Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 16, 2023; 11(2): 385-393
Published online Jan 16, 2023. doi: 10.12998/wjcc.v11.i2.385
Tear inflammation related indexes after cataract surgery in elderly patients with type 2 diabetes mellitus
Jun Lv, Cheng-Jian Cao, Wei Li, Shuang-Le Li, Jun Zheng, Xiu-Li Yang
Jun Lv, Jun Zheng, Department of Optometry, North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
Cheng-Jian Cao, Zigong Academy of Medical Sciences, Zigong First People’s Hospital, Zigong 643000, Sichuan Province, China
Wei Li, FB Biologie, Philipps-Universitaet Marburg, Marburg 35043, Germany
Shuang-Le Li, Xiu-Li Yang, Department of Ophthalmology, Zigong First People’s Hospital, Zigong 643000, Sichuan Province, China
Author contributions: Li SL was the guarantor and proposed the research topics; Lv J designed the research protocols and wrote the manuscript; Cao CJ and Zheng J participated in the analysis and interpretation of the data; Li W revised the major elements of the manuscript; Yang XL participated in data collection; all authors reviewed and approved the final version to be published.
Supported by Cataract Prevention and Control Appropriate Technology Base of Sichuan Provincial Health Commission (Regional Demonstration), No. 2022JDXM012.
Institutional review board statement: The study was reviewed and approved by Zigong First Peoples Hospital.
Informed consent statement: All study participants or their legal guardians provided written informed consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to declare.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE statement checklist of items, and the manuscript was prepared and revised according to the STROBE statement checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shuang-Le Li, MM, Chief Physician, Department of Ophthalmology, Zigong First People’s Hospital, No. 42 The 1st Branch Road of Shangyihao, Ziliujin District, Zigong 643000, Sichuan Province, China. lishuangle06@163.com
Received: November 15, 2022
Peer-review started: November 15, 2022
First decision: November 30, 2022
Revised: December 15, 2022
Accepted: December 21, 2022
Article in press: December 21, 2022
Published online: January 16, 2023
Abstract
BACKGROUND

Quantitative studies on the changes in inflammation-related content in tears, especially the effect of diabetes, are lacking. In this study, we measured the preoperative and postoperative tear inflammatory mediator levels in cataract patients, focusing on the expression of inflammatory factors in postoperative cataracts in the diabetic, and investigated the effect of drugs on the control of postoperative inflammation.

AIM

To study the expression of inflammatory factors in elderly people with type 2 diabetes after cataract surgery.

METHODS

Patients with a mean age of 70.3 ± 6.3 years were divided into group A (composed of elderly patients with cataracts and type 2 diabetes, n = 20 eyes) and group B (patients with age-related cataract, n = 20 eyes). Their tears were collected before each operation and on days 1 and 3, and weeks 1, 2, 3, and 4 post-surgery. Saline (150 μL) was dropped into the conjunctival sac of the surgical eye, followed by oculogyration in four directions. The fluid in the conjunctival sac was extracted using a sterile syringe and stored in Eppendorf tubes at -80 °C until measurement. The expression levels of matrix metalloproteinase-2 (MMP-2), MMP-9, tissue inhibitor of metalloproteinase-1 (TIMP-1), TIMP-2, interleukin-6 (IL-6), and IL-20 in tear fluid were measured using enzyme-linked immunosorbent assays.

RESULTS

The postoperative expression levels of MMP-2, MMP-9, TIMP-2, IL-6, and IL-20 in group A were significantly higher than those in group B, whereas the concentration of TIMP-1 in group A remained lower than that in group B. The levels of MMP-2 and IL-6 in both groups continuously increased until the peak in the first postoperative week, and then gradually decreased over the next three weeks. Ultimately, MMP-2 declined to a lower level than that preoperatively at week 4, but IL-6 decreased to the same level as that preoperatively. The level of MMP-9 peaked in the first two weeks postoperative and then returned to the same level as 1-day post-operation. The concentration of TIMP-1 post-operation remained constant at a lower level than before surgery, and TIMP-2 Levels remained stable in both groups. IL-20 content started to increase in the third week after surgery.

CONCLUSION

Inflammatory factor levels in tears fluctuated before and post-operation, which indicated more severe postoperative inflammation in the first two weeks.

Keywords: Type 2 diabetes mellitus, Elderly patients, Cataract surgery, Tear inflammation-related indicators, Temporal changes, Prognosis

Core Tip: In this study, we compared the expression of inflammatory factors in postoperative tears of cataract patients and found that postoperative inflammation was more severe in elderly patients with cataract combined with type 2 diabetes; moreover, the level of postoperative inflammatory factors fluctuated greatly, and the inflammation was more severe in the first two weeks after surgery.