To ac tap or not to ac tap: Multi-centre outcomes of patients receiving anti-VEGF injections

PurposeTo compare intraocular pressure (IOP) and retinal nerve fibre layer (RNFL) thickness in patients receiving intravitreal anti-vascular endothelial growth factor (VEGF) injections with and without anterior chamber paracentesis (ACP).MethodsThis multicentre retrospective cohort study included 269 injection-naïve eyes from 210 patients with neovascular age-related macular degeneration (AMD) or diabetic macular oedema (DME). A matched subset of 140 eyes (70 with ACP, 70 without) was selected based on age, sex, diagnosis, laterality, and number of injections. RNFL thickness (overall and by quadrant) was measured at baseline and one-year follow-up. Additional outcomes included IOP, visual acuity (VA), and central retinal thickness (CRT).ResultsThe matched cohort had a mean age of 71.06 ± 11.44 years, with 61.4% female participants. ACP eyes had worse baseline VA, higher IOP, and thicker CRT (p < 0.050, for all), but showed greater VA improvement (p = 0.023) and a trend towards greater CRT reduction (p = 0.061). RNFL thinning over one year did not differ between the groups (-3.24 ± 11.82 µm vs -2.95 ± 7.81 µm, p = 0.883). No major complications were observed.ConclusionACP did not significantly reduce RNFL thinning over one year but was well tolerated. It may be considered in patients at higher risk from transient IOP elevations. Future prospective studies are warranted to clarify its role in specific patient subgroups.