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

Highlights

• This was an interventional case series of patients with novel onset of idiopathic persistent iritis after cataract surgery (IPICS).

• Most of the population were African American, female, and antinuclear antibody–positive.

• The first best treatment for remission is slowly tapering topical steroids for 2 months.

• If inflammation persists, systemic medication must be started.

• The first line of therapy is meloxicam, which can be escalated to methotrexate.

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.