Download Correlation of Conjunctival and Corneal Staining With Elevated

Paper #13545
Correlation of Conjunctival and Corneal Staining
With Elevated Matrix Metalloproteinase-9 on the
Ocular Surface of Dry-Eye Patients
The authors have no financial interests to
disclose, relevant to the topic of this poster.
Authors:
Allister Gibbons, MD
Felipe Valenzuela, MD
Daniel Waren, MSPH
Victor L. Perez, MD
Introduction
• Dry eye is a multifactorial disease of the tears and
ocular surface that results in symptoms of
discomfort, visual disturbance, and tear film
instability with potential damage to the ocular
surface. It is accompanied by increased
osmolarity of the tear film and inflammation of
the ocular surface.1
1The
Definition and Classification of Dry Eye Disease: Report of the Definition and Classification
Subcommittee of the International Dry Eye Work Shop (2007). Ocul Surf. 2007 Apr;5(2):93-107.
Introduction
• Ocular surface inflammation is both a marker
for dry eye and is also involved in its
pathophysiology
• Matrix Metalloproteinase-9 (MMP-9) is one of
the main mediators identified in the
inflammatory cascade associated with dry eye
Pflugfelder SC, et al. Dry eye and delayed tear clearance: "a call to arms".
Adv Exp Med Biol. 2002;506(Pt B):739-43.
Purpose
• To evaluate the clinical correlation between a
point-of-care MMP-9 immunoassay with
ocular surface staining and other objective
tear film and subjective ocular surface
parameters
Methods
• Retrospective non-comparative case series
– Included all patients referred for dry eye.
• 82 Eyes of 41 patients (70.7% women)
– All received a full dry eye evaluation
– Eye with highest score on dry eye battery
testing was used for analysis
Methods - Staining
• Corneal Fluorescein Staining
– 10 ul 1 % Fluorescein
– Scored from 0-3 (per quad) at 2’
• Conjunctival Staining
– 15 ul 1% Lissamine Green
– Each sector scored from 0-3 at 2 minutes
Methods – MMP 9
• The commercially available
MMP-9 kit comes calibrated
to indicate a positive response
when levels are > 40 ng/ml
• The sampling fleece is
saturated in the patient’s tear
from the inferior fornix and
then left in the test cassette
for 10 minutes.
Results
Ocular surface test
OSDI > 12
n (%)
36 Patients (87.8%)
TBUT < 10 sec
79 Eyes (96.3%)
Schirmer’s < 10 sec
35 Eyes (42.7%)
Osmolarity > 316 mOsm/L
53 Eyes (64.6%)
MMP 9 (+)
24 Eyes (29.0%)
Unilateral (+)
8 patients (19.5%)
Bilateral (+)
8 patients (19.5%)
OSDI = Ocular Surface Disease Index // TBUT = Tear Break-Up Time
Results
MMP (-)
MMP (+)
p value
Fluorescein Stain
3.4 ± 3.4
8.6 ± 4.2
<0.001
Lissamine Green Stain
6.0 ± 4.2
12.0 ± 4.9
<0.001
OSDI
48.0 ± 25.6
50.5 ± 26.2
NSS (0.76)
Osmolarity (osm)
337.5 ± 26.2
336.0 ± 25.0
NSS (0.89)
Schirmer’s test (mm)
11.6 ± 8.3
10.13 ± 7.6
NSS (0.59)
TBUT (sec)
4.2 ± 2.6
3.8 ± 1.1
NSS (0.51)
Age (years)
57.48 ± 13.5
60.38 ± 14.5
NSS (0.52)
OSDI = Ocular Surface Disease Index
TBUT = Tear Break-Up Time
Results
Corneal Staining
p < 0.001
8
8.7
6
4
3.4
2
0
Positive
Negative
MMP 9 Detection Status
Mean Conjunctival Lissamine
Green Staining (NEI Scale)
Mean Corneal Fluorescein
Staining (NEI Scale)
10
Conjunctival Staining
14
p < 0.001
12
10
12.0
8
6
4
6.0
2
0
Positive
Negative
MMP 9 Detection Status
Results
• There was a strong correlation with having more
ocular surface staining and a positive MMP 9 test.
• If the test was unilaterally positive for MMP 9
– The eye with higher test scores was the one positive
• No adverse effect from testing was observed
Conclusion
• Detection of supra-threshold MMP-9 levels
correlates significantly with ocular surface staining
• This supports evidence that there is an underlying
inflammatory process ongoing in the ocular surface
of these eyes
• Detection of ocular surface inflammation can be
used clinically to guide anti-inflammatory therapy
in dry eye patients