AIM: To investigate the performance of angiopoietin-like protein 4(ANGPTL4)and hypoxia-inducible factor 1α(HIF-1α)levels in the aqueous humor in predicting the occurrence of postoperative macular edema of patients with diabetic cataract.

METHODS: A total of 61 cases of diabetic cataract patients who underwent surgical treatment and developed macular edema in Jiaozhou Central Hospital of Qingdao from January 2021 to December 2023 were selected as study group, and 42 cases of patients who did not develop macular edema were collected as control group. According to the grading of macular edema, they were separated into 39 cases of grade I macular edema, 18 cases of grade II macular edema, and 4 cases of grade III macular edema. Enzyme-linked immunosorbent assay(ELISA)was applied to determine the levels of ANGPTL4, HIF-1α, inflammatory factors such as vascular endothelial growth factor(VEGF), interleukin-8(IL-8), and monocyte chemotactic protein-1(MCP-1)in aqueous humor. Optical coherence tomography was applied to measure the thickness of the macular fovea. Pearson method was applied to analyze the correlation of ANGPTL4 and HIF-1α in aqueous humor with inflammatory factors and foveal thickness in patients with diabetic cataract. Logistic regression was applied to analyze factors affecting the prediction of macular edema after surgery in diabetic cataract. Receiver operating curve(ROC)was applied to analyze the performance of ANGPTL4 and HIF-1α levels in aqueous humor on predicting postoperative macular edema.

RESULTS: The levels of ANGPTL4, HIF-1α, VEGF, IL-8, MCP-1 in the aqueous humor of the study group and the macular foveal thickness were obviously higher than those of the control group(all P<0.01). With the exacerbation of macular edema, the levels of ANGPTL4 and HIF-1α in aqueous humor obviously increased(all P<0.01). The levels of ANGPTL4 and HIF-1α in aqueous humor were positively correlated with VEGF, IL-8, MCP-1, and macular foveal thickness, respectively(all P<0.05). ANGPTL4, HIF-1α, VEGF and MCP-1 were risk factors for predicting macular edema after cataract surgery in diabetic cataract(all P<0.05). The AUC for predicting postoperative macular edema of ANGPTL4, HIF-1α, and their combination in aqueous humor was 0.883, 0.844, and 0.945, respectively, and the combined prediction was obviously higher than the levels of ANGPTL4 and HIF-1α predicted separately.

CONCLUSION: The levels of ANGPTL4 and HIF-1α in aqueous humor of diabetic cataract patients are obviously increased, the combination of the two can effectively predict the occurrence of postoperative macular edema, and clinical treatment can reduce the probability of postoperative macular edema by interfering with the levels of the two.