1. Correlation of Conjunctival and Corneal Staining With Elevated Matrix Metalloproteinase-9 on the Ocular Surface of Dry-Eye Patients Authors: Allister Gibbons, MD Felipe Valenzuela, MD Daniel Waren, MSPH Victor L. Perez, MD The authors have no financial interests to disclose, relevant to the topic of this poster. Paper #13545

2. 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 1 The 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.

3. 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.

4. 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

5. 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

6. 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

7. 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.

8. Results Ocular surface testn (%) OSDI > 1236 Patients (87.8%) TBUT < 10 sec79 Eyes (96.3%) Schirmer’s < 10 sec35 Eyes (42.7%) Osmolarity > 316 mOsm/L53 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

9. Results MMP (-)MMP (+)p value Fluorescein Stain3.4 ± 3.48.6 ± 4.2<0.001 Lissamine Green Stain6.0 ± 4.212.0 ± 4.9<0.001 OSDI48.0 ± 25.650.5 ± 26.2NSS (0.76) Osmolarity (osm)337.5 ± 26.2336.0 ± 25.0NSS (0.89) Schirmer’s test (mm)11.6 ± 8.310.13 ± 7.6NSS (0.59) TBUT (sec)4.2 ± 2.63.8 ± 1.1NSS (0.51) Age (years)57.48 ± 13.560.38 ± 14.5NSS (0.52) OSDI = Ocular Surface Disease Index TBUT = Tear Break-Up Time

10. Results

11. 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

12. 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