Iris Vascular Area Density-Based Preoperative Pain-Risk Screening and Intervention in Second-Eye Cataract Surgery

Inclusion criteria

• Aged ≥ 50 years.
• Definite diagnosis of age-related cataract.
• The first-eye cataract surgery under local anesthesia has been completed at this hospital, and the second-eye cataract surgery under local anesthesia is planned with the same surgeon within 1 year of the first-eye surgery.
• Able to cooperate with preoperative iris optical coherence tomography angiography (OCTA) examination of the operative eye.
• On the day of the second-eye surgery, preoperative iris vascular area density (VAD) ≥ 0.2167 in the operative eye.

Exclusion criteria

• History of ocular trauma, ocular surgery (excluding the first-eye cataract surgery already performed), uveitis, chorioretinal disease, glaucoma;
• Presence of significant corneal disease, marked iris abnormalities, or any active ocular surface disease, including recent conjunctivitis, keratitis, or severe dry eye.
• Severe complications during or after the first-eye surgery (e.g., posterior capsule rupture, zonular dialysis, dislocation of the lens nucleus into the vitreous cavity, postoperative endophthalmitis, or glaucoma).
• History of chronic pain syndromes or neuropathic pain.
• Long-term use of opioids, other systemic analgesics, or sedative-hypnotic drugs.
• Known autoimmune disease or ongoing immunosuppressive therapy.
• Severe psychiatric disorders or cognitive impairment interfering with pain assessment.
• Use of topical corticosteroid eye drops in the second eye within 1 month prior to the planned surgery.
• Long-term use of α-adrenergic blockers or other medications associated with intraoperative floppy iris syndrome (IFIS).
• Participation in any other clinical trial involving ophthalmic or systemic drugs within the past 6 months.
• Known allergy or contraindication to topical nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., pranoprofen) or topical corticosteroids (e.g., prednisolone acetate) used in this study.