Re: Iftikhar et al.: Cystoid macular edema after cataract surgery in the United States: IRIS® Registry (Intelligent Research in Sight) analysis (Ophthalmology. 2023;130:1005-1014)

We thank Iftikhar et al1Iftikhar M. Dun C. Schein O.D. et al.Cystoid macular edema after cataract surgery in the United States: IRIS(R) Registry (Intelligent Research in Sight) analysis.Ophthalmology. 2023; 130: 1005-1014Abstract Full Text Full Text PDF Scopus (2) Google Scholar for their contributions to the literature on postcataract surgery cystoid macular edema (CME). Among their conclusions, the authors found that a person's racial self-identification as Black was a risk factor for developing postoperative CME. Although the authors discuss “health literacy, access to care, and affordability of treatment” as potential causes, our group and others have shown that racial self-identification as African American or Afro-Caribbean is highly associated with postcataract surgery persistent anterior uveitis.2Reddy A.K. Patnaik J.L. Miller D.C. et al.Risk factors associated with persistent anterior uveitis after cataract surgery.Am J Ophthalmol. Oct 2019; 206: 82-86Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar, 3Halim J. Westcott F. Cascone N. et al.Risk factors associated with post-operative uveitis after cataract surgery: a retrospective case-control study.Eye (Lond). 2022; 36: 198-205https://doi.org/10.1038/s41433-021-01486-1Crossref PubMed Scopus (2) Google Scholar, 4Neatrour K. McAlpine A. Owens T.B. et al.Evaluation of the etiology of persistent iritis after cataract surgery.J Ophthalmic Inflamm Infect. 2019; 9: 4https://doi.org/10.1186/s12348-019-0170-2Crossref PubMed Scopus (17) Google Scholar, 5Soifer M. Mousa H.M. Jammal A.A. et al.Diagnosis and management of idiopathic persistent iritis after cataract surgery (IPICS).Am J Ophthalmol. Feb 2022; 234: 250-258https://doi.org/10.1016/j.ajo.2021.10.004Abstract Full Text Full Text PDF Scopus (1) Google Scholar These findings of more pronounced postoperative inflammation, whether persistent anterior uveitis or CME, in Black patients presumably have a similar pathophysiologic mechanism. Our group, for example, postulated that higher amounts of iris pigmentation may lead to increased melanin release during phacoemulsification cataract surgery, leading to augmentation of intraocular inflammation. As the ophthalmology and health care communities increasingly prioritize equitable health outcomes, these findings of racial disparities in cataract surgery outcomes are further validated by multiple retrospective studies in different population settings and an effort to more precisely identify the etiology of this postoperative inflammation seems warranted. It may also be helpful to evaluate whether a modified perioperative anti-inflammatory medication regimen in Black patients decreases the rates of these complications. Cystoid Macular Edema after Cataract Surgery in the United States: IRIS® Registry (Intelligent Research in Sight) AnalysisOphthalmologyVol. 130Issue 10PreviewTo determine the incidence, risk factors, and visual outcomes of cystoid macular edema (CME) after cataract surgery in the United States. Full-Text PDF ReplyOphthalmologyVol. 131Issue 1PreviewWe thank Reddy et al1 for their comments regarding our study on cystoid macula edema after cataract surgery. As the authors postulate, there may indeed be a pathophysiological mechanism underlying the increased risk of postoperative inflammation in Black individuals.2 However, it is important to note that race is a social construct based on inconsistent criteria such as self-identification, as opposed to a discrete biological determinant. As such, we must be careful when attributing racial differences to biological mechanisms. Full-Text PDF