Abstract
Purpose :
Tear osmolarity (Osm) and Matrix metalloproteinase-9 (MMP9) are useful and proven tools in diagnosing dry eye disease (DED), however scarce information exists on their utility for discerning DED etiology. The aim of this study is to evaluate whether in-office Osm and MMP9 tests could aid to differentiate DED associated with primary and secondary Sjogren’s syndrome (pSS and sSS, SS) from patients with rheumatoid arthritis but no SS (non-SS RA) and non-SS DED patients. This is a prospective, consecutive, cross-sectional, and comparative study.
Methods :
Data was analyzed from a cohort of rheumatic patients with DED symptoms (2015-2023). Patients aged 18-years or older, with DED symptoms and rheumatic disease were included. Control group consisted of non-rheumatic patients with DED. Osm, MMP9, Ocular Surface Disease Index (OSDI), tear breakup time (TBUT), ocular surface staining (OSS), Schirmer test (ST) and corneal sensitivity (CS) were evaluated. Associations and correlations with Osm, MMP9 and DED etiology were performed (Chi2, Kruskal-Wallis and Kendall’s tau b). Institutional ethics committee approval was received; all participants provided written informed consent.
Results :
Positive MMP9 was more frequently observed in pSS (25.3%) and sSS (32.0%) than non-SS RA (6.9%) and controls (9.3%) (p≤0.001), but no significant difference between pSS and sSS was observed. Osm showed no significant difference between study groups: pSS=309(277-398), sSS=306(276-390), non-SS RA=308(282-386), control=301(277-367) (p=0.067). Positive MMP9 patients showed greater OSS in pSS (p≤0.001), sSS (p=0.013) and non-SS RA (p=0.041), but not in controls; reduced CS in non-SS RA (p=0.023) and controls (p=0.049); shorter TBUT (p=0.007) and ST w. and w/o anesthesia (p≤0.001, p=0.011) in pSS; and higher OSDI in controls (p=0.038). Osm showed no association with positive MMP9 in any group (pSS p=0.459, sSS p=0.731, non-SS RA p=0.763, control p=0.638), but was significantly weakly correlated with TBUT (r=-0.107, p=0.005), OSS (r=0.188, p≤0.001), STT w. (r=-0.127, p=0.001) and w/o anesthesia (r=-0.125, p=0.001).
Conclusions :
Patients with pSS and sSS have greater percentages of positive MMP9, and it was associated with more severe DED. MMP9 could be used as an adjuvant tool to help identify SS DED and those with worse DED. Tear Osm was weakly correlated with other DED test but was not useful for discerning DED etiology
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.