| ObjectiveAt present,cataract is still the first blind eye disease in China,accounting for about 56.7%.Most of the cataract patients suffer from binocular disease.After the first eye cataract surgery,due to the inconsistent binocular vision and refractive status,which affects the binocular visual function,more and more patients require second eye cataract surgery in the short term.However,some patients who underwent cataract surgery for the second eye within a short period of time(provided that the operating environment,the surgeon,the surgical method,and the anesthesia method are exactly the same as the first eye)were found to complain that the intraoperative eye pain was significantly worse than the first eye,resulting in a decrease in the ability of the patient to cooperate with the surgeon during the operation,such as:frequent eye movements,increased posterior chamber pressure,and even increased heart rate and blood pressure Increased,emotional stress and other associated reactions,the above conditions increase the difficulty and risk of surgery,increase the incidence of surgical complications(such as posterior capsule rupture,increased intraocular pressure,fundus bleeding,etc.),reducing patient satisfaction with second eye surgery.Therefore,how to reduce the patient’s surgical pain and further improve the patient’s surgical satisfaction cannot be ignored.In this study,animal experiments and clinical trials were used to detect the levels of TNF-α and IL-1β in the aqueous humor of rabbits’ humor and aqueous humor and age-related cataract patients.Possible mechanism of allergy.Methods1.Animal experiment1)Experimental grouping: For animal experiments,40 healthy adult New Zealand white rabbits were selected as the test subjects,both male and female,weighing 2-2.5kg.Random number table method was used to divide them into group A(experimental group)and group B(blank control group).The surgical eye of the experimental group and the first eye of the control group were randomized into the group.Twenty-five rats(25 eyes)in the experimental group underwentphacoemulsification aspiration,which was divided into 1 day after operation,3 days after operation,7 days after operation,14 days after operation,and operation.Five groups were selected from the next 21 days,with 5 animals in each group.There are15 control groups,which are blank control groups.They are divided into 5 groups with 3 animals in each group.2)Postoperative observation: The conjunctival hyperemia,corneal opacity and anterior chamber reaction of the rabbit eyes were observed before and after the operation of the slit lamp at 1 d,3 d,7 d,14 d and 21 d.Record data.3)Changes in relative expression of TNF-αm RNA and IL-1βm RNA in body fluids: blood samples of rabbit limbs of experimental group and control group were taken before operation,1 d,3 d,7 d,14 d,and 21 d after operation,and serum was collected after centrifugation for real-time quantification-Polymerase chain reaction(RT-q PCR)was used to detect the relative expression levels of TNF-αm RNA and IL-1βm RNA in rabbit body fluids.4)Detection of TNF-α and IL-1β in aqueous humor: before operation,the humor in group A and the first eye in group B were taken,and group A was taken non-operatively after 1 day,3 days,7 days,14 days,and 21 days.Aqueous humor in the second eye of group B and group B was tested by enzyme-linked immunoassay(ELISA)for TNF-α and IL-1β.5)Sensitivity of corneal perception: The same experimenter used a Cochet-Bonnet corneal perceptron to measure the corneal perception of the non-surgical eye of the experimental group and the second eye of the control group before and after operation 1 d,3 d,7 d,14 d,and 21 d.Sensitivity.Record data.2.Clinical Trials1)Trial grouping: Clinical study divided 30 patients with age-related cataracts into 6 groups,with 5 people in each group,group A(the first eye cataract surgery 1day after the first eye cataract surgery,1d),B Group(3 days after first eye cataract surgery,second eye cataract surgery,3d),Group C(7 days after first eye cataract surgery,second eye cataract surgery,7d),Group D(after first eye cataract surgery)Cataract surgery for the second eye on day 10,10d),group E(cataract surgery on the second eye 14 days after the first eye cataract surgery,14d),group F(cataract surgeryon the second eye 21 days after the first eye cataract surgery,21d).2)Patient demographics: Use structured research forms and questionnaires to collect the following data for the enrolled patients: patient age and gender,concomitant disease(hypertension),operation time of the first and second eyes.Record and organize the data.3)NRS scores of patients undergoing two operations: Using structured research forms and questionnaires to collect data,each patient was subjected to NRS scores after cataract surgery in the first eye and after cataract surgery in the second eye.The score is 0 to 10,where 0 means no pain,1-3 means mild pain,4-6 means moderate pain,and 7-10 means severe pain.Instruct patients to choose the single number that best represents the level of pain they experience.Take good notes.4)Pain questionnaire for patients undergoing two operations: Using structured research forms and questionnaires to collect data,each patient was subjected to a questionnaire survey on pain after cataract surgery in the first eye and after cataract surgery in the second eye.The allowed answers are "I feel more painful in the first eye surgery","I feel more painful in the second eye surgery","I experienced the same pain in both eye surgery","I don’t remember "".Instruct patients to choose the option that best represents the level of pain they experience.Take good notes.5)Detection of TNF-α and IL-1β in aqueous humor: Aqueous humor samples were collected before cataract surgery in all eyes of all enrolled patients,and enzyme-linked immunoassay(ELISA)was used to detect TNF-α and IL-1β in the collected samples content.Record data.Results1.Animal experiment1)Postoperative observation: In group A of animal experiment,1 day,3 days,and 7 days after operation,conjunctival hyperemia,corneal opacity,and anterior chamber Ⅰ-Ⅱ inflammation occurred in 25 eyes.At 14 days after surgery,the eyes still had grade I inflammation.The 21-day postoperative eye reaction was grade 0.The three indexes of the non-surgical eye and the control group were negative at the same time.2)Changes in relative expression of TNF-αm RNA and IL-1βm RNA in bodyfluids: after conversion into relative expression by ΔΔCT method in group A,the serum TNF-αm RNA and IL-1βm RNA contents were taken as baseline values??before operation,1 d,3 