Sympathetic Nerve-Mediated Fellow Eye Pain During Sequential Cataract Surgery by Regulating Granulocyte Colony Stimulating Factor CSF3.

Zheng Fan,Bin Zhang,Bi Ning Zhang,Wenfeng Li,Xiaomin Liu,Benxiang Qi,Yusen Huang,Xia Qi,Caixia Fan

doi:10.3389/fncel.2022.841733

Abstract

Patients were found to experience more pain during their second eye cataract surgery compared with their first eye surgery. This study aimed to explore the inflammatory alterations along time in the fellow eye after the first eye surgery and to reveal the underlying mechanism. Eighty patients with bilateral cataracts were recruited and were divided into four groups based on the time of having the second eye surgery. The second eye aqueous humor samples were collected just before surgery and analyzed by mass spectrometry and PCR array. Cytokine activity was enriched in the aqueous humor of the contralateral eye with granulocyte colony-stimulating factor CSF3 significantly upregulated at both gene and protein levels. Rabbits with or without superior cervical ganglionectomy (SCGx) were subjected to lensectomy to mimic human situations. In both human and rabbit models, the fellow eye CSF3 peaked at 1 week post the first eye surgery. Consistently, more neutrophils were recruited to the contralateral eye aqueous humor. Corneal sensitivity and trigeminal electrophysiology were recorded to imply the pain severity in rats receiving capsulorrhexis with or without SCGx. A more intense pulse was detected in the contralateral trigeminal ganglion after the rat received one eye surgery. SCGx could effectively reduce the fellow corneal sensitivity and trigeminal nerve pain. These alterations were under direct regulation of the sympathetic nerves on the surgical eye side. Our results suggest that CSF3 and sympathetic activity could serve as potential analgesic targets during ocular surgeries.

Highlights

IntroductionCataract surgery is the most common therapeutic modality for patients with cataracts
62.5% of patients receiving the second eye surgery at a 1-week interval after their first eye surgery complained of more pain (Table 3), while the proportion dropped to 25% when the interval extended to 1 month (Table 3)
Though more intense pain was widely reported during the second eye cataract surgery than the first eye surgery (Tan et al, 2011; Ursea et al, 2011; Adatia et al, 2015; Jiang et al, 2015; Yu et al, 2016; Liu et al, 2020), we examined this observation in the animal model

Summary

Introduction

Cataract surgery is the most common therapeutic modality for patients with cataracts. Staged cataract surgical operation for bilateral eyes is more commonly performed than simultaneous cataract surgery in both eyes, mainly to avoid the catastrophic bilateral endophthalmitis (Kushner, 2010). Sympathetic Nerves, CSF3 and Pain during clinical practice, there are still patients complaining of eye pain, dry eyes, foreign body sensation, or other discomfort symptoms. These symptoms were more intense during the surgery in the second eye than that in the first eye, especially for pain perception, which had been noticed extensively (Tan et al, 2011; Ursea et al, 2011; Adatia et al, 2015; Jiang et al, 2015; Yu et al, 2016; Liu et al, 2020). Psychological factors like anxiety and perception during the first surgery would influence the patient’s eye sensation (Nijkamp et al, 2002; Ang et al, 2007; Adatia et al, 2015) while physiological factors, such as repeated penetrating injuries, might have triggered a subclinical sympathetic inflammatory reaction in the fellow eye (Zhu et al, 2015)

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