CLINICAL FACTORS INFLUENCING THE RESPONSE TO TOPICAL NON-STEROIDAL ANTI-INFLAMMATORY TREATMENT IN IRVINE–GASS SYNDROME FOLLOWING CATARACT SURGERY

To evaluate the anatomical and functional outcomes of topical non-steroidal anti-inflammatory drug (NSAID) therapy in patients who developed Irvine–Gass Syndrome (IGS) after cataract surgery and to identify clinical factors associated with treatment response.

Department of Ophthalmology, İstanbul Faculty of Medicine, İstanbul University, İstanbul Türkiye.

This retrospective study included 77 eyes of 62 patients (38 males, 24 females) who developed IGS following cataract surgery between January 2023 and January 2025 and were treated with topical NSAIDs (nepafenac) . Data on demographics, ophthalmologic parameters, and Optical Coherence Tomography (OCT) findings were collected. Regression of cystoid macular edema on OCT was defined as a positive treatment response.

The mean age of the patients was 71.1±7.1 years (range, 52–85), and the mean follow-up period was 7.8 ± 5.7 months (range, 2–26). A total of 62 eyes (80%) responded to treatment, with a mean response duration of 2.2 ± 1.7 months (range, 1–10). There was no significant association between treatment response and the presence of intraoperative posterior capsule rupture with anterior vitrectomy (p = 0.13), intraocular lens position (capsular bag vs. sulcus; p = 0.89), or diabetes mellitus (p = 0.11). A longer interval between bilateral cataract surgeries was significantly associated with a decreased likelihood of developing IGS in the fellow eye (p < 0.01). Patients who developed IGS in both eyes had significantly higher preoperative central macular thickness (CMT) (p = 0.02), although this was not correlated with treatment response (p = 0.25). Preoperative and IGS-onset best-corrected visual acuity (BCVA) were not related to treatment response (p = 0.42, p = 0.63). In patients who responded to topical therapy, mean BCVA improved from 0.72 ± 0.24 at the onset of IGS to 0.90 ± 0.15 after treatment (p < 0.01). Preoperative CMT was not associated with response (p = 0.54) or response duration (r = 0.21, p = 0.08). CMT at IGS onset was not predictive of response (p = 0.22) but showed a weak positive correlation with treatment duration (r = 0.28, p = 0.05). Disruption of the external limiting membrane or ellipsoid zone was not significantly associated with treatment duration (p = 0.06), although greater disruption tended to prolong recovery.

Appropriate topical NSAID therapy is an effective treatment option for IGS following cataract surgery and may improve both anatomical and functional outcomes. In this study, treatment response and duration were not significantly associated with clinical parameters such as CMT, BCVA or the presence of diabetes mellitus. However, higher preoperative CMT was associated with an increased risk of bilateral IGS, while this elevation did not significantly influence the therapeutic response to topical NSAID treatment. Additionally, a longer interval between surgeries was associated with a markedly reduced risk of IGS development in the fellow eye