Presence or absence of ocular surface inflammation directs clinical and therapeutic management of dry eye

Robert Sambursky Coastal Eye Institute, Cornea and Comprehensive Ophthalmology, Bradenton, FL, USA Background: The presence of clinically significant inflammation has been confirmed in the tears of 40%–65% of patients with symptoms of dry eye. Ocular surface inflammation may lead to tear...

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Autor principal:	Sambursky R
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2016
Materias:	dry eye inflammation MMP-9 cyclosporine diagnosis treatment Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/0d92b21ed1354c6897bfaf3bd18e2ab4
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spelling	oai:doaj.org-article:0d92b21ed1354c6897bfaf3bd18e2ab42021-12-02T08:47:29ZPresence or absence of ocular surface inflammation directs clinical and therapeutic management of dry eye1177-5483https://doaj.org/article/0d92b21ed1354c6897bfaf3bd18e2ab42016-11-01T00:00:00Zhttps://www.dovepress.com/presence-or-absence-of-ocular-surface-inflammation-directs-clinical-an-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Robert Sambursky Coastal Eye Institute, Cornea and Comprehensive Ophthalmology, Bradenton, FL, USA Background: The presence of clinically significant inflammation has been confirmed in the tears of 40%–65% of patients with symptoms of dry eye. Ocular surface inflammation may lead to tear film instability, epithelial cell irregularities, and permeability, resulting in chronic symptomatic pain and fluctuating vision as well as negative surgical outcomes.Patients and methods: A retrospective single center medical chart review of 100 patients was conducted. All patients were tested with the InflammaDry test to determine if patients exhibited elevated levels of matrix metalloproteinase 9 (MMP-9). InflammaDry-positive patients were started on a combination of cyclosporine 0.05% twice daily, 2,000–4,000 mg oral omega-3 fatty acids, and frequent artificial tear replacement. InflammaDry-negative patients were started on 2,000–4,000 mg of oral omega-3 fatty acids and frequent artificial tear replacement. Each patient was retested at ~90 days. A symptom questionnaire was performed at the initial visit and at 90 days.Results: 60% of the patients with dry eye symptoms tested positive for elevated MMP-9 at the initial visit. 78% of all patients returned for follow-up at ~90 days including 80% (48/60) of the previously InflammaDry-positive patients and 75% (30/40) of the previously InflammaDry-negative patients. A follow-up symptom questionnaire reported at least 75% symptomatic improvement in 65% (31/48) of the originally InflammaDry-positive patients and in 70% (21/30) of the initially InflammaDry-negative patients. Symptomatic improvement of at least 50% was reported in 85% (41/48) of previously InflammaDry-positive patients and 86% (26/30) of previously InflammaDry-negative patients. Following treatment, 54% (26/48) of previously InflammaDry-positive patients converted to a negative InflammaDry result.Conclusion: Identifying which symptomatic dry eye patients have underlying inflammation may predict patient responses to treatment and influence clinical management strategies. Keywords: dry eye, inflammation, MMP-9, cyclosporine, diagnosis, treatmentSambursky RDove Medical Pressarticledry eyeinflammationMMP-9cyclosporinediagnosistreatmentOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 10, Pp 2337-2343 (2016)
institution	DOAJ
collection	DOAJ
language	EN
topic	dry eye inflammation MMP-9 cyclosporine diagnosis treatment Ophthalmology RE1-994
spellingShingle	dry eye inflammation MMP-9 cyclosporine diagnosis treatment Ophthalmology RE1-994 Sambursky R Presence or absence of ocular surface inflammation directs clinical and therapeutic management of dry eye
description	Robert Sambursky Coastal Eye Institute, Cornea and Comprehensive Ophthalmology, Bradenton, FL, USA Background: The presence of clinically significant inflammation has been confirmed in the tears of 40%–65% of patients with symptoms of dry eye. Ocular surface inflammation may lead to tear film instability, epithelial cell irregularities, and permeability, resulting in chronic symptomatic pain and fluctuating vision as well as negative surgical outcomes.Patients and methods: A retrospective single center medical chart review of 100 patients was conducted. All patients were tested with the InflammaDry test to determine if patients exhibited elevated levels of matrix metalloproteinase 9 (MMP-9). InflammaDry-positive patients were started on a combination of cyclosporine 0.05% twice daily, 2,000–4,000 mg oral omega-3 fatty acids, and frequent artificial tear replacement. InflammaDry-negative patients were started on 2,000–4,000 mg of oral omega-3 fatty acids and frequent artificial tear replacement. Each patient was retested at ~90 days. A symptom questionnaire was performed at the initial visit and at 90 days.Results: 60% of the patients with dry eye symptoms tested positive for elevated MMP-9 at the initial visit. 78% of all patients returned for follow-up at ~90 days including 80% (48/60) of the previously InflammaDry-positive patients and 75% (30/40) of the previously InflammaDry-negative patients. A follow-up symptom questionnaire reported at least 75% symptomatic improvement in 65% (31/48) of the originally InflammaDry-positive patients and in 70% (21/30) of the initially InflammaDry-negative patients. Symptomatic improvement of at least 50% was reported in 85% (41/48) of previously InflammaDry-positive patients and 86% (26/30) of previously InflammaDry-negative patients. Following treatment, 54% (26/48) of previously InflammaDry-positive patients converted to a negative InflammaDry result.Conclusion: Identifying which symptomatic dry eye patients have underlying inflammation may predict patient responses to treatment and influence clinical management strategies. Keywords: dry eye, inflammation, MMP-9, cyclosporine, diagnosis, treatment
format	article
author	Sambursky R
author_facet	Sambursky R
author_sort	Sambursky R
title	Presence or absence of ocular surface inflammation directs clinical and therapeutic management of dry eye
title_short	Presence or absence of ocular surface inflammation directs clinical and therapeutic management of dry eye
title_full	Presence or absence of ocular surface inflammation directs clinical and therapeutic management of dry eye
title_fullStr	Presence or absence of ocular surface inflammation directs clinical and therapeutic management of dry eye
title_full_unstemmed	Presence or absence of ocular surface inflammation directs clinical and therapeutic management of dry eye
title_sort	presence or absence of ocular surface inflammation directs clinical and therapeutic management of dry eye
publisher	Dove Medical Press
publishDate	2016
url	https://doaj.org/article/0d92b21ed1354c6897bfaf3bd18e2ab4
work_keys_str_mv	AT samburskyr presenceorabsenceofocularsurfaceinflammationdirectsclinicalandtherapeuticmanagementofdryeye
_version_	1718398346568138752

Presence or absence of ocular surface inflammation directs clinical and therapeutic management of dry eye

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