Foster Center for Ocular Immunology, Duke Eye Institute, Durham, North Carolina, USA (M.S., H.M.M., C.S., V.L.P.); and Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, USA (M.S., H.M.M., A.A.J., C.S., V.L.P.).
and Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, USA (M.S., H.M.M., A.A.J., C.S., V.L.P.).
Am J Ophthalmol. 2022 Feb;234:250-258. doi: 10.1016/j.ajo.2021.10.004. Epub 2021 Oct 12.
To investigate the diagnosis and management of patients with idiopathic persistent iritis after cataract surgery (IPICS).
Retrospective interventional case series.
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.
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.
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.
探讨白内障术后特发性持续性虹膜炎（IPICS）患者的诊断和治疗方法。
回顾性干预性病例系列研究。
评估诊断为 IPICS 的患者的人口统计学和临床特征以及免疫血液标志物。对随访时间超过 6 个月的患者进行评估，以确定治疗效果是否达到缓解（即 3 个月内无炎症），治疗方法为局部类固醇的缓慢逐渐减量或需要全身免疫抑制。
45 例患者出现 IPICS。大多数为非裔美国人（39 例，86.7%）或女性（33 例，77.3%）。23 例（69.9%）患者存在抗核抗体。主要并发症为类固醇依赖（38 例，84.4%）、青光眼（24 例，53.5%）和黄斑水肿（11 例，37.5%）。32 例患者有治疗随访。在这些患者中，通过局部类固醇逐渐减量，15 例（46.9%）患者在平均 6.1 个月内达到缓解，17 例（53.1%）患者需要辅助抗炎全身药物治疗。在这些患者中，使用美洛昔康与缓解相关的有 11 例（64.7%），在少数持续性虹膜炎患者中，治疗升级为甲氨蝶呤，其中 4 例（100%）成功。
IPICS 是一种独特的前葡萄膜炎，最常见于非裔美国人和女性患者，其特征为白内障手术后虹膜炎意外发作，类固醇依赖、青光眼和黄斑水肿发生率高。初始缓慢减少局部类固醇的使用是最佳治疗方法；尽管需要辅助全身抗炎治疗才能缓解并避免并发症。
