Comparison of local inflammatory response after phacoemulsification complicated by intraoperative fluid misdirection syndrome, with draining posterior capsulorhexis

Purpose. To evaluate the severity of the local inflammatory response after cataract surgery complicated by intraoperative fluid misdirection syndrome (IFMS) by assessing the profile of proinflammatory cytokines in tears and morphological changes in the macular area according to OCT. To evaluate the safety and efficacy of draining posterior capsulorhexis (DPCR) in case of IFMS. Material and methods. There were 3 groups of patients in the prospective study: control group — uneventful phacoemulsification (30 patients); comparison group — phacoemulsification complicated by IFMS with lens particles in the retrolental space (30 patients); study group — phacoemulsification complicated by IFMS with DPCR (30 patients). BCVA, the concentration of IL-6, IL-8 in tears using enzymelinked immunosorbent assay (ELISA), central retinal thickness (CRT) and the volume of the macular area according to OCT were assessed before surgery, on the 1st day, at 1 week and 1 month postop. Results. There were no statistically significant differences between the groups in BCVA. All groups showed an increase in the CRT and macular volume at 1 week and 1 month postop. A statistically significant (p≤0.05) increase of these measurements was determined in the comparison group. In all groups, an increase in the concentration of the studied cytokines was noted on 1st day postop, followed by a decrease in the concentrations of IL-6 and IL-8 at 1 week postop. However, the degree of decrease in the concentration of proinflammatory cytokines was significantly (p≤0.05) lower in the comparison group. Conclusion. The development of IFMS during cataract surgery leads to an increased local inflammatory response. It was confirmed by a higher concentration of proinflammatory cytokines in tears, as well as a significant increase in the CRT and volume of the macular area according to OCT at 1 month postop. Performing DPCR allows to reduce the severity of the local inflammatory response, that was confirmed by the lower concentration of pro-inflammatory cytokines in the tear compared to the comparison group with the development of IFMS, as well as the absence of significant changes in the CRT and the volume of the macular area according to OCT. Key words: phacoemulsification, primary posterior capsulorhexis, intraoperative fluid misdirection syndrome