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MMP-9 and the perioperative management of LASIK surgery
Robert Sambursky1, Terrence P O'Brien
1Manatee Sarasota Eye Clinic and Laser Center, Sarasota, Florida, USA. robsambo@yahoo.com
Purpose Of Review:
Hyperosmolarity is a central mechanism causing ocular surface inflammation and eye irritation in typical patients suffering from tear dysfunction. Tear composition in dry eyes, or dysfunctional tear syndrome, may destabilize the tear film and cause ocular surface epithelial disease. Increased activity of matrix metalloproteinases (MMPs), especially MMP-9, plays a critical role in wound healing and inflammation and is primarily responsible for the pathologic alterations to the ocular surface that leads to a dysfunctional tear state.
Recent Findings:
Altered corneal epithelial barrier function is the cause for ocular irritation and visual morbidity in dry eye disease. The increased MMP-9 activity in dry eyes may contribute to deranged corneal epithelial barrier function, increased corneal epithelial desquamation, and corneal surface irregularity.
Summary:
Dry eye is one of the most common complications of photorefractive keratectomy and laser in-situ keratomileusis (LASIK). LASIK has both a neurotrophic effect on the cornea and leads to a physical change in corneal shape that results in a change in tear dynamics, leading to ocular surface desiccation. The reduction in tear function after LASIK may induce an increase in osmolarity and consequently raise the concentration of proinflammatory cytokines and MMP-9 in the tear film, which results in dry eyes and insufficient attachment between the corneal flap and the corneal bed. Appropriate diagnosis and management of dysfunctional tear syndrome may lead to less postoperative LASIK complications.
Insights
Dry eye disease, characterized by hyperosmolarity and increased matrix metalloproteinase-9 (MMP-9) activity, causes ocular surface inflammation and visual issues. Managing dysfunctional tear syndrome is key to reducing complications after laser eye surgery.
Area of Science:
- Ophthalmology
- Ocular Surface Disease
- Tear Film Dynamics
Background:
- Hyperosmolarity and increased matrix metalloproteinases (MMPs), particularly MMP-9, are key factors in ocular surface inflammation and irritation associated with dysfunctional tear syndrome.
- Tear film instability in dry eye disease can lead to ocular surface epithelial disease and visual morbidity.
- MMP-9 plays a critical role in wound healing and inflammation, contributing to pathological changes in the ocular surface.
Purpose of the Study:
- To review the role of hyperosmolarity and MMP-9 in dry eye disease.
- To understand the impact of altered corneal epithelial barrier function on ocular surface health.
- To explore the relationship between dry eye disease and refractive surgery like LASIK.
Main Methods:
- Review of current literature on dry eye disease mechanisms.
- Analysis of the role of MMP-9 in ocular surface pathology.
- Examination of the effects of LASIK on tear dynamics and ocular surface health.
Main Results:
- Increased MMP-9 activity in dry eyes is linked to compromised corneal epithelial barrier function, increased epithelial desquamation, and surface irregularity.
- Altered corneal epithelial barrier function contributes to ocular irritation and visual impairment in dry eye disease.
- LASIK surgery can alter tear dynamics, increase osmolarity, and elevate MMP-9 levels, leading to dry eye complications.
Conclusions:
- Dry eye is a common complication following photorefractive keratectomy and LASIK.
- LASIK-induced changes in corneal shape and neurotrophic effects can disrupt tear dynamics, causing ocular surface desiccation.
- Effective diagnosis and management of dysfunctional tear syndrome are crucial for minimizing postoperative LASIK complications.
