Sodium hyaluronate combined with rhEGF contributes to alleviate clinical symptoms and Inflammation in patients with Xerophthalmia after cataract surgery

Abstract

Background: To determine the effect of sodium hyaluronate combined with recombinant human epidermal growth factor (rhEGF) on clinical symptoms and inflammation in patients with newly diagnosed xerophthalmia after cataract surgery.

Methods: A total of 106 patients who underwent cataract surgery and were newly diagnosed with xerophthalmia in our hospital between June 2018 and August 2019 were enrolled. Of these, 50 patients who were treated with sodium hyaluronate (0.1%) were assigned to the monotherapy group (MG) and the remaining 56 patients who were treated with sodium hyaluronate (0.1%) combined with rhEGF (20 μg/ml) were assigned to the combination group (CG). The 2 groups were compared based on ocular surface disease index (OSDI) score, break-up time (BUT), fluorescein corneal staining level, Schirmer I test (SI) level, clinical efficacy (disappearance of typical symptoms, including eyes drying, burning sensation, foreign body sensation, etc), and interleukin (IL)-1, IL-6, and tumor necrosis factor-α (TNF-α) levels. Spearman correlation analysis was conducted to analyze the relationship between IL-1, IL-6, TNF-α and clinical efficacy. In addition, receiver operating characteristic curves were drawn to analyze the predictive value of IL-1, IL-6, and TNF-α in efficacy on xerophthalmia.

Results: After treatment, the CG showed reduced OSDI score compared with the MG. The CG showed increased BUT (s) and SI (mm) levels compared with MG. After treatment, the CG exhibited decreased levels of IL-1(ng/mL), IL-6 (ng/mL), and TNF-α (ng/mL) compared with the MG. Spearman correlation analysis revealed that IL-1, IL-6, and TNF-α were negatively correlated with clinical efficacy. The areas under the curves of IL-1, IL-6, and TNF-α were 0.801, 0.800, and 0.736 respectively.

Conclusions: Sodium hyaluronate combined with rhEGF is helpful to alleviate clinical symptoms and inflammation in patients with xerophthalmia undergoing cataract surgery.

Keywords: Cataract surgery; Sodium hyaluronate; Xerophthalmia; rhEGF.

Fig. 1

There was no significant difference in OSDI score between the 2 groups before treatment. After treatment, the OSDI scores of both groups decreased (P < 0.001), and the OSDI score of the combination group was significantly lower than that of the monotherapy group (P < 0.001). *** indicates P < 0.001

Fig. 2

Correlation of IL-1, IL-6, and TNF-α with clinical efficacy. A With the increase of IL-1 level, the clinical efficacy gradually declined, and IL-1 level was negatively correlated with clinical efficacy (r = 0.485, P < 0.001). B With the increase of IL-6 level, the clinical efficacy gradually declined, and IL-6 level was negatively correlated with clinical efficacy (r = 0.497, P < 0.001). C With the increase of TNF-α level, the clinical efficacy gradually declined, and TNF-α level was negatively correlated with clinical efficacy (r = 0.536, P < 0.001)

Fig. 3

A The level of IL-1 in the good efficacy group was significantly lower than that in the poor efficacy group. B The level of IL-6 in the good efficacy group was significantly lower than that in the poor efficacy group. C The level of TNF-α in the good efficacy group was significantly lower than that in the poor efficacy group. * * * indicates P < 0.001

Fig. 4

ROC curves showing the predictive value of IL-1, IL-6, and TNF-α in the efficacy on xerophthalmia. The red line indicates the ROC curve of the predictive value of IL-1 in the efficacy on xerophthalmia, and the area under the curve was 0.801. The blue line indicates the ROC curve of the predictive value of IL-6 in the efficacy on xerophthalmia, and the area under the curve was 0.800. The green line indicates the ROC curve of the predictive value of TNF-α in the efficacy on xerophthalmia, and the area under the curve was 0.736