Anterior Chamber Paracentesis

Indications
  • Ghost-cell glaucoma:
  • Are the cells in the anterior chamber ghost erythrocytes?



    Ghost erythrocytes from an anterior chamber paracentesis specimen.

 

  • Phacolytic glaucoma:

    Are the cells in the anteior chamber macrophages that have engulfed high molecular-weight lens protein?




    Macrophges from an anterior chamber paracentesis. The macrophages are filled with granular material from a patient with a hypermature cataract and phacolytic glaucoma.

  • Epithelial downgrowth:

    After anterior segment surgery, the intraocular pressure may be high or the surgeon may observe a persistent, chronic anterior chamber "cell and flare". If the cells in the aqueous appear to be large, suspect epithelial downgrowth and consider a diagnostic anterior chamber paracentesis.




    Squamous epithelial cell from an anterior chamber paracentesis. The ophthalmologist noticed "very large cells" as part of a persistent anterior chamber cell and flare. The "very large cells" were squamous epithelial cells as illustrated here and the patient had epithelial downgrowth.

  • Suspected neoplasm:

    A mass in the iris or ciliary body may shed cells into the aqueous which may be captured and identified after anterior chamber paracentesis.

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Preparation by Ophthalmologist
  • It may be helpful to hand the syringe directly to a pathology or cytology technician.
  • If a technician is not available, or if the aspiration is being performed in a private office setting or surgical center, one may follow these instructions:
    • Before proceeding with the anterior chamber paracentesis, have a suitable fixative on hand (Saccomanno fluid works well or one may use 95% ethanol) and a small vial with a cap that can be screwed on tightly.
    • The paracentesis procedure itself usually yields only 0.15 ml (the total volume of the anterior chamber is only about 0.3 ml). After removing the syringe from the eye, aspirate an amount of fixative equal to that in the syringe and flush the contents of the syringe through the needle used for aspiration into the collection vial.

  • Be sure the cap on the vial forms a tight seal before sending the specimen for processing and interpretation.

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Preparation by Ophthalmic Histotechnologist/Cytotechnologist
  • Specimens may be processed by a cytospin preparation. Slides may be stained with the Papanicolaou stain or even with hematoxylin-eosin.

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More Questions?

If you have more questions about anterior chamber paracentesis specimens, please contact one of us:

Ophthalmic Pathologists

Robert Folberg, MD, FCAP, Director

Deepak P. Edward, MD

Consultation Coordinator

Marnie Pomeroy

 

 

 

 

 

 


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