Schargus Marc, Ivanova Svetlana, Kakkassery Vinodh, Dick H Burkhard, Joachim Stephanie
*Department of Ophthalmology, Ruhr-University Hospital, Bochum, Germany; and †Experimental Eye Research Institute, Ruhr-University Eye Hospital, Bochum, Germany.
Cornea. 2015 Jul;34(7):739-44. doi: 10.1097/ICO.0000000000000449.
Given that early-stage dry eye is difficult to diagnose, the purpose of this study was to evaluate the performance of matrix metalloproteinase 9 (MMP-9) and tear film osmolarity (TFO) in a cohort of elderly patients with potential dry eye disease (DED).
A group of 20 patients, aged 60 years and above, previously undiagnosed with DED were selected. The following DED tests were performed: tear osmolarity, MMP-9 (InflammaDry), Schirmer test, tear film break-up time, Ocular Surface Disease Index (OSDI) questionnaire, corneal fluorescein staining, and conjunctival lissamine green staining. MMP-9 concentrations in tears collected through Schirmer strips were analyzed by an MMP-9 enzyme-linked immunosorbent assay [ELISA]. Subjects were classified by symptoms (classification A: OSDI ≥10, n = 9), based on suspected mild dry eye (classification B: n = 14), TFO difference >8 mOsm/L between both eyes (classification C: n = 13), and TFO cutoff at 308 mOsm/L (classification D: >308 mOsm/L, n = 11).
Eleven percent (1/9) of the symptomatic and 14% (2/14) of the suspected mild dry eye were positive for MMP-9. InflammaDry MMP-9 tests were confirmed to be accurate through an ELISA. Sixty-seven percent (6/9) of the symptomatic and 64% (9/14) of the suspected mild dry eye were positive for tear osmolarity. None of the evaluated tear film parameters showed a significant correlation, although tear osmolarity and symptoms trended toward significance (r = 0.433, P = 0.06), whereas MMP-9 and corneal staining showed a positive association (r = 0.376, P = 0.10).
Similar to corneal staining, the MMP-9 is likely a late-stage sign that is rarely overexpressed in mild subjects, whereas tear osmolarity tends to be a more frequent early indicator of ocular surface disequilibrium within mild subjects.
鉴于早期干眼症难以诊断，本研究旨在评估基质金属蛋白酶9（MMP - 9）和泪膜渗透压（TFO）在一组有潜在干眼症（DED）的老年患者中的表现。
选取一组20名年龄在60岁及以上、先前未被诊断为DED的患者。进行了以下干眼症测试：泪液渗透压、MMP - 9（InflammaDry）、泪液分泌试验、泪膜破裂时间、眼表疾病指数（OSDI）问卷、角膜荧光素染色和结膜丽丝胺绿染色。通过泪液分泌试纸收集的泪液中的MMP - 9浓度采用MMP - 9酶联免疫吸附测定（ELISA）进行分析。受试者根据症状进行分类（A类：OSDI≥10，n = 9），基于疑似轻度干眼症（B类：n = 14），双眼TFO差异>8 mOsm/L（C类：n = 13），以及TFO截止值为308 mOsm/L（D类：>308 mOsm/L，n = 11）。
有症状患者中11%（1/9）、疑似轻度干眼症患者中14%（2/14）的MMP - 9呈阳性。通过ELISA证实InflammaDry MMP - 9检测准确。有症状患者中67%（6/9）、疑似轻度干眼症患者中64%（9/14）的泪液渗透压呈阳性。尽管泪液渗透压与症状有显著相关性趋势（r = 0.433，P = 0.06），而MMP - 9与角膜染色呈正相关（r = 0.376，P = 0.10），但所评估的泪膜参数均未显示出显著相关性。
与角膜染色类似，MMP - 9可能是晚期体征，在轻度患者中很少过度表达，而泪液渗透压往往是轻度患者眼表失衡更常见的早期指标。
