Incidence and Risk Factors for Chronic Uveitis following Cataract Surgery

Persistent Anterior Uveitis Following Cataract Surgery

PURPOSE

To determine the incidence of and risk factors for persistent anterior uveitis following cataract surgery.

METHODS

This was a retrospective cohort study of patients who underwent cataract surgery at a tertiary referral center in Connecticut, USA. Those with prior uveitis, complex ocular pathology, concurrent procedures, and surgical complications were excluded. The outcome was development of persistent anterior uveitis, defined as anterior chamber cell grade ≥ 0.5+ and steroid treatment beyond two months. Patients who did and did not develop persistent anterior uveitis were compared using univariate and multivariate analysis.

RESULTS

Of 3341 patients (5419 eyes), 45 (61) developed persistent anterior uveitis (1.1% incidence). Cases were significantly younger (64.6 years vs. 69.6 years, p < 0.001), and there were significantly higher proportions of female (73.8% compared to 58.5%, p = 0.016) and Black or African American (54.1% vs. 15.5%, p < 0.001) patients, as well as those with age-related macular degeneration (9.8% vs. 1.5%, p < 0.001), previous intravitreal injections (14.8% vs. 6.0%, p = 0.004), and diabetes (18.0% vs. 8.9%, p = 0.013). In multivariate analysis, older age was associated with a significantly lower likelihood of persistent anterior uveitis (adjusted odds ratio (AOR) = 0.963, 95% confidence interval (CI)=[0.942, 0.984]), whereas Black race (AOR = 9.102, 95% CI = [4.836, 17.133]) and wet age-related macular degeneration (AOR = 37.700, 95% CI = [6.408, 221.792]) were associated with a significantly higher likelihood.

CONCLUSIONS

In this study, 1.1% of eyes developed persistent anterior uveitis following cataract surgery. Younger age, Black race, and wet age-related macular degeneration should be investigated as potential risk factors to improve its prophylaxis, identification, and management.

Etiology of Anterior Uveitis in a Finnish Single-Center Register Study - Differences in Clinical Characteristics, Treatment Outcomes, and Ocular Complications

PURPOSE

To evaluate clinical characteristics, treatment outcomes, and complications in anterior uveitis (AU) with idiopathic, systemic disease-associated, infectious, postoperative, and posttraumatic etiology.

METHODS

Long-term analysis of a single-center register study from adults with AU in 2009. Etiology, age at onset, sex distribution, course of uveitis, visual outcomes, treatments, and ocular complications were studied during 1998-2018.

RESULTS

A total of 413 patients with AU were included. A total of 195 patients (47%) had idiopathic, 150 (36%) systemic disease-associated, 25 (6%) infectious, 26 (6%) postoperative, and 17 (4%) traumatic AU. Average onset age varied from 38 ± 13 (95% CI, 36.2-40.5) in systemic disease-associated to 59 ± 19 (95% CI, 51.5-66.5) in postoperative AU (p < 0.001). Sex distribution varied between 62% females in postoperative and 29% females in traumatic uveitis. Traumatic AU was predominantly acute (59%), and infectious AU recurrent (44%) or chronic (40%). Idiopathic (58%), systemic disease-associated (65%), and postoperative AU (62%) were commonly chronic (p = 0.036). After the active follow-up, traumatic patients gained +2 ETDRS letters, while vision remained stable in idiopathic (-0.5 letters) and systemic disease-associated (+0.8 letters) AU. Patients with infectious and postoperative AU lost -2 and -10 letters, respectively. Highest frequency of complications occurred in traumatic (50%) and the lowest in postoperative AU (35%). Three patients with idiopathic and two with postoperative AU were blind after the follow-up.

CONCLUSION

The study underscores significant differences in the onset age, course of uveitis, vision, intraocular pressure, flare, and treatment modalities among the etiological subgroups of AU. However, no substantial differences were observed concerning complications or visual outcomes.

Diagnosis and Management of Idiopathic Persistent Iritis after Cataract Surgery (IPICS)

PURPOSE

To investigate the diagnosis and management of patients with idiopathic persistent iritis after cataract surgery (IPICS).

DESIGN

Retrospective interventional case series.

METHODS

Patients diagnosed with IPICS were evaluated for demographic and clinical characteristics and immune blood markers. Those with more than 6 months of follow-up were evaluated for treatment efficacy to achieve remission (ie, absence of inflammation for 3 months), with either exclusive slow tapering of topical steroids or the need for systemic immunosuppression.

