Evaluation of cytokine levels in the aqueous humor, intraoperative miosis, and postoperative intraocular inflammation in patients with pseudoexfoliation syndrome using or not using topical nonsteroidal anti-inflammatory eye drops

This study aimed to elucidate the pathophysiology of pseudoexfoliation syndrome (PES) and to evaluate the effects of preoperative topical nepafenac 0.1% on postoperative inflammatory response, intraoperative pupil dynamics, and cystoid macular edema (CME) development following cataract surgery in patients with PES. This cross-sectional, retrospective clinical study was conducted at the Department of Ophthalmology, Trakya University Faculty of Medicine, and included 73 patients who underwent cataract surgery for senile cataract. Patients were divided into three groups: a control group without pseudoexfoliation (n=26), a pseudoexfoliation group without medication (n=25), and a pseudoexfoliation group pretreated with topical nepafenac (n=22). During surgery, aqueous humor samples were collected, and thirteen inflammatory cytokines were quantified using flow cytometry. On postoperative day one, the anterior chamber reaction was significantly higher in the pseudoexfoliation group compared to the control group (p<0.05), whereas the medicated group demonstrated values comparable to controls. At one month postoperatively, the mean central retinal thickness was 270.6 µm in the pseudoexfoliation group and approximately 25 µm lower in the control and medicated groups (p<0.001). The mean intraoperative change in pupil diameter was 0.7 mm in the pseudoexfoliation group and 0.3 mm in the other two groups (p<0.001). Cytokine analysis revealed significantly elevated IL-6 and MCP-1 levels in the pseudoexfoliation group, with no significant difference between the control and medicated groups (p<0.05). These findings suggest that IL-6 and MCP-1 may serve as potential biomarkers in the pathogenesis of pseudoexfoliation syndrome. Furthermore, preoperative topical nepafenac 0.1% appears to effectively suppress surgery-induced inflammatory responses, thereby reducing both anterior and posterior segment complications and serving as a beneficial prophylactic agent in PES patients. Keywords: Pseudoexfoliation syndrome, Nepafenac, Cytokines, Inflammation, Cataract