Chan TC, Ye C, Chan KP, et al.
期刊名称：British Journal of Ophthalmology
干眼 中金 泪液
本研究旨在评价准分子激光原位角膜磨镶术（LASIK）后采用床旁检测手段检测干眼的基质金属蛋白酶9（MMP-9）水平的应用情况。研究方法：我们开展一项LASIK术后轻度到中度干眼患者与年龄相匹配的正常人之间的比较性研究。对两组受试者的眼表疾病指数（OSDI）、泪膜破裂时间（TBUT）、以及泪膜MMP-9和总蛋白质水平进行比较。采用一种床旁检测装置（RPS InflammaDry, Sarasota, Florida, USA）来确定泪膜中MMP-9的升高水平。研究结果：共有14只LASIK术后干眼和34只正常眼纳入研究范围。两组患者的年龄和性别无显著性差异（P＞0.175）。干眼患者与正常受试者相比，他们的OSDI明显较高（25.5±7.7 vs 7.4±2.5；P＜0.001），但TBUT水平明显较低（5.4±0.9 vs 13.5±2.3；P＜0.001）。LASIK术后干眼和正常眼的泪膜MMP-9水平分别为52.7±32.5ng/ml和4.1±2.1ng /ml（P＜0.001）。并且在LASIK术后的14只干眼中有7只眼的MMP-9水平＞40ng/ml（50%）。有8只眼的InflammaDry检测结果呈阳性（57.1%）。并且所有阳性病例的泪膜MMP-9水平≥38.03ng/ml。在LASIK术后干眼中，InflammaDry结果和MMP-9水平之间的一致性表现优异，其Cohenκ值为0.857。研究结论：我们发现只有一半的LASIK术后干眼出现明显炎症症状，而这种炎症与MMP-9的升高相关。OSDI有助于症状性干眼患者的非特异性识别，而InflammaDry检测则可以确定患者的干眼症状与明显炎症之间的相关性，而这种相关性又可以指导治疗管理决策。
AIM:To evaluate the performance of a point-of-care test for detection of matrix metalloproteinase 9 (MMP-9) levels in post-laser-assisted in situ keratomileusis (LASIK) dry eyes.METHODS:A comparative study between patients with mild to moderate post-LASIK dry eyes and age-matched normal subjects was conducted. Ocular surface disease index (OSDI), tear break-up time (TBUT), and tear film MMP-9 and total protein levels were compared between the two groups. A point-of-care test device (RPS InflammaDry, Sarasota, Florida, USA) was utilised to confirm elevated MMP-9 levels in tear film.RESULTS:Fourteen post-LASIK dry eyes and 34 normal eyes were included. There was no significant difference in age and gender between both groups (p>0.175). The OSDI was significantly higher (25.5±7.7 vs 7.4±2.5; p<0.001) and TBUT levels were significantly lower (5.4±0.9 vs 13.5±2.3; p<0.001) in patients with dry eye compared with normal subjects. The tear film MMP-9 levels were 52.7±32.5ng/mL in dry eyes and 4.1±2.1ng/mL in normal eyes (p<0.001). MMP-9 levels were >40ng/mL in 7/14 (50.0%) post-LASIK dry eyes. The InflammaDry was positive in 8/14 (57.1%) post-LASIK eyes. All positive cases had tear film MMP-9 levels ≥38.03ng/mL. Agreement between InflammaDry and MMP-9 was excellent with Cohen κ value of 0.857 in post-LASIK dry eyes.CONCLUSIONS:Only half of post-LASIK dry eyes were found to have significant inflammation associated with elevated MMP-9. The OSDI is useful to non-specifically identify patients with symptomatic dry eye while the InflammaDry determined which patients with dry eye were associated with significant inflammation that may guide therapeutic management decisions.