RESULTS

Forty-five patients presented with IPICS. Most were African American (39, 86.7%) or female (33, 77.3%). Antinuclear antibodies were present in 23 (69.9%) of patients. Main complications were steroid dependency (38,84.4%), glaucoma (24,53.5%), and macular edema (11,37.5%). Thirty two patients presented treatment follow up. On these,the proposed treatment strategy achieved remission in 30 (93.8%) of cases in a mean of 6.1 months via tapering of topical steroids in 15 (46.9%) of patients. However, in 17 (53.1%) of cases, adjuvant anti-inflammatory systemic medication was indicated. Meloxicam use was associated with remission in 11 (64.7%) of these patients and, in a minority with persistent iritis, treatment was escalated to methotrexate, which was successful in 4 (100%) of the cases.

CONCLUSIONS

IPICS is a distinct clinical anterior uveitis most common in African American and female patients, characterized by an unexpected onset of iritis after cataract surgery and high rates of steroid dependency, glaucoma, and macular edema. It is best treated with an initial slow taper of topical steroids; although adjuvant systemic anti-inflammatory therapy may be necessary to obtain remission and avoid complications.

Risk factors associated with post-operative uveitis after cataract surgery: a retrospective case-control study

BACKGROUND/AIM

Post-operative uveitis is the most common complication after cataract surgery in the UK. The study aims to evaluate the risk of post-operative uveitis in cataract surgery patients of different ethnicity in the presence and absence of co-morbidities as well as operative complications using multivariate analysis.

METHODS

A retrospective case-control study of patients undergoing phacoemulsification cataract surgery between January 2018 to December 2019 at two hospital sites. Differences in demographic and clinical characteristics were compared between two groups defined by the development of post-operative uveitis. Statistically significant factors in univariate analysis were further analysed using multivariate analysis to account for confounders.

RESULTS

One thousand and five hundred eighty seven eyes had undergone phacoemulsification cataract operations with 104 (6.6%) developing post-operative uveitis. Compared to eyes of White/Mixed/Other ethnicity, Asian and Afro-Caribbean eyes were associated with a twofold (OR 2.02, 95% CI 1.16-3.52, P = 0.013) and fivefold (OR 5.15, 95% CI 2.85-9.29, P < 0.001) risk of post-operative uveitis, respectively. Complicated surgery involving eyes with small pupil/iris hooks/Malyugin ring (OR 2.70, 95% CI 1.16-6.30, P = 0.022) and posterior capsular rupture (OR 6.00, 95% CI 2.55-14.12, P < 0.001) were associated with an increased risk of post-operative uveitis.

CONCLUSIONS

The factors significantly associated with a post-operative uveitis outcome were patients of Asian and Afro-Caribbean ethnicity, small intra-operative pupil size, use of iris hooks or Malyugin ring and PCR. The post-operative management plan should be tailored in these group of patients with a view of early assessment and prompt management of symptoms.

Evaluation of the etiology of persistent iritis after cataract surgery

Background

The purpose of this study was to evaluate patients with persistent iritis after cataract surgery to determine its incidence and risk factors. Adjusting the management of patients at risk could allow for a more predictable post-operative course and outcome. A retrospective chart review was performed of patients who had post-operative iritis longer than 1 month after cataract surgery during a 2-year period at Storm Eye Institute at the Medical University of South Carolina (MUSC) in Charleston, South Carolina. Patient demographics and various pre-operative, intra-operative, and post-operative factors were analyzed for trends.

Results

Thirty-nine patients (49 eyes) met the inclusion criteria, and this group was compared to a control cohort of 40 patients (66 eyes) who did not have persistent iritis after cataract surgery. The overall incidence of post-operative iritis was 1.75%. In all patients with post-operative iritis lasting greater than 1 month, African American race and pupil expansion device use were statistically significant factors. After excluding patients with a history of ocular inflammation or known inflammatory or autoimmune diagnosis (1.20% incidence), there were still a significantly higher proportion of African Americans compared to the control group. When patients with post-operative iritis of less than 6 months in duration were additionally excluded, the incidence was 0.32%, and history of diabetes was statistically significant in addition to race.

Conclusions

Risk factors for persistent iritis after cataract surgery include being diabetic, of African American racial background, and pupil expansion device use. These patients can be better informed of the higher risk of prolonged inflammation in their post-operative course, and peri-operative management can be tailored accordingly.

