Aqueous Proteomic and Metabolomic Profiles in Low-Energy vs High-Energy Femtosecond Laser-Assisted Cataract Surgery

To investigate the aqueous proteomics and metabolomics in low-energy and high-energy femtosecond laser-assisted cataract surgery (FLACS).

In this prospective observational study, 72 patients were randomized to 3 groups: low-energy FLACS, high-energy FLACS, and conventional phacoemulsification (controls). Aqueous was collected after femtosecond laser treatment or at the beginning of surgery (controls). Proteomic analysis was conducted using a data-independent acquisition method, whereas aqueous metabolomics were analyzed with liquid chromatography-tandem mass spectrometry. Bioinformatics analyses were performed to integrate the results of proteomics and metabolomics.

Compared with low-energy FLACS, significantly elevated aqueous hemoglobin subunit beta, G protein subunit beta, carbonic anhydrase 1, and asymmetric dimethylarginine were observed in high-energy FLACS, suggesting significantly greater oxidative stress, inflammation, immunity, metabolism, and mitochondrial fatty acids oxidation. Compared with controls, significantly increased aqueous proteins and metabolites related to immune and inflammation (beta-crystallin B1, hemoglobin subunit beta, putrescine, and spermine) and oxidative stress (heat shock proteins, peroxiredoxins, and long-chain acylcarnitines) were observed in FLACS. Joint pathway analysis revealed nicotinate/nicotinamide metabolism and riboflavin metabolism were significantly overexpressed in high-energy FLACS compared with low-energy FLACS, whereas the pentose phosphate pathway and glycolysis were the most significant pathways when comparing FLACS with controls.

FLACS induced higher immunological and inflammatory responses, oxidative stress reactions, and mitochondrial fatty acid oxidative stress compared with controls. These differential effects were more pronounced when a higher laser energy was used.