TO STUDY THE ROLE OF TEAR FILM MATRIX METALLOPROTEINASE-9 (MMP-9) IN THE DIAGNOSIS AND MANAGEMENT OF INFLAMMATORY DRY EYE DISEASE USING POINT TO CARE RAPID MMP-9 IMMUNOASSAY KIT

Purpose: To study the role of Matrix Metalloproteinase-9 (MMP-9) in the tear film for the diagnosis and management of inflammatory dry eye disease using point to care Rapid MMP-9 immunoassay kit. Methods: This prospective interventional study was conducted at a tertiary eye care centre in a duration of two years. 300 eyes (Right Eye) of 300 patients with Dry Eye Disease (DED) were included in the study. After assessing the signs and grade of dry eye clinically, the patients were subjected to MMP-9 immunoassay of the tear film. The tear MMP-9 immunoassay results were interpreted using qualitative (positive or negative) and quantitative (reagent band density on a four-point scale: 0 = negative 1 = weakly positive 2 = moderately positive 3 = strongly positive) methods. The patients who were tested negative for MMP-9 were treated with eye drop Carboxy methyl cellulose (CMC) 0.5% thrice a day, while those who were tested positive for MMP-9 were given eye drop Cyclosporine 0.05 % twice a day in addition to lubricants. Treatment and follow up was done for a period of six months and the response to treatment was re-assessed at the end of first week, first month, three months and six months. Result: At presentation among 120 MMP-9 positive patients, 34%(41) were mild positive, 45%(54) were moderate positive, 21%(25) were severe positive. 88.98%(105) of 120, MMP-9 positive patients became mild positive and 10.8% converted to MMP-9 negative at the end of six months follow up. In MMP-9 positive group, mean reduction in OSDI from baseline 33.46 ± 13.47 to 11.86 ± 2.99, mean increase in Schirmer from baseline 9.22 ± 1.64 to 13.15 ± 2.42 and mean increase in TBUT from baseline 8.68 ± 1.11 to 11.33 ± 1.36 were observed at the end of six month follow up. Conclusion: In this study, we found that there is a positive correlation between the MMP-9 immunoassay results with that of the severity of the signs and symptoms of DED. It was also observed that patients who were in MMP-9 positive group were found to have higher OSDI, lower Schirmer and TBUT values at baseline andthey showed significant improvement in the scores of dry eye with anti-inflammatory drops.Hence, topical anti-inflammatory eye drops plays a major role in the management of patients with severe DED.