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Giuseppe Giannaccare, Marco Pellegrini, Leonardo Taroni, Federico Bernabei, Carlotta Senni, Arianna Grendele, Fabiana Moscardelli, Mario Arpinati, Francesca Bonifazi, Mariarosaria Sessa, Piera Versura, Emilio C Campos; Ocular Graft Versus-host Disease Patients Exhibit Impaired Corneal Biomechanics.. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6810.
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Increased levels of tear matrix metalloproteinase-9 (MMP-9) have been detected in ocular graft versus host disease (oGVHD) patients. Since MMP-9 is a proteolytic enzyme involved in the degradation of corneal extracellular matrix components, we hypothesized that higher tears levels of MMP-9 might impair corneal biomechanics. Therefore, the purpose of this study was to compare corneal biomechanical properties between patients with oGVHD and healthy matched subjects, and to further correlate these values with ocular surface characteristics.
In this prospective case-control study, the following tests were conducted in both oGVHD patients (severity scale II-III ICCGVHD Criteria) and controls: Schirmer test type 1, break-up time (BUT), corneal staining, conjunctival staining, tear matrix metalloproteinase-9 (MMP-9) assay (InflammaDry test, Rapid Pathogen Screening, Inc, Sarasota, FL). Corneal biomechanics calculated by using ocular response analyzer (ORA, Reichert Instruments, Depew, New York, USA) included corneal hysteresis (CH) and corneal resistance factor (CRF). The Mann-Whitney U test was used to compare continuous variables between patients and controls. Correlations of corneal biomechanical properties with ocular surface parameters were examined in the oGVHD group using Spearman's correlation.
A total of 43 eyes of 43 oGVHD patients (mean age 51.5 ± 7.1 yrs; 20 M, 23 F) and 34 matched control subjects (47.8 ± 6.1 yrs; 15 M, 19F) were included. Patients with oGVHD showed significantly lower values of CH and CRF compared to controls (respectively, 9.4±1.8 mmHg vs 11.6±1.6 and 9.7±1.4 mmHg vs 12.3±1.3; always p<0.001) (Figure). Twenty-seven of the oGVHD eyes (62.8% of the total) were strong-positive for MMP-9, while 16 (37.2%) were weak-positive. Conversely, only 4 of the control eyes (11.8%) were weak-positive for MMP-9. In patients with oGVHD, CH was significantly correlated with corneal staining (Rs=-0.321, p=0.036), conjunctival staining (Rs=-0.435, p=0.004), Schirmer test (Rs=0.406, p=0.007), BUT (Rs=0.439, p=0.003) and MMP-9 positivity grade (Rs=-0.442, p=0.003), while CRF was correlated with corneal staining (Rs=-0.305, p=0.047).
CH and CRF values are reduced in patients with oGVHD. The more severe was the ocular surface impairment, the greater was the alteration of corneal biomechanics. Furthermore, the decrease of CH was well correlated with increased tear levels of MMP-9.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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