Abstract
Purpose :
To evaluate objective measures of ocular surface inflammation in pediatric blepharokeratoconjunctivitis (BKC) using non-invasive tear-based analyses.
Methods :
This is a prospective longitudinal observational study. Patients aged 18 and younger with active BKC and healthy controls were enrolled in the study. Participants with a history of other ocular surface diseases, concurrent ocular infection, intraocular inflammation, contact lens use in the past 30 days, and ocular surgery in the past 90 days were excluded. Tear film osmolarity analysis (TearLab, CA), fluorescein-based tear breakup time (TBUT), and matrix metalloproteinase-9 (MMP-9) testing (InflammaDry, Quidel, CA) were conducted. Keratograph 5M tear film analyzer was used to measure bulbar and limbal conjunctival redness. In children with BKC, these tests were performed at enrollment, and repeated at 3, 6 and 12 months after enrollment. In normative controls, these tests were performed at enrollment and at 12 months follow-up. Statistical analyses were performed with SPSS version 26.
Results :
In this interim analysis, 12 eyes of 12 pediatric BKC patients and 9 eyes of 9 healthy controls were included. Mean tear film osmolarity at the enrollment was 302.09±13.93 mOsm/L in the BKC group and 300.89±9.09 mOsm/L in the control group (p=0.826). TBUT at enrollment was 10.7±4.4 seconds in the BKC group and 9.0±14.4 seconds in the control group, with no significant differences observed (p=0.130). At enrollment, mean bulbar redness index was 1.54 ± 0.75 in the BKC group and 0.59 ± 0.37 in the control group (p<0.01); whereas mean limbal redness index was 1.12 ± 0.75 in the BKC group and 0.39 ± 0.24 in the control group (p=0.010). Significant correlations were found between bulbar and limbal redness indexes in the BKC group (r=0.957, p <0.001) and the control group (r=0.953, p <0.001). Tear film MMP-9 testing was positive in 91.7% among BKC patients but none in the control group (p<0.001).
Conclusions :
MMP-9 levels in the tear film were significantly higher in the pediatric patients with active BKC compared to healthy controls. Objective gradings of bulbar and limbal conjunctival injection showed a significant difference between children with BKC and healthy controls. Therefore, non-invasive analyses of MMP-9 and the redness index from Keratograph tear film analyzer showed promises in the evaluation of ocular surface inflammation in children with BKC.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.