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
ARTICLE HIGHLIGHTS
Research 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 diabetic cataracts in the elderly, and investigated the effect of drugs on the control of postoperative inflammation.

Research motivation

Postoperative inflammation is more severe in diabetic patients with cataracts than in elderly cataract patients who are not diabetic, and the level of inflammatory factors in the postoperative tears is also higher in the former. Therefore, this strengthened the recommendation for the use of anti-inflammatory drugs in the first two postoperative weeks, that was proposed based on our observations.

Research objectives

This study studies the expression of inflammatory factors in elderly people with type 2 diabetes after cataract surgery. This may provide a basis for the timing and duration of anti-inflammatory medication use in patients undergoing cataract surgery.

Research methods

This study was an observational study. The patients were divided into two groups. Group A (patients with cataracts with combined type 2 diabetes) and group B (patients with cataracts without combined type 2 diabetes). Their tears were collected before each operation and on days 1 and 3 and weeks 1, 2, 3, and 4 post-surgery, and an enzyme-linked immunosorbent assay was used to detect the level of inflammatory mediators in tear fluid.

Research results

The expression levels of matrix metalloproteinase-2 (MMP-2), MMP-9, tissue inhibitor of metalloproteinase-2 (TIMP-2), interleukin-6 (IL-6), and IL-20 in group A were significantly higher than those in group B after surgery, whereas the expression level of TIMP-1 in group A was always lower than that in group B.

Research conclusions

Postoperative tear inflammation is more severe in cataract patients with diabetes than in elderly patients. Inflammatory factor levels in tears fluctuated before and post-operation, which indicated more severe postoperative inflammation in the first two weeks.

Research perspectives

Future studies should expand the sample size, standardize inclusion criteria for cataract patients with or without type 2 diabetes, measure their blood glucose levels before surgery, and investigate other disease characteristics to reduce confounding factors and increase the number of preoperative tear collections and tear volumes for patients.