Effect of intraocular surgery and ketamine on aqueous and serum cytokines

PURPOSE To determine the effect of intraocular surgery and anesthesia on aqueous and serum cytokines. METHODS Patients undergoing routine cataract surgery under general and local (peribulbar) anesthesia were randomized to those given general anesthetic with and without the use of ketamine and those having local anesthesia. Aqueous and serum levels of cytokines were collected at commencement of surgery and were determined by an immunoassay using multi-analyte biochip array technology at 18 h post-operatively. RESULTS At 18 h postoperative, all patients (37) showed significant and many fold increases in their aqueous levels of interleukin (IL)-1alpha, IL-1beta, IL-4, IL-6, IL-8, vascular endothelial growth factor (VEGF), tumor necrosis factor (TNF)-alpha, interferon (IFN)-gamma, epidermal growth factor (EGF), and monocyte chemotactic protein (MCP)-1. There was little to no increase in IL-2 and IL-10. Significant increases in some cytokines (EGF, IL-6, and IFN-gamma) in the serum were also found (p=0.038). There were no significant differences in aqueous cytokine levels following the use of ketamine or between those patients who had general and local anesthesia (0.11<p<0.97). CONCLUSIONS There is an aqueous and serum cytokine response following intraocular surgery whether local (peribulbar) or general anesthesia is used. Of the aqueous cytokines measured, three different patterns of responses emerged at 18 h post-cataract surgery; those that were highly increased (IL-8, IL-6, IFN-gamma, and TNF-alpha), medium increase (IL-1beta, VEGF, IL-4, and MCP-1), and those with little to no change (EGF, IL-1alpha, IL-2, and IL-10).