d,On 7d and 14 d,the relative levels of serum TNF-αm RNA and IL-1βm RNA were higher than before operation,the difference was statistically significant(P <0.05).It reached a peak at 7 days after operation,and then showed a gradual downward trend.It fell to the preoperative level at 21 days after operation.Compared with the preoperative period,the difference was not statistically significant(P> 0.05).There was a statistically significant difference between two adjacent time points(P <0.05).Serum sampling time of group B was synchronized with that of group A.The relative content of serum TNF-αm RNA and IL-1βm RNA of group B at different time points was not statistically different from the baseline value of group B.There was no statistically significant difference between two adjacent time points(P> 0.05).3)Detection of TNF-α and IL-1β levels in aqueous humor: the TNF-α and IL-1βlevels in the aqueous humor of the preoperative eyes of group A were taken as baseline values,1 day,3 days,7 days,and 14 days after surgery,non-operation The levels of TNF-α and IL-1β in the aqueous humor were higher than the preoperative baseline values,and the difference was statistically significant(P <0.05).It reached a peak at 7 days after operation,and then showed a gradual downward trend.It fell to the preoperative level at 21 days after operation.Compared with the preoperative eyes,the difference was not statistically significant(P> 0.05).There was a statistically significant difference between two adjacent time points(P <0.05).The time point of aqueous humor extraction in group B was synchronized with that of group A.The content of TNF-α and IL-1β in aqueous humor of the first eye was taken as the baseline value.There was no statistically significant difference between the baseline values.There was no statistically significant difference between two adjacent time points(P> 0.05).4)Corneal perception sensitivity: the preoperative non-surgical corneal perception threshold of group A is the baseline value,and the non-surgical corneal perception threshold of the non-surgical eye is lower than the baseline level at 1d,3d,7d,and 14 d after the first eye operation.Perceptual sensitivity increased(P <0.05).The corneal perception threshold was the lowest and the corneal perception sensitivity was the highest on the 7th postoperative day.After that,the corneal perception sensitivity gradually decreased,and basically returned to the baseline level on the 21 st day after the operation.There was no significant difference in the corneal perception sensitivity of the second eye in group B at different time points(P> 0.05).Compared with each other at adjacent time points,there was a statistically significant difference in non-surgical corneal perception sensitivity in group A(P <0.05),and no difference in corneal perception sensitivity in group B’s second eye(P> 0.05).2.Clinical trials1)Patient demographic characteristics: Patient data was collected using structured research forms and questionnaires.The following patient data were collected in the questionnaire: patient age and gender,concomitant disease(hypertension),operation time of first and second eyes.The average operation time of the first eye operation was 11.5 ± 1.9min,and the average operation time of the second eye operation was 11.7 ± 1.8min.The difference in operation time was not statistically significant(P> 0.05).2)NRS score for patients undergoing two operations: Group A(cataract surgery for the second eye 1 day after the first eye cataract surgery,1d),Group B(cataract surgery for the second eye 3 days after the first eye cataract surgery,3d),Group C(7days after the first eye cataract surgery,second eye cataract surgery,7d),Group D(10days after the first eye cataract surgery,second eye cataract surgery,10d),Group E(first eye cataract Cataract surgery for the second eye 14 days after surgery,14d),group F(cataract surgery for the second eye 21 days after cataract surgery for the first eye,21d)Comparison of cataract surgery for the first eye among the six groups,no statistical difference in NRS scores Academic significance(P> 0.05).(Group A: 0.90± 0.37,Group B: 1.50 ± 0.32,Group C: 1.30 ± 0.51,Group D: 1.40 ± 0.58,Group E:1.20 ± 0.51,Group F: 1.40 ± 0.58).There was no statistically significant difference in NRS score between the second group of cataract surgery among the six groups(P>0.05).(Group A: 1.10 ± 0.58,Group B: 1.60 ± 0.37,Group C: 1.50 ± 0.55,Group D:1.60 ± 0.58,Group E: 1.50 ± 0.45,Group F: 1.50 ± 0.44).Compared with the NRS scores of the first and second eyes in the six groups,the difference was notstatistically significant(P> 0.05).3)Pain questionnaire for patients undergoing two operations: a total of 4 people chose me to feel more painful during the first eye surgery,17 people chose me to feel more painful during the second eye surgery,and 9 people chose me to use both eye surgery Experienced the same pain.4)Detection of TNF-α and IL-1β levels in aqueous humor: TNF-α and IL-1βlevels in the humor of the first eye cataract surgery in the six groups A,B,C,D,E and F The difference between the two comparisons was not statistically significant(P> 0.05).In each of the six groups,the content of TNF-α and IL-1β in the aqueous humor of the first eye was taken as the baseline,and the content of TNF-α and IL-1βin the aqueous humor of the second eye was higher than that of the first eye,the difference was statistically significant(P < 0.05).With the increase of the operation interval of the second eye,the content of TNF-α and IL-1β in the cataract surgery room water of the second eye increased first and then decreased.The TNF-α and ILin the cataract surgery room water of the second eye in group D The content of 1βwas the highest,and then showed a downward trend.The difference in pain value of the second eye between the six groups was statistically significant(P <0.05).ConclusionThis study found through animal experiments and clinical trials that after the first eye cataract surgery,the second eye surgery has more pain,which may be related to the trauma of the first eye surgery and the expression of TNF-α and IL-1β in the aqueous humor of the second eye.The upregulation,in turn,causes the sensory branch of the trigeminal nerve in this eye to be sensitized,which can further cause hyperalgesia in the eye.Therefore,this study speculates that after the first eye cataract surgery,the increased sensitivity of pain in the second eye is not just a simple psychological reaction,but the pathophysiological mechanism may be more complicated. |
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