Abstract:AIM: To investigate the predictive value of serum pentraxin-3(PTX3), Toll-like receptor 4(TLR4), stromal cell-derived factor-1(SDF-1)for postoperative dry eye disease(DED)in patients with type 2 diabetes mellitus(T2DM)complicated with cataract.
METHODS:Prospective study.T2DM patients with cataract who underwent phacoemulsification combined with intraocular lens implantation in the hospital from February 2024 to August 2025 were enrolled. Patients were divided into the DED group and the non-DED(N-DED)group according to the occurrence of postoperative DED. Meanwhile, another patients with simple cataract admitted during the same period were selected as the control group(cataract group). The levels of serum PTX3, TLR4, and SDF-1 were measured by enzyme-linked immunosorbent assay(ELISA). Multivariate Logistic regression analysis was performed to screen the factors influencing the occurrence of postoperative DED in patients with T2DM complicated with cataract. Receiver operating characteristic(ROC)curves were used to evaluate the predictive value of serum PTX3, TLR4, and SDF-1 for postoperative DED in these patients. Internal validation was performed by generating a calibration curve using the bootstrap resampling method. Decision curve analysis(DCA)was used to evaluate the clinical applicability of the combined prediction model for postoperative DED in these patients.
RESULTS: This study included 120 patients in the T2DM with cataract group(39 cases in the DED group and 81 cases in the N-DED group)and 120 patients in the cataract group. In the T2DM with cataract group, there were 63 males and 57 females, with a mean age of 58.38±7.11 y; in the cataract group, there were 65 males and 55 females, with a mean age of 58.62±7.21 y; in the DED group, there were 21 males and 18 females, with a mean age of 58.61±7.25 y; and in the N-DED group, there were 42 males and 39 females, with a mean age of 58.27±7.04 y. The serum levels of PTX3, TLR4, and SDF-1 in the T2DM combined with cataract group were significantly higher than those in the simple cataract group(all P<0.001). Meanwhile, the duration of T2DM, HbA1c, and serum levels of PTX3, TLR4, SDF-1 in the DED group were markedly elevated compared with the N-DED group, and the BUT was shorter than that in the N-DED group(all P<0.001). Serum levels of PTX3, TLR4, and SDF-1 were identified as risk factors for postoperative DED in patients(all P<0.05). The area under the curve(AUC)of combination of serum PTX3, TLR4, and SDF-1 levels in predicting DED was significantly higher than that of individual predictions(Z=2.394, 2.538, 2.529, all P<0.05). The calibration curve of the combined model of serum PTX3, TLR4, and SDF-1 for predicting postoperative DED in T2DM patients with cataract showed good agreement with the ideal curve. Within the high-risk threshold range of 0.04 to 0.85, the combined model of serum PTX3, TLR4, and SDF-1 in predicting the net benefit rate of postoperative DED in these patients was superior to the individual prediction.
CONCLUSION:In T2DM patients with cataract who develop postoperative DED, serum PTX3, TLR4, and SDF-1 levels are significantly elevated and demonstrate certain predictive value for postoperative DED.
