Etiology and treatment outcomes of persistent postoperative inflammation in primary resident-performed cataract surgeries at a large tertiary care public hospital.

ABSTRACT

PURPOSE: To determine the risk factors, intraoperative and postoperative complications, therapeutic interventions, and visual outcomes for persistent postoperative inflammation in primary resident-performed cataract surgeries. SETTING: Ben Taub General Hospital, Houston, Texas, USA. DESIGN: Retrospective case series. METHODS: Primary resident-performed cataract surgeries from January 2012 to June 2015 were analyzed for persistent postoperative inflammation, defined as persistent anterior chamber inflammatory reaction after a standard 1-month topical corticosteroid and nonsteroidal antiinflammatory drug (NSAID) drops taper. Preoperative characteristics, operative complications, therapeutic modalities, and duration of therapy were analyzed. The primary outcome measures were duration of corticosteroid and NSAID therapy, treatment modalities, and postoperative visual outcomes at the 1-month postoperative visit. RESULTS: The study assessed 1290 primary resident-performed cataract surgeries. Persistent postoperative inflammation occurred in 82 eyes (6.6%). The presumed etiology was classified as idiopathic persistent postoperative inflammation, nonadherence to topical therapy, and complicated cataract surgery. Patients with persistent postoperative inflammation were more likely of African American descent, had hypertension, or used aspirin, anticoagulants, or prostaglandins (P = .019, P = .027, P = .028, P = .020, respectively). The complicated cataract subgroup required a longer duration of therapy (P = .021) and was the only subgroup to require injections or systemic corticosteroids. There was no significant difference in postoperative corrected distance visual acuity (CDVA) when comparing patients with persistent postoperative inflammation with those without inflammation or between the subgroups. CONCLUSIONS: The idiopathic and nonadherent subgroups were successfully treated with topical antiinflammatory therapy; the complicated subgroup required longer duration and multiple modalities of treatment. Visual outcomes were comparable to the general cataract population with no differences in postoperative CDVA.