| ObjectiveIn recent years,femtosecond laser assisted cataract surgery is becoming more and more widely used in clinic.Many studies have confirmed its safety,accuracy and effectiveness,and reduce the risk of operation.In the course of clinical application,we found that femtosecond laser has a high incidence of intraoperative miosis.Recent studies have shown that the mechanism of femtosecond laser can induce the release of cytokines such as prostaglandins in aqueous humor.Previous studies have shown that high concentration of inflammatory factors in aqueous humor is a significant risk factor for macular edema.In addition,the occurrence of miosis in the operation will greatly increase the difficulty of operation.In recent years,more and more attention has been paid to it.How to reduce and avoid the occurrence of miosis in the operation has become the focus of clinical attention.Diclofenac sodium is a typical representative of NSAIDs in traditional phacoemulsification,which can effectively prevent the miosis in the operation and inhibit the inflammation of the anterior segment after cataract surgery.It has a prevention and treatment effect on the macular cystoid edema,one of the main causes of poor visual acuity after cataract surgery.Based on the above,we designed this prospective clinical study to detect the aqueous concentration of prostaglandin E2?interleukin 6?interleukin 1??tumor necrosis factor? and vascular endothelial growth factor during the femtosecond laser assisted cataract surgery in the patients with diabetes mellitus,the potential relationship with postoperative diabetic macular edema is also discussed.It provides a theoretical basis for the selection of femtosecond laser assisted cataract surgery,and guides the selection of cataract surgery for patients with diabetes mellitus.At the same time,diclofenac sodium was used as a representative of nonsteroidal anti-inflammatory drugs in the perioperative period of femtosecond laser assisted cataract surgery,intraoperative miosis and macular change after surgery were observed,to evaluate the efficacy and safety of topical diclofenac sodium 0.1% on femtosecond laser-assisted cataract surgery.With the improvement of cataract surgery and the design of intraocular lens,thevisual quality of the patients has been greatly improved,and the reduction of postoperative irritation symptoms is the main problem that affects the patient's satisfaction.Changes in tear film and corneal sensitivity after cataract surgery are the main causes of irritation.The negative pressure attraction and laser operation steps added to the femtosecond laser-assisted cataract surgery require direct contact with the ocular surface,which may have potential effects on tear film and corneal sensitivity.Therefore,we compare the changes in tear film and corneal sensitivity after the femtosecond laser-assisted cataract surgery and 2.2 mm microincisional phacoemulsification surgery,and evaluate the effect of the femtosecond laser-assisted cataract surgery on the changes in tear film and corneal sensitivity.Methods1.A prospective control study.112 eyes of 112 patients having femtosecond laser-assisted cataract surgery were divided into 2 groups,61 eyes from patients with diabetes mellitus were DM group,51 eyes from 51 non-diabetic patients were control group,100 ?L of aqueous humour was collected after laser treatment.The Prostaglandin E2,Interleukin 6,Interleukin 1?,Tumor Necrosis Factor ? and Vascular Endothelial Growth Factor(Human PGE2,IL-6,IL-1?,TNF-? and VEGF ELISA Kits,Bio-Swamp Life Science)were used to determine the concentrations of PGE2,IL-6,IL-1?,TNF-? and VEGF in the aqueous humour.Central foveal thicknesss was measured using OCT before and after surgery,and DME was defined as an 30%increase in foveal thickness after operation.All patients were treated with non-steroidal anti-inflammatory drugs prior to surgery.2.A prospective,randomized control study.96 eyes of 96 age-related cataract subjects scheduled to undergo femtosecond laser-assisted cataract surgery were randomized into two groups according to the topical treatment: Group 1,study group(51 eyes),preoperative diclofenac sodium 0.1% and levofloxacin 0.5% postoperative add steroid;Group 2(45 eyes),preoperative levofloxacin 0.5% only,postoperative add steroid,as a control.No epinephrine was used in the intraoperative irrigationsolution.Outcome measures included intraoperative change in pupil size,postoperative change in macular thickness and volume.Pupil diameter was measured three different times during surgery: in front of femtosecond laser,before the first incision formation and the end of phacoemulsification.Macular thickness was measured during the preoperative?1 day?7 days and 1 month postoperatively.3.A prospective cohort study.53 eyes of 53 patients with age-related cataract were included.The patients were divided into the femtosecond laser group and the microincisional group.26 eyes in the femtosecond laser group received femtosecond laser-assisted cataract surgery,and 27 eyes in the microincisional group received 2.2mm microincisional phacoemulsification surgery.The data of corneal sensitivity,Schirmer test values,non-invasive tear film break-up time(NIBUT)and subjective score for dryness were collected in 7 days,1 month and 3 months after surgery,and these results were compared between the two groups.Results1.For PGE2,IL-6,IL-1?,TNF-? and VEGF,respectively,the mean concentration values in aqueous humour were(87.4±12.1)pg/mL,(39.7±6.6)pg/mL,(59.2±7.2)pg/mL,(6.3±1.0)pg/mL,(274.1±40.4)pg/mL in the DM group,and(67.6±9.4)pg/mL,(24.8±5.7)pg/mL,(27.1±5.3)pg/mL,(3.1±0.5)pg/mL,(189.7±17.6)pg/mL in the control group.Concentrations of PGE2,IL-6,IL-1?,TNF-? and VEGF were significantly higher in the DM group than those in the control group(all P <0.01).There no significant correlations between concentrations of PGE2,IL-6,IL-1?,TNF-? or VEGF and age,sex,cataract densities,suction time or laser time(all P >0.05).In DM group,the mean fovea thickness were(142.5±7.6)?m preoperatively and(166.5±13.6)?m postoperatively,and difference was not significant(P>0.05).In control group,the mean fovea thickness were(139.4±10.2)?m preoperatively and(156.2±7.0)?m postoperatively,and difference was notsignificant(P>0.05).2.The results showed that the miosis occurred in all the observation subjects and was most obvious at the end of the femtosecond laser,indicating that the effect of the femtosecond laser on the intraocular tissue was the main factor causing the miosis.In the study group using diclofenac sodium,the incidence of miosis at three set observation time points was significantly lower than that in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in the thickness of the macular fovea between the study group and the control group before operation,1 day and 7 days after operation(P>0.05),and there was a significant difference in the 1 months after operation(P<0.05),but did not reach the diagnostic criteria of macular edema occurred.3.In the objective dry eye index,the upper and the central corneal sensitivity and NIBUT value decreased first and then increased,and the Schirmer value decreased first and then increased in the coaxial micro-incision group during the observation process.The above observation indexes all recovered to the preoperative level 3months after the operation.3 months after the operation,the subjective score for dryness in the both groups were still higher than that before operation,and the difference was statistically significant(P<0.05),consider the use of artificial tears after surgery was 1 months after the operation,this change is caused by considering the medication adjustments.Conclusions1.Aqueous humour concentrations of PGE2,IL-6,IL-1?,TNF-?,VEGF significantly higher in the DM group than those in the control group after femtosecond laser treatment,but there was no significant difference in the retinal thickness of the macular fovea before and after the operation and no cystoid macular edema was found in the two groups.2.Adding preoperative and postoperative diclofenac sodium 0.1% to topical treatment can reduce intraoperative miosis and macular change more effectively than postoperative steroid alone.3.Femtosecond laser-assisted phacoemulsification has the same effect on tear film and corneal perception as 2.2mm coaxial micro-incision phacoemulsification.The objective indexes of tear film and corneal sensitivity in both groups recovered to the preoperative level three months after operation,but the subjective dry eye score was higher than that before operation.It is suggested that the use of local artificial tears should be extended to 3 months after operation. |
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