Intraoperative pain sensitivity and aqueous humor inflammatory cytokine profiles in hepatitis C virus antibody-positive cataract patients.

purposeTo investigate the differences in intraoperative pain sensitivity between cataract patients with and without hepatitis C virus (HCV) antibody-positivity, and to compare the expression levels of inflammatory cytokines in aqueous humor.

methodsThis was a case-control study that enrolled a total of 17 HCV antibody-positive cataract patients and 17 HCV antibody-negative cataract patients. Aqueous humor samples were collected during cataract surgery, and 40 cytokines were detected and analyzed. The intraoperative pain levels were evaluated using three subjective questionnaires consisting of two components: the first component was a blinded assessment performed by the same chief surgeon during the operation, and the second component was a patient self-assessment of pain completed 1 h after surgery. Age and the parameters of liver and kidney function, which were approximately normally distributed continuous variables, were presented as Mean ± SD, and between-group comparisons were performed using the independent-samples t-test. Pain scores and inflammatory cytokines levels, which were non-normally distributed continuous variables, were expressed as "median [Q1, Q3]", and between-group comparisons were conducted using the Mann‑Whitney U test. Categorical variables including gender and laterality of the affected eye were compared using the chi‑square test. Correlation analysis was performed using Spearman's correlation coefficient.

resultsIntraoperative cooperation scores were 2 [2, 3] in HCV antibody-positive patients and 1 [1, 2] in HCV antibody-negative patients, with a significant difference (P = 0.01). Intraoperative pain expression scores were 2 [2, 3] and 1 [1, 2], respectively (P < 0.01). Intraoperative pain self-assessment scores were 4 [2, 6] and 2 [1, 2], respectively (P < 0.01). Aqueous humor levels of TNF‑β were 0.12 [0.11, 0.19] ng/L in HCV antibody-positive patients and 3.77 [1.97, 4.68] ng/L in HCV antibody-negative patients (P < 0.01). M‑CSF levels were 0.27 [0.19, 0.40] ng/L and 0.09 [0.08, 0.12] ng/L, respectively (P < 0.01). I‑309 levels were 2.83 [1.73, 3.37] ng/L and 1.37 [0.71, 1.85] ng/L, respectively (P = 0.01). MCP‑1 levels were 786.04 [667.62, 963.99] ng/L and 657.12 [636.74, 694.78] ng/L, respectively (P = 0.01). Furthermore, pain scores were negatively correlated with TNF‑β levels, and all correlations were statistically significant (all P < 0.01).

conclusionHCV antibody-positive cataract patients demonstrated significantly higher pain sensitivity during phacoemulsification surgery compared with HCV antibody-negative patients. HCV antibody-positivity may represent one of the contributing factors for increased intraoperative pain in cataract patients, which may be associated with abnormal expression of inflammatory cytokines in the aqueous humor.