOP [31]. Because postinjection IOP may become elevated up to the central retinal arterial pressure and a rapid increase in IOP may induce sight-threatening side effects such as CRAO, follow-up observations regarding IOP fluctuations after injection are necessary.…”

Section: Discussionmentioning

confidence: 99%

Short-Term Visual Acuity and Intraocular Pressure Changes and Their Correlation after Anti-Vascular Endothelial Growth Factor Injection

Lim

Kim²,

Jo³

et al. 2016

Ophthalmologica

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Purpose: To assess the effect of intravitreal anti-vascular endothelial growth factor injection on short-term changes in intraocular pressure (IOP) and visual acuity (VA) and the correlation between the two values. Methods: This study included 25 eyes of 25 patients undergoing intravitreal injection of bevacizumab (IVB) with preinjection uncorrected VA (UCVA) >20/40. IOP and UCVA were measured before injection and 1, 5, 10, 15, 20, 25, and 30 min after injection, using a Tono-Pen (Reichert, Chicago, Ill., USA). The IOP and VA values before and after injection were compared. The correlation between IOP and VA at each time point was analyzed. Results: The preinjection IOP value (17.7 mm Hg) increased sharply to 43.1 mm Hg 1 min after injection, followed by a decrease to 30.4, 24.6, 20.7, 18.7, 18.2, and 17.7 mm Hg at 5, 10, 15, 20, 25, and 30 min, respectively. The preinjection UCVA value (0.21; logMAR) increased to 0.96 one minute after injection, followed by a decrease to 0.61, 0.44, 0.33, 0.27, 0.23, and 0.22 at 5, 10, 15, 20, 25, and 30 min, respectively. Significant differences were evident between the preinjection IOP and VA values and those observed over the 5- to 25-min period after injection (p < 0.05). The correlation between IOP and VA was significant 1, 5, and 10 min after injection [p < 0.001 (1 min), p = 0.033 (5 min), and p = 0.002 (10 min)]. Conclusions: Differences in all IOP and VA values were significant up to 25 min after IVB, compared with preinjection values; however, no significant difference was found 30 min after injection. Such fluctuations in VA and IOP were positively correlated. The patients' own knowledge of VA fluctuations after injection may provide ophthalmologists with sufficient evidence to make an indirect clinical judgment regarding short-term complications of intravitreal injection.

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Dear Editors,We read with interest on your article by Arnavielle et al [1] on the potential benefits of anterior chamber (AC) paracentesis in patients with acute angle-closure glaucoma. Lam et al [2,3] first proposed this technique in treating patients with acute angle-closure glaucoma.

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mentioning

confidence: 97%

Anterior chamber paracentesis in patients with acute elevation of intraocular pressure

Pong

2007

Graefes Arch Clin Exp Ophthalmol

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Dear Editors,We read with interest on your article by Arnavielle et al. [1] on the potential benefits of anterior chamber (AC) paracentesis in patients with acute angle-closure glaucoma. Lam et al. [2,3] first proposed this technique in treating patients with acute angle-closure glaucoma. His pilot study recruited ten eyes in eight patients, and IOP was maintained at normal range 2 hours after paracentesis. The effect of paracentesis was found to be temporary, with subsequent rise of IOP at 30 minutes, and therefore medications were still needed for breaking the pupil block and to substantiate the IOP-lowering effects. However in your study, IOP was only measured at 10 minutes, 1 day, 7 days, 30 days and 1 year after the paracentesis. In addition, most of your cases received additional surgical interventions such as laser iridotomy and cataract extraction subsequently. Hence, we believed that your study only reflected the overall management of the cases, and the IOP measurements had little relevance on the true effect of the AC paracentesis. The potential long-term complications could be increased risks of peripheral anterior synechiae, and further loss of endothelial cells counts caused by the shallow anterior chamber from the paracentesis. It would be useful to know the angle status in long term in such cases with AC paracentesis performed compared to those without. However, your study did not provide information in this regard. We believe a prospective randomized controlled trial with larger sample size, post-operative gonioscopic findings and endothelial counts in the long term is necessary.The pathogenesis of secondary angle-closure glaucoma is widely varied and they are notoriously difficult in management. Inclusions of secondary angle-closure glaucoma in your study could confound the results, and have to be interpreted with caution. In fact, AC paracentesis was not found to be useful in secondary angle-closure cases in your study. With paracentesis, additional risks of hyphema from neovascular irides and even tumour seeding (in the case of choroidal melanoma) could occur if not managed correctly. We therefore do not recommend AC paracentesis in cases with secondary angle-closure glaucoma.From the limited studies in the literature, AC paracentesis provides a methodology which is quick and effective in lowering IOP in the immediate stage of acute angle-closure glaucoma, and the effect seems to be maintained with the help of the topical and oral glaucoma medications. The complications reported so far in the limited literature are trivial. However, it is important to note that AC paracentesis is not a treatment that alleviates the true cause of the acute angle closure, which is mainly because of pupillary block with increased posterior chamber pressure. The possible side effects of ocular tissue injury, decompression retinopathy [4], suprachoroidal haemorrhage, aqueous misdirection and infection could be drastic and equally vision-threatening. Long-term risks of peripheral anterior synechiae and corneal endoth...

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Anterior chamber paracentesis in patients with acute elevation of intraocular pressure

Abstract: ACP is a safe and effective procedure for acute elevation of IOP in acute primary primary angle-closure but only remains an add-on therapy to usual treatments. However, this technique must be evaluated in larger series.

Cited by 27 publications

References 23 publications

Immediate Anterior Chamber Paracentesis with a 30-Gauge Needle for Acute Primary Angle Closure

Immediate Anterior Chamber Paracentesis with a 30-Gauge Needle for Acute Primary Angle Closure

Short-Term Visual Acuity and Intraocular Pressure Changes and Their Correlation after Anti-Vascular Endothelial Growth Factor Injection

Anterior chamber paracentesis in patients with acute elevation of intraocular pressure

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