前房穿刺的实践模式、诊断效用和安全性。

IF 4.2 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology Pub Date : 2025-05-23 DOI:10.1016/j.ajo.2025.05.017

Charlene H. Choo , Punyanuch Pisitpayat , Daisy Yan , Aaron Chang , Sarah Lopez , Shreya Malli , Gerami D. Seitzman , John Gonzales , Nisha Acharya , Thuy Doan , Jessica G. Shantha

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引用次数: 0

摘要

目的探讨加州大学旧金山分校（UCSF）眼科炎症患者前房穿刺术（AC）的安全性和诊断价值。设计：本研究分为两部分，包括一项评估AC穿刺实践模式的横断面调查研究和一项对2012年4月至2023年3月在UCSF进行的所有门诊AC穿刺的回顾性诊断和安全性研究。研究对象：临床实践模式调查研究的参与者为普罗克特基金会列表服务的眼科医生。2012年至2023年在加州大学旧金山分校接受至少一次门诊AC穿刺的所有患者均纳入回顾性诊断和安全性调查。在诊断和安全性研究中，主要结局包括不良事件的频率和各种水溶液检测中病原体的阳性结果。结果在我们的调查研究中，大多数提供者（68%）接受过角膜和/或葡萄膜炎的培训，并在裂隙灯下与患者进行AC穿刺（75%）。我们的回顾性诊断和安全性研究包括386例患者（51.3%为女性，平均年龄56.7岁）和528例AC穿刺。并发症发生率为5.7%。总体pcr阳性率为24.2%(97/401)，巨细胞病毒阳性率最高(56/386；14.5%)。在多变量分析中，局部皮质类固醇增加了病毒病原体pcr阳性的几率（P = .01- 0.02）。高AC细胞水平也与HSV/VZV pcr阳性几率增加相关（P = .01）。结论本研究结果证明了AC穿刺的安全性和诊断价值。这一程序促进了近25%的病例中葡萄膜炎感染性原因的诊断。

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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.

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来源期刊

American Journal of Ophthalmology 医学-眼科学

CiteScore

9.20

自引率

7.10%

发文量

406

审稿时长

36 days

期刊介绍： The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.