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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