Skip to main content

Advertisement

SpringerLink
Log in

Neutrophil lymphocyte ratio as a predictor of perioperative complications in patients with PEX Syndrome during cataract surgery

  • Original Paper
  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

Introduction

Pseudoexfoliation syndrome (PES) is an age-related process associated with glaucoma and cataracts. It increases the risk of complications during cataract surgery. Blood neutrophil-to-lymphocyte ratio (NLR) is shown to be an effective biomarker of inflammation in PES. We aimed to investigate association of NLR and pseudoexfoliation (PEX) related cataract surgery complications.

Methods

A total of 210 eyes who underwent cataract surgery between January 2016 and January 2020 in our department were analyzed retrospectively. Patients were grouped with respect to developing complications and the two groups were compared. Medical records were reached to obtain neutrophil and lymphocyte values to calculate NLR. Data obtained were analyzed using chi-square test. Receiver operating characteristics curve analysis was performed to determine cutoff, sensitivity and specificity values. p value of ≤ 0.05 was considered statistically significant.

Results

The mean age was 68.1 ± 7.2 years and mean NLR was 2.11 ± 0.81. Complications were observed in 32 (15.2%) of the patients (group 1). Neutrophil counts (5.19 ± 0.64 vs. 4.43 ± 0.86, p < 0.001) and the NLR (2.68 ± 0.73 vs. 2.01 ± 0.81, p < 0.001) of group 1 were significantly higher than group 2. The ROC analysis revealed a cutoff value of 2.33 for NLR to predict cataract surgery complications with sensitivity of 87.5% and specificity of 78.1%.

Conclusion

There is an association between NLR and increased risk of complications during cataract surgery in PES patients. NLR can be used as an easy method to help ophthalmologists in predicting the risks associated with cataract surgery in PEX eyes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Jonas JB, George R, Asokan R et al (2014) Prevalence and causes of vision loss in Central and South Asia: 1990–2010. Br J Ophthalmol 98(5):592–598. https://doi.org/10.1136/bjophthalmol-2013-303998

    Article  PubMed  Google Scholar 

  2. Schlötzer-Schrehardt U, Naumann GO (2006) Ocular and systemic pseudoexfoliation syndrome. Am J Ophthalmol 141(5):921–937. https://doi.org/10.1016/j.ajo.2006.01.047

    Article  PubMed  Google Scholar 

  3. Shingleton BJ, Crandall AS, Ahmed II (2009) Pseudoexfoliation and the cataract surgeon: preoperative, intraoperative, and postoperative issues related to intraocular pressure, cataract, and intraocular lenses. J Cataract Refract Surg 35(6):1101–1120. https://doi.org/10.1016/j.jcrs.2009.03.011

    Article  PubMed  Google Scholar 

  4. Tamhane UU, Aneja S, Montgomery D, Rogers EK, Eagle KA, Gurm HS (2008) Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol 102(6):653–657. https://doi.org/10.1016/j.amjcard.2008.05.006

    Article  PubMed  Google Scholar 

  5. Azab B, Jaglall N, Atallah JP et al (2011) Neutrophil-lymphocyte ratio as a predictor of adverse outcomes of acute pancreatitis. Pancreatology 11(4):445–452. https://doi.org/10.1159/000331494

    Article  PubMed  Google Scholar 

  6. Yoon NB, Son C, Um SJ (2013) Role of the neutrophil-lymphocyte count ratio in the differential diagnosis between pulmonary tuberculosis and bacterial community-acquired pneumonia. Ann Lab Med 33(2):105–110. https://doi.org/10.3343/alm.2013.33.2.105

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kurtul BE, Ozer PA, Kabatas EU (2016) Elevated neutrophil-to-lymphocyte ratio in pseudoexfoliation syndrome. Eye (Lond) 30(8):1045–1048. https://doi.org/10.1038/eye.2016.89

    Article  CAS  Google Scholar 

  8. Damji KF, Bains HS, Stefansson E et al (1998) Is pseudoexfoliation syndrome inherited? A review of genetic and nongenetic factors and a new observation. Ophthalmic Genet 19(4):175–185. https://doi.org/10.1076/opge.19.4.175.2310

    Article  CAS  PubMed  Google Scholar 

  9. Zenkel M, Lewczuk P, Jünemann A, Kruse FE, Naumann GO, Schlötzer-Schrehardt U (2010) Proinflammatory cytokines are involved in the initiation of the abnormal matrix process in pseudoexfoliation syndrome/glaucoma. Am J Pathol 176(6):2868–2879. https://doi.org/10.2353/ajpath.2010.090914

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Yildirim Z, Yildirim F, Uçgun NI, Sepici-Dinçel A (2013) The role of the cytokines in the pathogenesis of pseudoexfoliation syndrome. Int J Ophthalmol 6(1):50–53. https://doi.org/10.3980/j.issn.2222-3959.2013.01.10

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Türkyılmaz K, Öner V, Kırbas A et al (2013) Serum YKL-40 levels as a novel marker of inflammation and endothelial dysfunction in patients with pseudoexfoliation syndrome. Eye (Lond) 27(7):854–859. https://doi.org/10.1038/eye.2013.92

    Article  CAS  Google Scholar 

  12. Kurtul BE, Ozer PA (2016) The Relationship between Neutrophil-to-lymphocyte Ratio and Age-related Macular Degeneration. Korean J Ophthalmol 30(5):377–381. https://doi.org/10.3341/kjo.2016.30.5.377

