Serial paracenteses in the management of acute elevations of intraocular pressure

Abstract

Objective To study the effectiveness of serial paracenteses in eyes with symptomatic elevated intraocular pressure (IOP). Design Retrospective, noncomparative, interventional case series. Participants Five eyes of four patients with acute elevations in IOP. Methods A 5-year review of records was performed in one practice (LP) to identify patients who underwent more than one paracentesis for control of symptomatic increases in IOP when greater than 30 mmHg. Five eyes of four patients were identified, and charts were analyzed for cause and duration of elevated pressure, control of symptoms associated with elevated pressure, number of paracenteses, and visual outcome. All patients received topical anesthetic (proparacaine 0.5%) before paracentesis, and topical ciprofloxacin, 0.35%, or tobramycin, 0.3%, before and after paracentesis, which was performed at the temporal limbus with a 0.75-mm sterile surgical blade. Results Paracentesis provided almost immediate symptomatic relief in all cases. The procedure could be repeated easily whenever symptoms recurred. The average number of paracenteses performed was three. No complications of paracentesis were noted. Visual outcomes were variable and dependent on the etiology of elevated IOP. Two eyes with neovascular glaucoma had poor visual outcomes. None of the other three eyes lost vision because of increased IOP. Conclusions Acute symptomatic elevations of IOP in patients with a deep anterior chamber can be effectively treated with paracentesis. In selected cases, serial paracenteses may obviate the need for filtration surgery. If filtration surgery is required, serial paracenteses may allow it to be scheduled electively rather than emergently.