HCV antibody-positive cataract patients experience increased intraoperative pain and altered aqueous humor cytokine profiles

Managing intraoperative pain during cataract surgery is crucial for patient comfort and surgical success. While local anesthesia is standard, individual pain perception varies, potentially influenced by systemic conditions. Hepatitis C virus (HCV) infection is known to induce chronic systemic inflammation, which can impact various physiological processes, including pain pathways and local tissue inflammatory responses. Understanding how HCV status affects ocular inflammation and pain sensitivity could lead to more personalized pain management strategies, addressing a gap in current preoperative assessments for cataract patients.

This case-control study 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 from all participants. These samples were then analyzed for the expression levels of 40 cytokines using a detection method not specified in the abstract. Intraoperative pain levels were evaluated using three subjective questionnaires: a blinded assessment by the chief surgeon and a patient self-assessment completed 1 hour post-surgery. Between-group comparisons for pain scores and cytokine levels, which were non-normally distributed, were conducted using the Mann-Whitney U test.

HCV antibody-positive cataract patients exhibited significantly higher intraoperative pain sensitivity compared to HCV antibody-negative controls. Intraoperative cooperation scores were 2 [2, 3] in HCV antibody-positive patients versus 1 [1, 2] in HCV antibody-negative patients, a significant difference (P=0.01). Similarly, intraoperative pain expression scores were 2 [2, 3] for HCV-positive patients and 1 [1, 2] for HCV-negative patients (P<0.01). Patient self-assessment of pain also showed a marked difference, with scores of 4 [2, 6] for HCV-positive patients compared to 2 [1, 2] for HCV-negative patients (P<0.01). These findings indicate a consistent pattern of increased pain perception and reduced cooperation in patients with HCV antibodies during surgery. Regarding inflammatory profiles, aqueous humor levels of TNF-β were notably different between the groups.

TNF-β levels were 0.12 [0.11, 0.19] ng/L in HCV antibody-positive patients, significantly lower than the 3.77 [1.97, 4.68] ng/L observed in HCV antibody-negative patients (P<0.01). This suggests a distinct local inflammatory milieu in HCV-positive individuals, potentially influencing pain modulation, although the abstract only fully reported TNF-β results among the 40 cytokines analyzed.