Abstract:AIM: To investigate the predictive value of tear secretion-related protein 5(SFRP-5), hypoxia-inducible factor-1α(HIF-1α), and interferon regulatory factor 4(IRF4)for postoperative dry eye in patients with age-related cataracts.
METHODS: A total of 212 patients with age-related cataracts admitted to our hospital from January 2024 to December 2024 were prospectively selected(study group). According to whether postoperative dry eye occurred, they were divided into a dry eye group(96 cases)and a non-dry eye group(116 cases). Additionally, 110 individuals who underwent health check-ups during the same period were selected as the control group. The correlation between tear fluid levels of SFRP-5, HIF-1α, and IRF4 and the history of keratoconjunctival disease, tear film break-up time(BUT), and fluorescein(FL)in dry eye syndrome patients was analyzed through Pearson and Spearman methods. Logistic regression analysis was used to identify factors for postoperative dry eye; relative risk analysis was conducted to assess the impact of different levels of tear SFRP-5, HIF-1α, and IRF4 on postoperative dry eye; ROC curve analysis was performed to evaluate the predictive value for postoperative dry eye.
RESULTS: The general data of the study group and the control group were comparable. The study group showed lower expression of SFRP-5 in tears and higher expression of HIF-1α and IRF4 in tears compared to the control group(all P<0.05). The proportion of patients with a history of corneal and conjunctival disease was higher in the dry eye group than in the non-dry eye group(P<0.05). Tear SFRP-5 expression was lower and tear HIF-1α and IRF4 expression was higher in the dry eye group compared to the non-dry eye group(all P<0.05). According to Pearson correlation analysis, tear SFRP-5, HIF-1α, and IRF4 correlated with BUT and FL(all P<0.05). SFRP-5 was a protective factor for postoperative dry eye, while HIF-1α, IRF4, and a history of corneal and conjunctival disease were risk factors(all P<0.05). The risk of postoperative dry eye in patients with low expression of SFRP-5 was 1.678 times that of patients with high expression of SFRP-5, the risk of postoperative dry eye in patients with high expression of HIF-1α was 1.536 times that of patients with low expression of HIF-1α, and the risk of postoperative dry eye in patients with high expression of IRF4 was 1.616 times that of patients with low expression of IRF4. The AUCs for predicting postoperative dry eye using tear SFRP-5, HIF-1α, and IRF4 individually and in combination were 0.772, 0.699, 0.724, and 0.872, respectively, with combined prediction outperforming individual markers(all P<0.05).
CONCLUSION: In patients with age-related cataracts, tear SFRP-5 expression is downregulated, while HIF-1α and IRF4 expression are upregulated, and this is associated with the development of dry eye after surgery. Combined detection can improve the predictive value for postoperative dry eye.
