A Longitudinal Analysis Of Anterior Chamber Flare Following Cataract Surgery Across Different Ethnic Groups

To investigate the impact of ethnicity on the magnitude and duration of intraocular inflammation following cataract surgery. Anterior chamber flare, a proxy for blood-aqueous barrier breakdown, is an objective and validated measure of inflammation, however ethnic variations in anterior chamber flare measurements after cataract surgery is largely unstudied. This study aims to compare flare readings between Afro-Caribbean and White patients at standardised time points to identify potential variations in inflammatory response and recovery.

A retrospective, observational, cohort study conducted at KCL Frost Eye Research Department at St Thomas' Hospital.

Data was derived from Afro-Caribbean and White patients who underwent routine uncomplicated cataract surgery between April 2019 and August 2023 and were enrolled in various prospective clinical trials at St Thomas' Hospital. Laser flare photometry was utilised to obtain 329 readings from 157 eyes (Afro-Caribbean = 76, White = 81). Post-operative intervals were categorized into the following time periods: weeks 1-2, 3-4, 5-6, 7-8, 9-12, and 13+. Statistical analysis was performed using the Mann-Whitney U test to compare flare values between the two ethnic groups within each time period to assess differences in rates of post-operative inflammation.

A total of 329 flare readings were analysed. In the immediate post-operative period, weeks 1-2, no significant difference was observed in median flare readings between Afro-Caribbean (26.60 pc/ms) and White (31.00 pc/ms) patients (p=0.761). However, at weeks 3-4, the Afro-Caribbean group demonstrated a higher median flare reading (23.70 pc/ms) compared to the White group (13.05 pc/ms) which was statistically significant (p=0.032). While individual time periods from Week 5 onwards did not reach statistical significance, the Afro-Caribbean cohort consistently maintained higher median flare values throughout the recovery phase including the long term 13+ weeks: Afro-Caribbean 12.80 pc/ms vs White 10.85 pc/ms (p=0.259).

Ethnicity is a significant risk factor in post-operative inflammation after routine cataract surgery. While immediate inflammatory responses are comparable between groups, Afro-Caribbean patients demonstrate significantly higher flare levels at the one-month mark (weeks 3-4) and maintain a consistent trend of higher inflammation levels throughout the late recovery period. These findings suggest that Afro-Caribbean patients may experience a more robust or prolonged inflammatory course following cataract surgery. Clinical practice should consider these ethnic variations when tailoring postoperative anti-inflammatory regimens to ensure optimal recovery across diverse patient populations.