Case report of secondary pigment dispersion glaucoma, recurrent uveitis and cystoid macular oedema following inadvertent implantation of an intraocular lens into the ciliary sulcus following cataract surgery

Background

This case highlights the important sequelae that can occur following the inadvertent implantation of a single-piece intraocular lens into the ciliary sulcus during cataract surgery; secondary pigment dispersion glaucoma, recurrent anterior uveitis and macular oedema.

Case presentation

A 67-year-old lady underwent routine left cataract surgery in a separate unit but subsequently attended our eye casualty with recurrent hypertensive anterior uveitis. She was found to have secondary pigment dispersion glaucoma as the intraocular lens had been inadvertently placed into the ciliary sulcus. She underwent a trabeculectomy to control the intraocular pressure and initially settled well but 12 months later developed persistent anterior segment inflammation and macular oedema. She subsequently had the intraocular lens removed and the macular oedema was treated successfully with intravitreal Bevacizumab.

Conclusions

We provide a summary of the evidence and a discussion over the management options available in managing such a difficult case.

Etiology and treatment outcomes of persistent postoperative inflammation in primary resident-performed cataract surgeries at a large tertiary care public hospital

PURPOSE

To determine the risk factors, intraoperative and postoperative complications, therapeutic interventions, and visual outcomes for persistent postoperative inflammation in primary resident-performed cataract surgeries.

SETTING

Ben Taub General Hospital, Houston, Texas, USA.

DESIGN

Retrospective case series.

METHODS

Primary resident-performed cataract surgeries from January 2012 to June 2015 were analyzed for persistent postoperative inflammation, defined as persistent anterior chamber inflammatory reaction after a standard 1-month topical corticosteroid and nonsteroidal antiinflammatory drug (NSAID) drops taper. Preoperative characteristics, operative complications, therapeutic modalities, and duration of therapy were analyzed. The primary outcome measures were duration of corticosteroid and NSAID therapy, treatment modalities, and postoperative visual outcomes at the 1-month postoperative visit.

RESULTS

The study assessed 1290 primary resident-performed cataract surgeries. Persistent postoperative inflammation occurred in 82 eyes (6.6%). The presumed etiology was classified as idiopathic persistent postoperative inflammation, nonadherence to topical therapy, and complicated cataract surgery. Patients with persistent postoperative inflammation were more likely of African American descent, had hypertension, or used aspirin, anticoagulants, or prostaglandins (P = .019, P = .027, P = .028, P = .020, respectively). The complicated cataract subgroup required a longer duration of therapy (P = .021) and was the only subgroup to require injections or systemic corticosteroids. There was no significant difference in postoperative corrected distance visual acuity (CDVA) when comparing patients with persistent postoperative inflammation with those without inflammation or between the subgroups.

CONCLUSIONS

The idiopathic and nonadherent subgroups were successfully treated with topical antiinflammatory therapy; the complicated subgroup required longer duration and multiple modalities of treatment. Visual outcomes were comparable to the general cataract population with no differences in postoperative CDVA.

Follow-Up Study of Over Three Years of Patients with Uveitis after Cataract Phacoemulsification: Outcomes and Complications

PURPOSE

To evaluate the rate and onset of intraoperative and postoperative complications post-phacoemulsification.

METHODS

One hundred sixty-two eyes of 145 patients with uveitis who underwent phacoemulsification between 2006 and 2009 were identified through surgical record review. Fifty-nine eyes of 46 patients met the inclusion criteria. Hazard ratio (HR) and Kaplan-Meier survival probability were calculated for each class of uveitis.

RESULTS

Macular edema (ME) resulted to be associated to chronic postoperative inflammation (r = 0.6; p = 0.00) and mostly related to patients who presented more than one postoperative relapse/year (r = 0.2; p = 0.02). Fuchs uveitis resulted to be a risk factor for posterior capsule opacification (PCO) (HR 3.36 IC95%1.0-10.5; p = 0.03). Hypotony and elevated intraocular pressure (IOP) were detected in the anterior uveitis group (0.02 EY).

CONCLUSION

The HR to develop ME was significantly related to chronic anterior uveitis. PCO and elevated IOP are most frequent in Fuchs uveitis. The postoperative visual acuity result was good among all the uveitis groups.