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 s…