Anterior chamber paracentesis after central retinal artery occlusion: a tenable therapy?

Abstract

Background: The goal of this study was to investigate the visual outcome of acute central retinal artery occlusion (CRAO) after current standard therapy with and without paracentesis. In addition, we investigated whether there was a dependence of the resulting visual acuity on the time between first symptoms and implementation of paracentesis. Finally, we analysed risk factors for CRAO.

Methods: We performed a retrospective analysis of data from patients with CRAO who received standard in-patient therapy with and without paracentesis at the Dr. Horst Schmidt Clinics in Wiesbaden, Germany between 2000 and 2012. The primary endpoint was the change of visual acuity 3 days after the initiation of intervention.

Results: Data from 74 patients with CRAO were included in the study. Fifteen patients were treated conservatively and 59 patients received additional paracentesis. Clinically significant improvement of BCVA (logMAR ≥ 0.3) after 3 days was observed in 26.7% of patients without paracentesis, 36.4% of patients with paracentesis within 6 hours, 20% of patients with paracentesis within 7-24 hours, and 23.1% of patients with paracentesis more than 24 hours after the onset of symptoms. There was no significant difference in the outcome between patients with (BCVA 1.9 ± 0.31) and without paracentesis (BCVA 1.75 ± 0.32) (p = 0.9), nor among the groups with paracentesis (p = 0.8). One patient suffered a lens injury due to the paracentesis, with subsequent need for cataract surgery.

Conclusions: There was no added gain in visual acuity by performing a paracentesis, independent of the time elapsed between first symptoms and the implementation of paracentesis. In the absence of any tangible effectiveness of paracentesis and the inherent risks of paracentesis such as intraocular infection and injury, paracentesis does not appear to be warranted as a treatment of CRAO.

Figure 1

Typical central retinal artery occlusion with cherry-red spot, retinal oedema and narrowing of the vessels.

Figure 2

Average change in visual acuity from time of hospital admission to three days after initiation of treatment for CRAO. The p-value of 0.9 indicates no significant difference with respect to vision improvement between patients treated with or without additional paracentesis.

Figure 3

Change in visual acuity for patients from time of hospital admission to three days after initiation of CRAO treatment as a function of the time elapsed between first symptoms and the initiation of therapy. No detectable functional dependence existed between these two parameters for the group of patients with conservative treatment (p = 0.8) and in the group treated with paracentesis (p = 0.4).