Altered mucins and aquaporins indicate dry eye outcome in patients undergoing Vitreo-retinal surgery.

Ramalingam Mani,Ratra Vineet,Saravanan Thilagavathi,Narayanasamy Angayarkanni,Ratra Dhanashree,P S Shobha,Natarajan Viswanathan,Padmanabhan Prema,Deepak Shukla

doi:10.1371/journal.pone.0233517

Ramalingam Mani, Ratra Vineet + Show 7 more

Open Access

https://doi.org/10.1371/journal.pone.0233517

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Abstract

Vitreo-retinal (VR) surgeries induce conjunctival changes. However, there are no study reports regarding prevalence and severity of dry eye after these surgeries. This study evaluated dry eye outcome after VR surgery. Patients undergoing VR surgery classified as scleral buckle and microincision vitrectomy surgery (n = 44, mean age: 56.09±10.2 years) were recruited. Dry eye evaluation was done before and 8 weeks after surgery (2 weeks after omitting topical eye drops). Conjunctival imprint cytology for goblet cell count and tear Mucin 5AC (MUC5AC) protein estimation was done. Gene expressions of MUC5AC, MUC4, MUC16, Aquaporin 4 (AQP4) and AQP5 were analyzed in the conjunctival imprint cells by qPCR. None of the patients exhibited clinical signs of dry eye after VR surgery. But the conjunctival goblet cell density (GCD) was significantly lowered post-VR surgery (63% cases, **p = 0.012) with no alterations in the tear MUC5AC protein. Post-VR surgery, the conjunctival cell gene expression of MUC4, MUC16 and AQP4 were significantly increased (*p = 0.025, *p = 0.05 and *p = 0.02 respectively) and AQP5 was significantly lowered (*p = 0.037), with no change in MUC5AC expression. Tear cytokines were significantly increased post-VR surgery (anti-inflammatory: IL1RA, IL4, IL5, IL9, FGF; PDGFbb and pro-inflammatory: IL2, IL6, IL15, GMCSF and IFNg). Though clinical signs of dry eye were not observed after VR surgery, ocular surface changes in the form of reduced GCD, altered MUC5AC, MUC4, MUC16, AQP4, AQP5 and cytokines are suggestive of dry eye outcome at the molecular level especially inpatients aged above 51 years, especially female gender and those who are diabetic.

Highlights

Dry eye syndrome (DES), a common ophthalmological problem, resulting from either excessive tear film evaporation or decrease in the tear production, can affect the quality of life
Dry eye evaluation based on Dry Eye Workshop (DEWS) [6] criteria 2007 was done to rule out any preexisting DES
The clinical evaluation of dry eye pre and post-VR surgery revealed no significant dry eye development based on the dry eye work up done to evaluate DES (Table 1)

Summary

Introduction

Dry eye syndrome (DES), a common ophthalmological problem, resulting from either excessive tear film evaporation or decrease in the tear production, can affect the quality of life. Over the past few years, PPV has been revolutionized by the development of small gauge transconjunctival sutureless technique. This technique can likely cause less dry eye due to fewer traumas to the conjunctiva. Wasfy et al [5] evaluated the changes in the tear film quality following 20G and 23G PPV but found no significant differences between the two groups. The frequency and severity of dry eye symptoms in patients following such small gauge VR surgery has not been addressed objectively in the previous literature. This study explores the dry eye status before and after VR surgery based on clinical evaluation and changes at molecular levels in terms of tear fluid cytokines, mucins and aquaporins

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