Persistent Anterior Uveitis After Cataract Surgery in a Global Majority Population in North West London

Persistent anterior uveitis (PAU) following cataract phacoemulsification is a rare but clinically significant complication. This study evaluated PAU persisting beyond 12 months in an ethnically diverse (Global Majority) population in North West London, focusing on systemic associations and disparities in care.

Retrospective observational case series.

Sixteen patients (20 eyes) with PAU ≥12 months after uncomplicated phacoemulsification with intraocular lens implantation (2018-2022) were included. Inclusion criteria were no prior uveitis, minimum 12-month follow-up, and slit-lamp evidence of anterior chamber inflammation >0.5+ cells and flare (SUN criteria).

At 4 weeks postoperatively, patients underwent assessment of visual acuity, intraocular pressure, autorefraction, macular OCT, and anterior/posterior segment examination. Dexamethasone drops were tapered according to inflammation. Records were reviewed for demographics, comorbidities, intraoperative factors, postoperative complications, and systemic screening (treponemal serology, QuantiFERON Gold, serum ACE). Multidisciplinary referrals were made when systemic disease was suspected.

Incidence of PAU lasting ≥12 months and detection of underlying inflammatory or infectious disease.

PAU occurred in 20 eyes of 16 patients; 69% of patients were female. Median age was 72 years (range 57-87). Ten patients (63%) were African-Caribbean, five (31%) South Asian, and one (6%) White. Bilateral PAU occurred in four patients (25%), and cystoid macular oedema (CMO) in seven patients (35%). Systemic screening identified treponemal antibodies in three patients (19%), positive QuantiFERON Gold in four patients(25%), and elevated serum ACE in six patients (38%). Multidisciplinary referrals were made for all positive cases.

PAU after uncomplicated cataract surgery disproportionately affects Global Majority patients, with undiagnosed systemic inflammatory or infectious disease contributing. Structured systemic screening and multidisciplinary management are essential. Further research is needed on immunopathogenesis, long-term outcomes, and optimal care models in diverse populations.