Abstract
Purpose Objective assessment of dry eye disease (DED) severity and ocular inflammation using the InflammaDry® test for extracellular matrix metalloproteinase-9 (MMP-9) and the impact of antiglaucoma eye drops in people with primary open-angle glaucoma (POAG). Methods Overall, 90 adults (180 eyes) were included: 60 had been diagnosed with POAG and were treated with prostaglandin analogue monotherapy and 30 were suspected of having POAG but did not receive any treatment (control group). Of those treated with prostaglandin eye drops, 30 received a preservative-free formulation (tafluprost) and 30 were treated with a formulation containing the preservative benzalkonium chloride (BAK) (latanoprost). Measurement of extracellular MMP-9 levels (InflammaDry test) provided a marker for ocular surface inflammation. Further assessments of disease severity and inflammation comprised Goldmann applanation tonometry for intraocular pressure (IOP), Schirmer's test with anesthesia, ocular surface staining with unpreserved fluorescein (Oxford scale index), tear breakup time (TBUT), McMonnies questionnaire, and the Ocular Surface Disease index (OSDI). Results Clinically significant MMP-9 levels (>40 ng/mL) were detected in tear film from 46.7% of subjects treated with BAK-containing medication. In contrast, only 16.7% of subjects treated with preservative-free medication or untreated individuals demonstrated similar MMP-9 levels. This difference was statistically significant (p < 0.05). MMP-9 results correlated with other indicators of inflammation and disease severity. BAK-containing medication was associated with rapid TBUT (<5 seconds) in 50% of cases, while only 10% of untreated subjects and individuals using preservative-free medication demonstrated comparable TBUT results. Conclusion Measurement of ocular surface MMP-9 level provides a useful marker for inflammation and DED in POAG. Use of a preservative-free topical prostaglandin formulation results in lower levels of ocular inflammation, compared with BAK-containing medication.
Highlights
Glaucoma is defined as a group of neuropathies that result in progressive optic nerve atrophy, with characteristic changes in the optic nerve head and progressive visual field defects. ese changes are usually accompanied by elevated intraocular pressure (IOP), which is the most widely known risk factor of glaucoma
Mean age across all study groups was 65.3 years, and the average age of subjects in the active treatment groups was higher than those in the untreated control arm; 67.6 years for the preservative-free treatment group, 67.1 for those treated with benzalkonium chloride (BAK)-containing eye drops, and 61.2 years for the untreated control group (Table 1)
Our results demonstrated that BAKcontaining eye drops were associated with raised levels of matrix metalloproteinase-9 (MMP-9), and surface inflammation and/or damage, compared with preservative-free prostaglandin analogue formulations
Summary
Glaucoma is defined as a group of neuropathies that result in progressive optic nerve atrophy, with characteristic changes in the optic nerve head and progressive visual field defects. ese changes are usually accompanied by elevated intraocular pressure (IOP), which is the most widely known risk factor of glaucoma. Glaucoma is defined as a group of neuropathies that result in progressive optic nerve atrophy, with characteristic changes in the optic nerve head and progressive visual field defects. Ese changes are usually accompanied by elevated intraocular pressure (IOP), which is the most widely known risk factor of glaucoma. Primary open-angle glaucoma (POAG) may be asymptomatic well into midstage development. Following diagnosis and initiation of topical eye drop treatment, it becomes a chronic and symptomatic disease. In more than 60% of cases, patients treated for glaucoma are diagnosed with ocular surface disorders (OSDs). Tolerance to different topical therapies varies, and the development of dry eye disease (DED) symptoms during chronic therapy may have considerable impact on life quality and compliance. Prostaglandin analogues are currently the most frequently used IOP lowering medications [1].
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