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To explore the difference and related mechanism of pain between eyes in sequential cataract surgery

Posting time:2023-01-31 05:41:00

To explore the difference and related mechanism of pain between eyes in sequential cataract surgery

The development of ophthalmology is changing with each passing day, and the development of ophthalmology in China is advancing by leaps and bounds. Build a bridge to convey the latest progress and scientific research achievements of Chinese ophthalmologists in academic research, and play a strong voice in the era of Chinese ophthalmology! ——Editor's note of the Voice of China Ophthalmology Series: Cataract is the first eye disease that causes blindness in the world, and its main treatment method is to restore visual function through surgery. In current clinical work, cataract surgery performed in stages is more common than simultaneous surgery in both eyes. Multiple studies have shown that patients experience more pain during surgery on the second eye, even when both eyes are staged by the same ophthalmologist under the same conditions. However, due to the limitations of pain assessment methods, some physicians are still skeptical about the pain differences in bilateral cataract surgery. To this end, Professor Huang Yusen of Qingdao Eye Hospital affiliated to Shandong First Medical University and his team conducted a related study. The study used patient samples and animal models to verify the pain difference of sequential cataract surgery in both eyes, and explored the effect of the first eye after surgery on the lens. Changes in the inflammatory response of the lateral anterior chamber, and elucidating the differential regulation mechanism of pain, in order to provide a reference for clinical prevention and treatment of cataract surgery pain. The research was recently published in the journal Frontiers in Cellular Neuroscience. Research methods 1. Cataract Surgery Pain Score Questionnaire Pain score questionnaire was conducted among patients undergoing cataract surgery after surgery, and the differences in pain scores between the two eyes were compared. 2. A total of 80 patients who underwent cataract surgery in the second eye were included in the experimental group to study the changes in the expression levels of cytokines in the contralateral aqueous humor after cataract surgery in one eye. month), the experimental group was divided into 4 subgroups. The control group included 20 patients who underwent unilateral cataract surgery for the first time. All operations were performed by the same doctor. Aqueous humor was collected during cataract surgery for protein profiling and PCR chip detection. 3. Study on the electrophysiological changes of contralateral trigeminal ganglion induced by one-sided lens operation in rats SD rats were randomly divided into two groups. One day after the right eye lens enucleation (ECLE) of the rats in the experimental group (Con_Post group), the spontaneous electrical signals of the left trigeminal ganglion (TG) neurons were collected. The rats without any surgery were used as the control group (Con_Pre group) to record the bioelectric signals of the left TG neurons. 4. Study on the up-regulation of cytokine CSF3 in contralateral aqueous humor caused by unilateral lens operation in rabbits New Zealand white rabbits were randomly divided into 3 groups, and phacoemulsification was performed in both eyes in stages. Aqueous humor was collected as a control sample during the operation of the first eye, and phacoemulsification of the contralateral eye was performed at 3 days, 1 week, and 1 month after the operation of the first eye. Quantitative PCR detection. 5. The study on the ipsilateral sympathetic nerve regulation of the contralateral aqueous humor CSF3 in the rabbit phacoemulsification model. New Zealand rabbits were randomly divided into two groups. One group underwent right superior cervical ganglionectomy (SCGx). Set as the experimental group (SCGx group), the other group did not undergo SCGx surgery (control group), both groups underwent left eye phacoemulsification 1 week after the right eye phacoemulsification surgery, and the aqueous humor in both eyes was collected during the operation for ELISA detection. . 6. The study of the ipsilateral sympathetic nerve in the first eye to regulate the pain of the contralateral eye (1) Electrophysiological experiment: SCGx rat model was established, and the spontaneous electrical signal of the left TG neuron was recorded 1 day after ECLE in the right eye. (2) SD rats were randomly divided into SCGx group (left and right random) and control group (Con group), and they all underwent circular capsulorhexis in the left eye 1 week after the circular capsulorhexis in the right eye. The corneas were measured before and after the operation. sensitivity. Aqueous humor was collected 24 hours after surgery, and flow cytometry was used for quantitative analysis of inflammatory cells. (3) Establishment of rat neutrophil clearance model: SD rats were randomly divided into fucoidan group (Fucoidan group) and control group (Con group). Fucoidan group was intravenously injected with fucoidan after capsulorhexis in the right eye. The Con group only underwent capsulorhexis of the right eye. Effects after neutrophil depletion were assessed by flow cytometry and corneal sensitivity measurements. Research results 1. There are differences in the pain of binocular staged cataract surgery (1) The pain score questionnaire results showed that there were differences in the pain visual analogue scale (VAS) scores of the two eyes in patients who underwent binocular cataract surgery by stages (P Figure 1 (2) ) Rat