Diagnosis and Management of Idiopathic Persistent Iritis after Cataract Surgery (IPICS).
Diagnosis and Management of Idiopathic Persistent Iritis after Cataract Surgery (IPICS).
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白内障手术后特发性持续性虹膜炎的诊断和治疗（IPICS）。
DOI：
10.1016/j.ajo.2021.10.004
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发表时间：
2022
影响因子：
4.2
通讯作者：
Perez,VictorL
中科院分区：
文献类型：
--
作者：
Soifer,Matias;Mousa,HazemM;Jammal,AlessandroA;Savarain,Christian;Perez,VictorL
目的探讨白内障术后特发性持续性虹膜炎(IPICS)的诊断和治疗。设计回顾性干预病例系列。方法对诊断为IPICS的患者进行人口学、临床特征和免疫血液标志物评估。对那些随访超过6个月的患者进行疗效评估，以达到缓解(即3个月内没有炎症)的治疗效果，要么完全缓慢地减少局部类固醇治疗，要么需要全身免疫抑制。大多数是非裔美国人(3986.7%)或女性(33.77.3%)。抗核抗体阳性23例(69.9%)。主要并发症为激素依赖(38，84.4%)、青光眼(24，53.5%)和黄斑水肿(11，37.5%)。32例患者进行了治疗和随访。在这些方面，拟议的治疗策略通过15例(46.9%)患者(46.9%)的局部类固醇的逐渐减少，在平均6.1个月内实现了30例(93.8%)的病例缓解。但在17例(53.1%)的病例中，辅助性抗炎全身用药。在这些患者中，美洛昔康的使用与缓解有关(64.7%)，在少数持续性虹膜炎患者中，治疗升级为甲氨蝶呤，4例(100%)成功。结论IPICS是一种独特的临床前葡萄膜炎，最常见于非裔美国人和女性患者，其特征是白内障手术后意外发生虹膜炎，类固醇依赖、青光眼和黄斑水肿的发生率较高。虽然辅助全身抗炎治疗可能是获得缓解和避免并发症所必需的，但最好的治疗方法是最初缓慢减少局部类固醇。
PurposeTo investigate the diagnosis and management of patients with idiopathic persistent iritis after cataract surgery (IPICS).DesignRetrospective interventional case series.MethodsPatients 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.ResultsForty-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.ConclusionsIPICS 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.