The effect of conjunctivochalasis on tear MMP-9 level and ocular surface

The effect of Conjunctivochlasis on Tear MMP-9 Level and Ocular Surface Purpose: To assess the effect of different treatment methods on tear MMP-9 level and ocular surface in patients with grade 2 or 3 conjunctivochalasis. Methods: 66 patients with grade 2 or 3 symptomatic conjunctivochlasis according to Yokoi grading method included in this study. Individuals were divided into three groups according to the treatment method. 22 patients in group 1 were treated with preservative-free artificial tear drops (Tears Naturale Free, Alcon), 22 patients in group 2 were treated with preservative-free artificial tear drops and ophthalmic anti-inflammatory agent (Acular LS, Allergan), and 22 patients in group 3 were treated with conjunctival electrocauterization method. Tear osmolarity measurement, tear MMP-9 level (inflammaDry test), Schirmer test, fluorescein break-up time (BUT), ocular surface disease index questionnaire (OSDI), corneal fluorescein staining (OXFORD) and conjunctival impression cytology procedure (right eye) were carried out before treatment and at the first and third month of the treatment. Results: Before treatment there was no difference between the groups according to age, sex, and tear function tests including tear osmolarity test, Schirmer test, tear break-up time test (TBUT), OSDI questionnaire, corneal fluorescein staining (OXFORD) (all, p>0.05). While there was no difference in MMP-9 level before the treatment (p>0.05), the difference in Nelson's grading system of conjunctival impression cytology procedure was significant between the groups (p<0.05). At the first month of treatment there was no significant difference in tear function tests except corneal fluorescein staining (p<0.05) The results of the dry eye tear tests were similar between the groups at the third month of the treatment (p>0.05). There was a significant reduction in OSDI score and corneal fluorescein staining and significant increment in Schirmer test results of the first group at the third month of the treatment (all, p< 0.05). The TBUT and Schirmer test results were significantly increased whereas OSDI score was significantly decreased in the second group. (all, p<0.05). There was no significant alteration in the result of tear osmolarity test whereas TBUT and Schirmer test results were significantly increased and OSDI score and corneal fluorescein staining score were found to be decreased in the third group (p<0.05). There was no difference in the MMP-9 positive and MMP-9 negative patients ratio between the groups at the first and third month of treatment (p>0.05). After three month treatment no significant difference was occurred in the levels of MMP-9 in the first and second group, but there was a significant decrease in the level of MMP-9 positive patients in the third group (p<0.05). No significant difference wasseen in Nelson grading scores of all groups during the treatment (p>0.05). Conclusion: Dry eye signs and ocular surface inflammation caused by conjunctivochalasis can be seen. Conjunctival electrocauterization treatment method thought to be more efficacious than used medical treatment methods in reducing the dry eye symptoms and inflammation via elimination of the conjunctival folds. Keywords: Conjunctivochalasis, MMP-9, inflammaDry, impression cytology, electrocauterization.