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Ilhan C, Citirik M, Uzel MM, Tekin K (2019) The relationship of neutrophil to lymphocyte ratio with vitreomacular traction syndrome. Med Hypothesis Discov Innov Ophthalmol 8(1):22–27

    PubMed  PubMed Central  Google Scholar 

  14. Ocakoglu O, Koyluoglu N, Kayiran A, Tamcelik N, Ozkan S (2004) Microvascular blood flow of the optic nerve head and peripapillary retina in unilateral exfoliation syndrome. Acta Ophthalmol Scand 82(1):49–53. https://doi.org/10.1046/j.1600-0420.2003.00196.x

    Article  PubMed  Google Scholar 

  15. Drolsum L, Haaskjold E, Sandvig K (1998) Phacoemulsification in eyes with pseudoexfoliation. J Cataract Refract Surg 24(6):787–792. https://doi.org/10.1016/s0886-3350(98)80132-6

    Article  CAS  PubMed  Google Scholar 

  16. Naik AU, Gadewar SB (2017) Visual outcome of phacoemulsification versus small incision cataract surgery in pseudoexfoliation syndrome - A pilot study. J Clin Diagn Res 11(1):NC05–NC08. https://doi.org/10.7860/JCDR/2017/22207.9311

    Article  PubMed  PubMed Central  Google Scholar 

  17. Joshi RS, Singanwad SV (2019) Frequency and surgical difficulties associated with pseudoexfoliation syndrome among Indian rural population scheduled for cataract surgery: hospital-based data. Indian J Ophthalmol 67(2):221–226. https://doi.org/10.4103/ijo.IJO_931_18

    Article  PubMed  PubMed Central  Google Scholar 

  18. Aigbe N, Madzou M, Fiqhi A et al (2014) Pseudoexfoliation syndrome and phacoemulsification: a comparative study with a control population. J Fr Ophtalmol 37(6):e91–e95. https://doi.org/10.1016/j.jfo.2013.09.010

    Article  CAS  PubMed  Google Scholar 

  19. Naumann GO, Küchle M, Schönherr U (1989) Pseudo-exfoliation syndrome as a risk factor for vitreous loss in extra-capsular cataract extraction. The Erlangen Eye Information Group. Fortschr Ophthalmol 86(6):543–545

    CAS  PubMed  Google Scholar 

  20. Lumme P, Laatikainen L (1993) Exfoliation syndrome and cataract extraction. Am J Ophthalmol 116(1):51–55. https://doi.org/10.1016/s0002-9394(14)71743-x

    Article  CAS  PubMed  Google Scholar 

  21. Shingleton BJ, Heltzer J, O’Donoghue MW (2003) Outcomes of phacoemulsification in patients with and without pseudoexfoliation syndrome. J Cataract Refract Surg 29(6):1080–1086. https://doi.org/10.1016/s0886-3350(02)01993-4

    Article  PubMed  Google Scholar 

  22. Avramides S, Traianidis P, Sakkias G (1997) Cataract surgery and lens implantation in eyes with exfoliation syndrome. J Cataract Refract Surg 23(4):583–587. https://doi.org/10.1016/s0886-3350(97)80219-2

    Article  CAS  PubMed  Google Scholar 

  23. Hyams M, Mathalone N, Herskovitz M, Hod Y, Israeli D, Geyer O (2005) Intraoperative complications of phacoemulsification in eyes with and without pseudoexfoliation. J Cataract Refract Surg 31(5):1002–1005. https://doi.org/10.1016/j.jcrs.2004.09.051

    Article  PubMed  Google Scholar 

  24. Nagashima RJ (2004) Decreased incidence of capsule complications and vitreous loss during phacoemulsification in eyes with pseudoexfoliation syndrome. J Cataract Refract Surg 30(1):127–131. https://doi.org/10.1016/S0886-3350(03)00465-6

    Article  PubMed  Google Scholar 

  25. Erkayhan GE, Dogan S (2017) Cataract surgery and possible complications in patients with pseudoexfoliation syndrome. Eurasian J Med 49(1):22–25. https://doi.org/10.5152/eurasianjmed.2016.0060

    Article  PubMed  Google Scholar 

  26. Sekeroglu MA, Bozkurt B, Irkec M, Ustunel S, Orhan M, Saracbasi O (2008) Systemic associations and prevalence of exfoliation syndrome in patients scheduled for cataract surgery. Eur J Ophthalmol 18(4):551–555. https://doi.org/10.1177/112067210801800408

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

No funding was received for this research.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Dr. Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Turkey

    Sabite Emine Gökce

  2. Department of Ophthalmology, Ankara City Hospital, Ankara, Turkey

    Ceyda Başkan

Authors
  1. Sabite Emine Gökce
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ceyda Başkan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sabite Emine Gökce.

Ethics declarations

Conflict of Interest

None of the authors have any financial relation to declare about the manuscript.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gökce, S.E., Başkan, C. Neutrophil lymphocyte ratio as a predictor of perioperative complications in patients with PEX Syndrome during cataract surgery. Int Ophthalmol 42, 1311–1316 (2022). https://doi.org/10.1007/s10792-021-02118-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-021-02118-z

Keywords

Search

Navigation