Abstract
The aim of this study was to explore the correlation between intraoperative hyperalgesia of the second eye and the dynamic changes of tumor necrosis factor (TNF)-α and interleukin (IL)-1β levels in aqueous humor (AH) of the second eye and whole blood after the first eye cataract surgery. A rabbit model of monocular phacoemulsification was established by administration of 0.3% levofloxacin. Whole blood and AH samples from non-surgical eyes in the experimental group (n =25) and second eye in the blank control group (n =15) were obtained and corneal sensitivity was examined after surgery (1, 3, 7, 14, and 21 days postoperatively). TNF-α and IL-1β levels in AH and TNF-α mRNA and IL-1β mRNA levels in whole blood were measured. In a clinical study, 30 patients who underwent bilateral phacoemulsification within 1 month were divided into six groups in accordance with the operation intervals (1, 3, 7, 10, 14, and 21days). TNF-α and IL-1β levels in AH were measured at the beginning of surgery and intraoperative pain was assessed immediately after surgery. Corneal sensitivity (F =244.910, P <0.05), TNF-α and IL-1β levels in AH (F =184.200, 82.900, P <0.05) of non-surgical eyes and in whole blood (F =272.800, 193.530, P <0.05) in the experimental group were significantly higher than the baseline levels after phacoemulsification. In the clinical study, NRS scores of second eye surgery were higher than those of the first eye(P =0.0025) and 19 (63.3%) patients reported more pain during the second eye surgery. TNF-α and IL-1β concentrations in AH of the second eye were significantly higher than those of the first eye (F =123.60, P <0.05; F =59.60, P <0.05). In conclusion, within 1 month after the first eye phacoemulsification, higher pain sensitivity (hyperalgesia) exists in the second eye, which may be related to dynamic changes in TNF-α, IL-1β levels in AH or whole blood.
Highlights
Phacoemulsification and intraocular lens implantation surgery under topical anesthesia is widely performed worldwide
It has been verified that tumor necrosis factor (TNF)-α and interleukin (IL)-1β induce Journal of Immunology Research leukocyte activation, chemotaxis, and inflammatory responses, and act as neuromodulators in the nervous system to enhance the sensitivity of sensory neurons, which will lead to neuropathic pain that includes hyperalgesia [10, 11]
The expression of TNF-α and IL-1β mRNA in blood was significantly higher at 1, 3, 7, and 14 days after surgery compared with baseline levels in the experimental groups (F =272.800, P
Summary
Phacoemulsification and intraocular lens implantation surgery under topical anesthesia is widely performed worldwide. Because of the inconsistent visual function of both eyes, many patients undergo second eye surgery a short time after the first eye surgery [1,2,3]. More eye pain and discomfort are commonly reported by patients with bilateral cataract during the second eye surgery, despite the same surgeon, anesthetic mode, procedure, and even operation circumstances, which is considered to be related to hyperalgesia [4,5,6,7,8,9]. Intraoperative hyperalgesia may reduce a patient’s willingness to cooperate, increase surgical difficulty and risk, and reduce patient postoperative satisfaction. The mechanism by which the pain experience is stronger during the second eye phacoemulsification is not entirely understood.
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