Purpose

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

Results

45 patients presented IPICS. Majority of these were African American (86.7%) or female (77.3%). Antinuclear antibodies (ANA) were present in 69.9% of patients. Main complications were steroid dependency (84.4%), glaucoma (53.5%), and macular edema (37.5%). The proposed treatment strategy achieved remission in 93.8% of the population with a mean of 6.1 months via tapering of topical steroids in 46.9% of patients. However, in 53.1% of cases, adjuvant anti-inflammatory systemic medication was indicated. Meloxicam use was associated with remission in 64.7% of these patients and in a minority with persistent iritis, treatment was escalated to Methotrexate which was successful in 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 a high rate 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

中文翻译：

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白内障手术后特发性持续性虹膜炎的诊断和治疗（IPICS）

目的

描述白内障手术后特发性持续性虹膜炎患者的诊断和治疗（IPICS）

设计

回顾性介入病例系列。

方法

对诊断为 IPICS 的患者进行人口统计、临床特征和免疫血液标志物的评估。对随访超过 6 个月的患者进行评估，以达到缓解（3 个月内没有炎症）的治疗效果，无论是局部类固醇缓慢减量还是需要全身免疫抑制。

结果

45 名患者出现 IPICS。其中大多数是非裔美国人（86.7%）或女性（77.3%）。69.9% 的患者存在抗核抗体 (ANA)。主要并发症是类固醇依赖（84.4%）、青光眼（53.5%）和黄斑水肿（37.5%）。提议的治疗策略通过在 46.9% 的患者中逐渐减少局部类固醇，在 93.8% 的人群中实现了缓解，平均为 6.1 个月。然而，在 53.1% 的病例中，需要辅助抗炎全身用药。使用美洛昔康与 64.7% 的这些患者的缓解有关，在少数患有持续性虹膜炎的患者中，治疗升级为甲氨蝶呤，这在 100% 的病例中是成功的。

结论

IPICS 是一种独特的临床前葡萄膜炎，最常见于非裔美国人和女性患者，其特征是白内障手术后虹膜炎的意外发作以及类固醇依赖、青光眼和黄斑水肿的高发生率。最好用最初缓慢逐渐减量的局部类固醇治疗；尽管可能需要辅助全身抗炎治疗以获得缓解和避免并发症