Diagnosis and Management of Idiopathic Persistent Iritis After Cataract Surgery (IPICS): Idiopathic Persistent Iritis After Cataract Surgery.

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.