In this study, 84.4% of patients with iritis that developed post-cataract surgery had steroid dependency. Photo: Paul M. Karpecki, OD.
In this study, 84.4% of patients with iritis that developed post-cataract surgery had steroid dependency. Photo: Paul M. Karpecki, OD. Click image to enlarge.

Idiopathic persistent iritis after cataract surgery is a distinct clinical anterior uveitis most common in African American and female patients. It is characterized by an unexpected onset of iritis after cataract surgery and a high rate of steroid dependency, glaucoma and macular edema. Recent research suggests it is best treated with an initial slow taper of topical steroids, although adjuvant systemic anti-inflammatory therapy may be necessary for remission and complication avoidance.

This retrospective interventional case series included 45 idiopathic persistent iritis after cataract surgery patients (86.7% African American, 77.3% female) who were evaluated for demographics, clinical characteristics and immune blood markers. Those with more than six months of follow-up were evaluated for treatment efficacy in achieving remission (absence of inflammation for three months), with either exclusive slow tapering of topical steroids or systemic immunosuppression.

Antinuclear antibodies were present in 69.9% of patients. The 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 the minority with persistent iritis, treatment was escalated to methotrexate, which was successful in 100% of the cases.

The authors recommend “a strict systematic treatment with an algorithm which begins with a slow tapering of steroids over two months, and if iritis flares, systemic medication should be introduced escalating from meloxicam to methotrexate.”

Soifer M, Mousa HM, Jammal AA, et al. Diagnosis and management of idiopathic persistent iritis after cataract surgery (IPICS). Am J Ophthalmol. October 12, 2021. [Epub ahead of print].