Comparison of Tear Matrix Metalloproteinase 9 (MMP-9) Estimation with Schirmer's Test in Ocular Surface Disorders

Overview

Journal Rom J Ophthalmol

Specialty Ophthalmology

Date 2024 Oct 28

PMID 39464763

Authors

Sandeep Gupta

Sandeep Shankar

Sunandan Bhatta

Avinash Mishra

Ankita Singh

Affiliations

Soon will be listed here.

Abstract

Background: Ocular surface disorder (OSD) is a vexed eye problem and a diagnostic conundrum. Diagnosis has traditionally depended upon symptoms and tests like Schirmer's, TBUT, staining with dyes, and tear meniscus height. Schirmer's test is the most popular. However, the test strips irritate with reflex tearing - producing false high results. Matrix Metalloproteinase 9 (MMP) in the tear is believed to be expressed by stressed epithelial cells of the corneal surface - a key pathology in dry eye disease. This study attempts to compare the results of Schirmer's test and MMP-9 so that the test can individually or severally add to a more definite diagnosis of dry eye disease.

Materials And Methods: 100 eyes of 50 symptomatic patients underwent MMP-9 estimation and were divided into two groups (MMP-9+ve and MMP-9-ve). They were then sub-grouped as per DEWS-2007 based on Schirmer test levels and Ocular Symptomatology Score (OSS). The two groups were compared for severity of dry eye based on Schirmer's test and OSS.

Results: Mean Schirmer's value was 12.85 (SD 7.07) for MMP-9+ve and 19.18 (SD 8.94) for MMP-9-ve patients. 80% of patients with severe dry eye and 55.6% of moderate dry eye patients were positive for MMP-9. 85% of the MMP-9 patients had OSS values of 2 or 3.

Discussion: A higher OSDI and positive MMP-9 were shown to be correlated in a statistically remarkable way (p<0.001). The OSDI values of 0-12 for 3/44 (6.8%) positive results, 13-22 for 2/8 (25%) positive results, 23-32 for 4/14 (28.6%) positive results, and 33-100 for 13/35 (37.1%) positive results all showed an increase in MMP-9 positivity along with a rise in the subjective severity of the illness.

Conclusion: MMP-9 compares well with Schirmer's values and DED categories based on Schirmer's. The result pointed towards the usefulness of this test in diagnosing patients who may have not yet manifested symptoms.

References

Vitali C, Moutsopoulos H, Bombardieri S . The European Community Study Group on diagnostic criteria for Sjögren's syndrome. Sensitivity and specificity of tests for ocular and oral involvement in Sjögren's syndrome. Ann Rheum Dis. 1994; 53(10):637-47. PMC: 1005429. DOI: 10.1136/ard.53.10.637. View

de Monchy I, Gendron G, Miceli C, Pogorzalek N, Mariette X, Labetoulle M . Combination of the Schirmer I and phenol red thread tests as a rescue strategy for diagnosis of ocular dryness associated with Sjögren's syndrome. Invest Ophthalmol Vis Sci. 2011; 52(8):5167-73. DOI: 10.1167/iovs.10-6671. View

Chotikavanich S, de Paiva C, Li D, Chen J, Bian F, Farley W . Production and activity of matrix metalloproteinase-9 on the ocular surface increase in dysfunctional tear syndrome. Invest Ophthalmol Vis Sci. 2009; 50(7):3203-9. PMC: 3594995. DOI: 10.1167/iovs.08-2476. View

Wright J, MEGER G . A review of the Schirmer test for tear production. Arch Ophthalmol. 1962; 67:564-5. DOI: 10.1001/archopht.1962.00960020564008. View

. Research in dry eye: report of the Research Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf. 2007; 5(2):179-93. DOI: 10.1016/s1542-0124(12)70086-1. View

Stevenson W, Chauhan S, Dana R . Dry eye disease: an immune-mediated ocular surface disorder. Arch Ophthalmol. 2012; 130(1):90-100. PMC: 3677724. DOI: 10.1001/archophthalmol.2011.364. View

Cedarstaff T, Tomlinson A . Human tear volume, quality and evaporation: a comparison of Schirmer, tear break-up time and resistance hygrometry techniques. Ophthalmic Physiol Opt. 1983; 3(3):239-45. View

Lemp M, Crews L, Bron A, Foulks G, Sullivan B . Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort: a retrospective study. Cornea. 2012; 31(5):472-8. DOI: 10.1097/ICO.0b013e318225415a. View

Schiffman R, Christianson M, Jacobsen G, Hirsch J, Reis B . Reliability and validity of the Ocular Surface Disease Index. Arch Ophthalmol. 2000; 118(5):615-21. DOI: 10.1001/archopht.118.5.615. View

10.

Belmonte C, Nichols J, Cox S, Brock J, Begley C, Bereiter D . TFOS DEWS II pain and sensation report. Ocul Surf. 2017; 15(3):404-437. PMC: 5706540. DOI: 10.1016/j.jtos.2017.05.002. View

11.

Shimazaki J, Goto E, Ono M, Shimmura S, Tsubota K . Meibomian gland dysfunction in patients with Sjögren syndrome. Ophthalmology. 1998; 105(8):1485-8. DOI: 10.1016/S0161-6420(98)98033-2. View

12.

Sambursky R, OBrien T . MMP-9 and the perioperative management of LASIK surgery. Curr Opin Ophthalmol. 2011; 22(4):294-303. DOI: 10.1097/ICU.0b013e32834787bb. View

13.

Lemp M . Report of the National Eye Institute/Industry workshop on Clinical Trials in Dry Eyes. CLAO J. 1995; 21(4):221-32. View

14.

Latkany R, Lock B, Speaker M . Nocturnal lagophthalmos: an overview and classification. Ocul Surf. 2006; 4(1):44-53. DOI: 10.1016/s1542-0124(12)70263-x. View

15.

Sambursky R, Davitt 3rd W, Latkany R, Tauber S, Starr C, Friedberg M . Sensitivity and specificity of a point-of-care matrix metalloproteinase 9 immunoassay for diagnosing inflammation related to dry eye. JAMA Ophthalmol. 2013; 131(1):24-8. DOI: 10.1001/jamaophthalmol.2013.561. View

16.

Patel S, Murray D, Mckenzie A, Shearer D, McGrath B . Effects of fluorescein on tear breakup time and on tear thinning time. Am J Optom Physiol Opt. 1985; 62(3):188-90. DOI: 10.1097/00006324-198503000-00006. View

17.

van Bijsterveld O . Diagnostic tests in the Sicca syndrome. Arch Ophthalmol. 1969; 82(1):10-4. DOI: 10.1001/archopht.1969.00990020012003. View

18.

Yang S, Lin C, Yang P, Chao S, Ye Y, Hu D . Increased expression of gelatinase (MMP-2 and MMP-9) in pterygia and pterygium fibroblasts with disease progression and activation of protein kinase C. Invest Ophthalmol Vis Sci. 2009; 50(10):4588-96. DOI: 10.1167/iovs.08-3147. View

19.

Hay E, Thomas E, Pal B, Hajeer A, Chambers H, Silman A . Weak association between subjective symptoms or and objective testing for dry eyes and dry mouth: results from a population based study. Ann Rheum Dis. 1998; 57(1):20-4. PMC: 1752470. DOI: 10.1136/ard.57.1.20. View

20.

Lemp M, Bron A, Baudouin C, Benitez Del Castillo J, Geffen D, Tauber J . Tear osmolarity in the diagnosis and management of dry eye disease. Am J Ophthalmol. 2011; 151(5):792-798.e1. DOI: 10.1016/j.ajo.2010.10.032. View