Dynamic monocyte chemoattractant protein-1 level as predictors of perceived pain during first and second phacoemulsification eye surgeries in patients with bilateral cataract

Abstract

Background The purpose of the study was to investigate whether dynamic monocyte chemoattractant protein-1 (MCP-1) level might be as predictors of perceived pain during the first and second phacoemulsification eye surgeries in patients with bilateral cataract. Methods Consecutive bilateral cataract patients undergoing bilateral sequential phacoemulsification were retrospectively enrolled. Patients’ preoperative anxiety score and intraoperative pain score were registered. Aqueous humor samples were obtained during surgery. MCP-1 level in the aqueous humor was measured by enzyme linked immunosorbent assay (Elisa). Patients were assigned to seven subgroups based on the interval between first-eye and second-eye cataract surgery. Comparisons were performed for a subjective sensation and MCP-1 levels among different subgroups. Results pain score during second-eye surgery was significantly higher than during first-eye surgery. Whereas there was no statistical difference in anxiety score between both surgeries. Result from subgroups comparison showed that the visual analog scale (VAS) pain score was statistically greater in 1-group and 6-group during the second eye surgery. Anxiety score did not statistically differ in subgroups. Additionally, the second-eye MCP-1 level was significantly higher at week 1and 6 intervals. Preoperative MCP-1 level was positively correlated with perceiving pain score during both surgeries. Conclusions MCP-1 level in aqueous humor significantly correlated with perceived pain during cataract surgery. Dynamic MCP-1 level could function as predictors of perceived pain during the first and second phacoemulsification eye surgeries in patients with bilateral cataract, which might support clinicians in treatment optimization and clinical decision-making.

Comparison of pain between first and second operated eyelids after upper eyelid blepharoplasty

“…It is known that pain is associated with inflammation and a significant relationship has been reported between various mediators and pain score. Similar to our study, Zhang et al evaluated pain in patients who underwent first and second eye cataract surgeries, and found that monocyte chemotactic protein was higher in the aqueous in the second eye surgery and stated that this mediator may be associated with pain [24]. In diabetic cataract patients, Substance P and monocyte chemotactic protein 1 levels evaluated from the aqueous fluid taken in first and second eye cataract surgery were found to be higher in second eye surgery, and it has been reported that these mediators are associated with pain, play a role in sympathetic inflammation and may cause noninfectious inflammation.…”

Combination of iris vessel area density and surgery interval as the predictor of perceived pain during consecutive second-eye cataract surgery

“…19,20 In addition, it was confirmed that surgery in the first eye could cause sympathetic ophthalmic-type uveitis in the second eye. 9,10 However, cataract extraction does not seem to cause significant inflammation in the contralateral eye which cannot be detected by common clinical examinations.…”

“…Previous studies also found that the time interval of sequential cataract surgery was related to perceived pain in the second-eye surgery. 10,16 However, the timing of peak inflammation after cataract surgery is controversial. Liu et al suggested that patients who underwent the second surgery at an interval of 2 weeks perceived more pain, while Zhang et al believed acute and delayed inflammatory response peaks in the second eye were at week 1 and week 6 after the first-eye surgery because visual analog scale pain scores and monocyte chemoattractant protein-1 levels in the aqueous humor during the second-eye surgery were significantly greater than those when surgery was conducted at other intervals.…”

“…Liu et al suggested that patients who underwent the second surgery at an interval of 2 weeks perceived more pain, while Zhang et al believed acute and delayed inflammatory response peaks in the second eye were at week 1 and week 6 after the first-eye surgery because visual analog scale pain scores and monocyte chemoattractant protein-1 levels in the aqueous humor during the second-eye surgery were significantly greater than those when surgery was conducted at other intervals. 10,16 The time interval can be greatly affected by subjective factors and psychological characteristics according to different patients, and the predictive effect of iris VAD is more objective. We hypothesized that the combination of both objective and psychological factors to predict pain can improve predictive reliability.…”

“…8 Zhu et al found that the expression of monocyte chemoattractant protein-1, a pain-related inflammatory chemokine, was significantly increased in the aqueous humor in the contralateral eye, and its level in the aqueous humor significantly correlated with perceived pain during cataract surgery. 9,10 There may be sympathetic ophthalmic-type uveitis in the contralateral eye after first-eye cataract surgery because inflammatory marker changes were detected in both eyes in patients with sympathetic ophthalmia after penetrating injury to 1 eye. 11 Nevertheless, this kind of sympathetic uveitis-like reaction is quite mild and is not accompanied by signs, such as the presence of cells, keratoprecipitates, and the Tyndall phenomenon in the anterior chamber.…”