Cytokines in aqueous humor of patients with congenital cataract during delayed sequential bilateral cataract surgery

Patients

This prospective study conducted in Shaanxi Eye Hospital, Xi’an People’s Hospital (Xi’an Fourth Hospital), Xi’an, China, from April 2022 to August 2022. It was approved by the ethics committee of Xi’an People’s Hospital and adhered to the tenets of the Declaration of Helsinki and its amendments. Guardians of each child were informed and signed consent before enrollment. The study was registered at www.chictr.org.cnon22/03/2022 and the clinical trial number is ChiCTR2200057927.

28 patients with bilateral CC were included in this study. Previous history of ocular surgery, other congenital ocular or systemic diseases, including but not limited to glaucoma, corneal disorders, vitreous and retinal diseases, congenital heart disease, with AH content less than 0.5 ml, were excluded from this study. 28 patients with CC underwent lens aspiration, posterior capsulotomy and anterior vitrectomy. Intraocular lens (IOL) were implanted in patients over 2 years old, but not in patients under 2 years old. One eye was randomly selected for the first surgery, which was the first eye group. The other eyes underwent the second surgery after a period of time, which was the second eye group.

All patients underwent thorough ophthalmologic examination, including slit-lamp examination, intraocular pressure, fundus examination and B-scan ultrasonography. Corneal endothelium and IOL master (Carl Zeiss Meditec, Jena, Germany) were examined in patients over 2 years old. The IOL power was calculated by Barrett II formula and the target diopter was determined according to the ocular axis and age of the patient. All surgeries were performed under general anesthesia by the same pediatric cataract surgeon, using a Stellaris platform (Bausch & Lomb Incorporated, Rochester, NY, USA). The procedures included conjunctival peritomy and 2.2 mm corneoscleral tunnel incision at the 11 o’clock position, the anterior continuous circular capsulorhexis with a diameter of about 5.5 mm, lens aspiration, posterior capsulotomy, limited anterior vitrectomy, in-the-bag implantation of IOL MI60 (Bausch & Lomb Incorporated, Rochester, NY, USA) and suturing conjunctival and corneoscleral incision. Postoperatively, a topical treatment included antibiotics (0.3% tobramycin eye drop, 4 times per day for a month) and steroids (1% prednisolone acetate eye drop, 4 times a day for a month).

Sample collection

Samples of AH (50–200µL) were collected with a 27-gauge needle before any incision was made during each operation. Avoid touching the iris, the corneal endothelium or the lens when the needle entered the anterior chamber from the limbus. AH samples were stored at -80℃ instantly until analysis.

Analysis of cytokines

The following cytokines including Granulocyte colony stimulating factor (G-CSF), interleukin 1 alpha (IL-1 α), interleukin 6 (IL-6), interleukin 7 (IL-7), epidermal growth factor (EGF), interleukin 3 (IL-3), interleukin 8(IL-8)/CXCL8, MCP-1/CCL2, tumor necrosis factorα(TNFα), platelet-derived growth factor AA (PDGF-AA), IP-10/CXCL10 and IL-2 were measured using a Luminex system (Luminex xMAP Technology, Bio-Rad Laboratories, Inc., Hercules, CA, USA) with Human Premixed Multi-Analyte Kit (Cat:LXSAHM-13, Lot: L141227;R&D system, Minneapolis, MN, USA). All assays were performed in accordance with the manufacturer’s guidelines.

Statistical methods

Statistical analysis was conducted with SPSS software for Windows (version 23.0, IBM Corp., CA, USA). The detection rate for each cytokine was compared between the first-eye and second-eye group with Fisher’s exact probability test. If the detection rate of any cytokines was more than 85%, the cytokines would be further statistically analyzed. The normality of all data was evaluated with Shapiro-Wilk test. If normality was achieved, student’s t test for paired data and student’s t test for unpaired data were used. If normality was not achieved, Wilcoxon rank-sum test was applied to analyze the paired data, and Mann-Whitney U test was used to compare the data between groups. Spearman’s correlation coefficient was used to analyze the correlation between age, interval and level of cytokines. A P value of less than 0.05 was considered as a statistically significant difference for all statistical tests. The results are expressed as the mean ± standard deviation.

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