ORIGINAL RESEARCH article
Front. Med.
Sec. Ophthalmology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1626533
This article is part of the Research TopicNew Concepts, Advances, and Future Trends in Clinical Research on Eye DiseasesView all 48 articles
Systemic Inflammatory and Oxidative Stress Biomarkers as Predictors of Pain in Sequential Bilateral Phacoemulsification for Age-Related Cataract
Provisionally accepted
- The Air Force Medical Center, Beijing, China
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Background: Second-eye cataract surgery is frequently associated with enhanced pain perception compared to first-eye procedures, yet the underlying pathophysiological mechanisms remain incompletely understood. This study investigated whether systemic inflammatory biomarkers and oxidative stress indicators could predict and explain the differential pain experience in sequential bilateral phacoemulsification for age-related cataract.Methods: In this prospective, single-blinded case-control study, we enrolled 80 patients with age-related cataract undergoing sequential bilateral phacoemulsification. Patients underwent first-eye surgery followed by second-eye surgery within a median interval of 2.5 months (range: 1-3 months). Matching was performed using propensity score matching based on age (±2 years), gender, diabetes status (HbA1c levels), and hypertension status (blood pressure measurements). Inflammatory biomarkers, including neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-8 (IL-8), and the oxidative stress marker superoxide dismutase (SOD), were analyzed in preoperative blood samples. Postoperative pain was evaluated 24 hours after surgery using the visual analogue scale (VAS). A novel cataract pain prediction model, along with correlation analysis and receiver operating characteristic (ROC) curves, was developed to assess the diagnostic and predictive value of these biomarkers.Results: The second-eye surgery group demonstrated significantly elevated levels of systemic inflammatory markers (NLR, MLR, CRP, IL-6, IL-8) and oxidative stress indicator (SOD) compared to first-eye patients (all P<0.05). VAS pain scores were notably higher in the second-eye group compared to the first-eye group (1.99±1.42 vs. 0.82±0.86, P<0.001). Significant positive correlations were observed between VAS scores and NLR (r=0.489, 95% CI: 0.315-0.632, P<0.001), MLR (r=0.385, 95% CI: 0.193-0.548, P<0.001), CRP (r=0.284, 95% CI: 0.082-0.464, P<0.001), and SOD (r=0.334, 95% CI: 0.136-0.507, P<0.001). ROC analysis confirmed the diagnostic value of these biomarkers for predicting enhanced postoperative pain (AUCs: NLR=0.800, MLR=0.737, CRP=0.669, SOD=0.718; all P<0.05). A multivariate prediction model incorporating these biomarkers achieved superior discriminative ability (AUC=0.812, P<0.001).Conclusion: This study demonstrates a significant association between increased systemic inflammatory biomarkers, oxidative stress indicators, and heightened pain perception in second-eye cataract surgery. Our findings provide valuable insights into the pathophysiological mechanisms underlying the second-eye phenomenon and offer potential clinical biomarkers for preoperative pain risk stratification.
Keywords: Age-related cataract, Phacoemulsification, Pain prediction, Inflammatory biomarkers, Oxidative Stress, Patient-centered outcomes
Received: 11 May 2025; Accepted: 25 Jun 2025.
Copyright: © 2025 Yin, Wang, Hou, Huang, Sun and Shao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Dewang Shao, The Air Force Medical Center, Beijing, China
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