electrophysiological experiments found that the spontaneous discharge (spike) frequency of the left TG in the Con_Post group was significantly higher than that in the Con_Pre group. Figure 22. There were differences in the expression levels of cytokines in the aqueous humor of both eyes (1) The detection results of human aqueous humor samples showed that cells The factor-mediated inflammatory response was associated with hyperalgesia in the second eye, and the level of inflammation in the second anterior chamber changed with the prolongation of the operation interval (Figure 3, Figure 4). PCR chip detection results showed that the experimental group and the control group There were up-regulated genes compared to the groups in which CSF3 was a cytokine common to the four time points (Table 4). Both the gene expression and protein levels of CSF3 in the aqueous humor of the second eye were significantly increased and 1 postoperatively in the first eye. The peak value was reached at 1 week (Fig. 5C). (2) The qPCR results of the phacoemulsification model in rabbits (Fig. 5D) showed that CSF3 in the second eye of the experimental group was significantly increased 1 week after the operation in the first eye (P graph). 3 Fig. 4 Fig. 5 Table 43. The ipsilateral sympathetic nerve of the first operated eye modulates the aqueous humor CSF3 and pain of the contralateral eye (1) Fig. 6 shows the ipsilateral sympathetic nerve of the first operated eye modulates the aqueous humor CSF3 of the contralateral eye. SCGx_R The level of CSF3 protein in the aqueous humor of the group was statistically different from that of the control group (1W group) (P Figure 6 (2) The ipsilateral sympathetic nerve of the first operated eye regulated the pain of the contralateral eye (Figure 7). (Figure 7A) Establishment of SCGx Rat model.(Figure 7B) The neutrophils in the aqueous humor of the second eye (OS) of rats without SCGx surgery (Con group) were on average 1.9 times higher than those of the first eye (OD). Right SCGx rats (SCGx_R group) the ratio of neutrophils in the aqueous humor in OS/OD was 0.3, which was significantly lower than that in the Con group (PPPP < 0.001). Figure 7 Conclusions 1. There are differences in intraoperative pain in patients undergoing cataract surgery by stage in both eyes 2. After cataract surgery in the first eye, the expression of cytokines in the aqueous humor of the contralateral eye was increased, and the protein level and gene expression of granulocyte colony-stimulating factor CSF3 were significantly up-regulated, and reached a peak 1 week after the operation of the first eye 3. Elevated CSF3 caused a significant increase in the content of neutrophils in the aqueous humor of the contralateral eye, and removal of neutrophils could effectively relieve pain in the contralateral eye.4. The content of CSF3 and neutrophils in the contralateral eye was affected by the first Only the regulation of the sympathetic nerve on the ipsilateral side of the operated eye. Removal of one side of the superior cervical ganglion can effectively reduce the corneal sensitivity and spontaneous discharge frequency of the contralateral trigeminal ganglion. Summary Professor Huang Yusen pointed out that this study was conducted through clinical pain questionnaires, rat electrophysiology Experiments found differences in the pain of cataract surgery in both eyes, and verified the changes in the inflammatory response of the contralateral anterior chamber after surgery in one eye through a rabbit phacoemulsification model. At the same time, the regulatory mechanism was further explored by establishing an animal model of superior cervical ganglionectomy, and found that CSF3 and sympathetic nerve activity have the potential to be targets for analgesia in ophthalmic surgery sex. At the same time, this study suggests that ophthalmologists should rationally arrange the interval between cataract operations in both eyes, attach importance to preoperative topical medication, and give patients adequate psychological intervention before the second eye surgery to improve patient satisfaction. Expert Profile Prof. Huang Yusen, MD, Chief Physician, Doctoral Supervisor. Director of Cataract Department of Qingdao Eye Hospital affiliated to Shandong First Medical University. Taishan Scholars Distinguished Expert, Qilu Health and Health Leading Talent, Qingdao Top Talent. Member of Cataract Group of Ophthalmology Branch of Chinese Medical Association (9th, 10th and 11th sessions), Standing Committee Member of Ophthalmology Branch of Ethnic Health Association, Deputy Director of Ophthalmology Branch of Shandong Medical Association, Member of Ophthalmology Branch of Chinese Geriatrics Association, China Research Member of the Professional Committee of Ophthalmology and Optometry of the Association of Hospitals. The first to undertake 4 National Natural Science Foundation of China, 6 provincial and ministerial level projects. Editor-in-chief of "Children's Cataract Science" (People's Health Publishing House). He has published more than 70 papers, and more than 30 first or corresponding SCI papers. He has won the Shandong Provincial Science and Technology Progress Award, the Chinese Medical Award, the Chinese Ophthalmology Association Award, and the Shandong Provincial Youth Science and Technology Award. References: Fan Zheng., Fan Caixia., Qi Benxiang., Zhang Bin., Li Wenfeng., Qi Xia., Liu Xiaomin., Zhang Bi Ning., Huang Yusen.(2022). Sympathetic Nerve-Mediated Fellow Eye Pain During Sequential Cataract Surgery by Regulating Granulocyte Colony Stimulating Factor CSF3. Front Cell Neurosci, 16, 841733. doi:10.3389/fncel.2022.841733.

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