Effects of Iris Pigmentation on Degree of Anterior Chamber Inflammation after Cataract Surgery using Automated Analysis by Spectral Domain Optical Coherence Tomography

Abstract

Purpose : Anterior Segment Optical Coherence Tomography (AS-OCT) has shown utility for imaging and quantifying anterior chamber (AC) inflammation after cataract surgery. The objective of this study was to elucidate the effects of iris pigmentation on the degree of AC inflammation after cataract surgery using AS-OCT.

Methods : This was an IRB-approved, observational, prospective case series of patients who underwent cataract surgery by one surgeon (RG) at the Cleveland Clinic Cole Eye Institute. Anterior chamber volume scans were obtained using AS-OCT (Avanti, Optovue Inc, Fremont, CA) at designated time points after cataract surgery including postoperative day 0 or 1 (POD0/1), postoperative week 1 (POW1), and postoperative month 1 (POM1). AS-OCT images were analyzed by an automated, proprietary algorithm, which identified inflammatory cells within the AC as previously described. Iris color was designated by the operating surgeon. Cell fluid density (number of inflammatory cells per mm3 of AC volume) was correlated to iris pigmentation.

Results : 155 eyes of 117 patients were analyzed. 40% of patients were female (n=47), and the average patient age was 69 years (range: 44-91 years). Distribution of iris color was 28% blue (n=43), 51% brown (n=79), 7% green (n=11), and 14% hazel (n=22). On automated analysis, no significant difference (p=0.16) was noted in average cell fluid density between blue (65.2 ± 102.9 cells/mm3) and brown (41.8 ± 48.8 cells/mm3) eyes at POD0/1. Average cell density of brown eyes (4.47 ± 8.87 cells/mm3) was significantly (p=0.04) greater than average cell density of blue eyes (2.11 ± 1.80 cells/mm3) at POW1. Likewise, at POM1, average cell density of brown eyes (2.01 ± 3.50 cells/mm3) was significantly greater (p=0.01) than average cell density of blue eyes (0.75 ± 0.72 cells/mm3).

Conclusions : Eyes with brown irises demonstrated significantly greater inflammatory cell density within the AC compared to eyes with blue irises at the POW1 and POM1 time points after cataract surgery. Brown irises, with greater levels of pigment, may be associated with prolonged inflammation after cataract surgery compared to iris colors with less pigment. Further work into the role of iris pigmentation on the inflammatory response after cataract surgery in larger cohort studies is needed to guide postoperative therapy considerations.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.