Using Electronic Health Record Data to Determine the Safety of Aqueous Humor Liquid Biopsies for Molecular Analyses.
Wolf Julian, Chemudupati Teja, Kumar Aarushi, Franco Joel A, Montague Artis A, Lin Charles C, Lee Wen-Shin, Fisher A Caroline, Goldberg Jeffrey L, Mruthyunjaya Prithvi
AI Summary
This study found aqueous humor liquid biopsies during eye surgery are very safe, with only one minor complication in 1418 cases, supporting their use for large-scale molecular analysis.
Abstract
Purpose
Knowing the surgical safety of anterior chamber liquid biopsies will support the increased use of proteomics and other molecular analyses to better understand disease mechanisms and therapeutic responses in patients and clinical trials. Manual review of operative notes from different surgeons and procedures in electronic health records (EHRs) is cumbersome, but free-text software tools could facilitate efficient searches.
Design
Retrospective case series.
Participants
A total of 1418 aqueous humor liquid biopsies from patients undergoing intraocular surgery.
Methods
Free-text EHR searches were performed using the Stanford Research Repository cohort discovery tool to identify complications associated with anterior chamber paracentesis and subsequent endophthalmitis. Complications of the surgery unrelated to the biopsy were not reviewed.
Main outcome measures
Biopsy-associated intraoperative complications and endophthalmitis.
Results
A total of 1418 aqueous humor liquid biopsies were performed by 17 experienced surgeons. EHR free-text searches were 100% error-free for surgical complications, >99% for endophthalmitis (<1% false positive), and >93.6% for anesthesia type, requiring manual review for only a limited number of cases. More than 85% of cases were performed under local anesthesia without ocular muscle akinesia. Although the most common indication was cataract (50.1%), other diagnoses included glaucoma, diabetic retinopathy, uveitis, age-related macular degeneration, endophthalmitis, retinitis pigmentosa, and uveal melanoma. A 50- to 100-μL sample was collected in all cases using either a 30-gauge needle or a blunt cannula via a paracentesis. The median follow-up was >7 months. There was only one minor complication (0.07%) identified: a case of a small tear in Descemet membrane without long-term sequelae. No other complications occurred, including other corneal injuries, lens or iris trauma, hyphema, or suprachoroidal hemorrhage. There was no case of postoperative endophthalmitis.
Conclusions
Anterior chamber liquid biopsy during intraocular surgery is a safe procedure and may be considered for large-scale collection of aqueous humor samples for molecular analyses. Free-text EHR searches are an efficient approach to reviewing intraoperative procedures.
Financial disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Shields Classification
Key Concepts5
Anterior chamber liquid biopsy during intraocular surgery is a safe procedure and may be considered for large-scale collection of aqueous humor samples for molecular analyses.
A total of 1418 aqueous humor liquid biopsies were performed by 17 experienced surgeons, with only one minor complication (0.07%) identified, which was a small tear in Descemet membrane without long-term sequelae.
No cases of postoperative endophthalmitis occurred following 1418 aqueous humor liquid biopsies performed during intraocular surgery.
Free-text Electronic Health Record (EHR) searches demonstrated 100% error-free detection for surgical complications, >99% for endophthalmitis (<1% false positive), and >93.6% for anesthesia type when identifying complications associated with anterior chamber paracentesis.
More than 85% of 1418 aqueous humor liquid biopsies were performed under local anesthesia without ocular muscle akinesia.
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