Persistent anterior uveitis after cataract surgery doesn’t necessarily lead to poor vision

This retrospective cohort study aimed to identify risk factors for persistent anterior uveitis after cataract surgery.

Study design

In this single-center study, researchers used medical records to identify patients who underwent standard phacoemulsification and cataract extraction with lens implantation during a 24-month period. Patients with a history of autoimmune disease or complex surgery were excluded. Of the 3,013 eyes reviewed, 61 eyes (48 patients) developed persistent anterior uveitis. Age, sex, surgery length, cumulative dissipated energy (CDE), final VA, final IOP, presence of macular edema and race were explored as risk factors for prolonged anterior uveitis.

Outcomes

Persistent anterior uveitis following cataract surgery was not associated with worse visual outcomes, though patients frequently required a prolonged course of steroids. African American patients may have a greater risk to develop PAU compared with Caucasians (relative risk 11.3). However, risk of persistent inflammation did not correlate with CDE, age, sex or length of surgery. Approximately 30% of study eyes also developed cystoid macular edema.

Limitations

This is a study from a single center that only reviewed uncomplicated cataract surgery cases, so the findings may not apply to all patients. Individual risk factors for uveitis and infection should be considered in every patient with postoperative inflammation.

Clinical significance

This study suggests that patients who undergo routine cataract surgery but have prolonged inflammation will tend to have good outcomes. The pathophysiology, however, is not completely understood. The study also suggests that there are no intraoperative surgical risk factors (operating time, CDE) associated with prolonged inflammation. In terms of clinical practice, patients may need support with local steroids and OCT imaging to manage macular edema.