Persistent anterior uveitis after cataract surgery in a global majority population in North West London

Title : Persistent anterior uveitis after cataract surgery in a global majority population in North West London

Abstract:

Objective: Persistent anterior uveitis (PAU) following uncomplicated cataract phacoemulsification surgery is a rare but clinically significant complication. This retrospective observational study evaluates PAU persisting beyond 12 months in an ethnically diverse (Global Majority) population in North West London, identifying systemic associations and highlighting disparities in care and research.

Methods: We retrospectively reviewed records from 2018 to 2022 for patients with PAU of equal to or greater than 12 months duration after uncomplicated phacoemulsification with lens implant. Data on demographics, ocular and systemic comorbidities, intraoperative factors (pupil size), post-operative complications and systemic screening were analysed. Inclusion criteria were no prior uveitis, minimum 12-month follow-up, and slit-lamp evidence of anterior chamber inflammation >0.5+ cells and flare. (Standardization of Uveitis Nomenclature criteria).

Results: Sixteen patients (20 eyes) were identified. 69% of patients were female; median age was 72 years (range 57–87). 88% of patients were of African-Caribbean or South Asian heritage. Bilateral PAU occurred in 25% of patients. Cystoid macular oedema occurred in 35% of patients. Systemic screening identified treponemal antibodies in three patients, positive QuantiFERON Gold titres in four patients and elevated serum ACE in six patients. A multidisciplinary referral pathway was initiated for appropriate systemic management.

Conclusion: PAU after cataract surgery disproportionately affects Global Majority patients. Inflammatory responses related to melanin and underlying undiagnosed systemic diseases (e.g. treponemal disease, tuberculosis, and sarcoidosis) likely contribute. Structured screening pathways and the MDT are essential. Further research is needed to understand the immunopathogenesis, long-term outcomes, and optimal care models for PAU in diverse populations.

Biography:

Dr Hinal Kumar is a Foundation Year 2 doctor based in the United Kingdom with clinical and academic experience in ophthalmology. She completed her medical degree at Imperial College London School of Medicine in 2024, graduating MBBS with Distinction, and holds a First Class intercalated BSc in Biomedical Engineering. Dr Kumar has contributed to ophthalmic service improvement through her work on several local NHS eye-health referral pathways and ophthalmology-focused audits. She partakes in regular laser and microsurgical simulation training and has been involved in teaching for members of the multidisciplinary team to enhance early recognition of eye conditions. Dr Kumar has a keen interest in ophthalmology research that delivers meaningful impact on patient care and outcomes.