Purpose:
The aim of this study was to characterize the presence of ocular surface inflammation, using matrix metalloproteinase-9 (MMP-9) as a marker, on the ocular surface of eyes with implanted Boston keratoprosthesis type 1 (KPro).
Methods:
Patients with implanted KPro at a single tertiary center were recruited to assess ocular inflammation. MMP-9 was measured using the InflammaDry test in both eyes of each patient. The non-KPro eye served as the control. Rate of positivity of MMP-9 was compared between groups. Possible associations between ocular surface inflammation and the development of postoperative complications were evaluated using univariate statistical analysis.
Results:
Fifty eyes from 25 patients were included. The mean age was 50 years. Noninflammatory indications for KPro were predominant among patients. Eighty-eight percent of KPro eyes had a positive test for MMP-9 while only 25% of control eyes were positive (P < 001). The most common complications were retroprosthetic membrane, epithelial defects, and sterile corneal melt. The presence of a strong positive result was associated with a higher frequency of complications (80% of eyes) compared with a faint positive test (54%) and a negative test (33%).
Conclusions:
The KPro device seems to increase MMP-9 levels on the ocular surface. High MMP-9 levels may be associated with higher risk of complications. MMP-9 testing can be useful to assess subclinical ocular surface inflammation with a potential role in the postoperative care of patients with KPro.
Diabetes rates in the United States are staggering and climbing. Importantly, traditional risk factors fail to completely account for the magnitude of the diabetes epidemic. Environmental exposures, including urban and metropolitan transportation quality, are implicated as contributors to disease. Utilizing data from the county-level Environmental Quality Index (EQI) developed for the United States, we analyzed associations between transportation and air quality environmental metrics with overall diabetes prevalence and control within urban/metropolitan counties in the United States from 2006-2012. Additionally, we examined effect modification by race/ethnicity through stratification based upon the county-level proportion of minority residents. Lastly, we applied mixture methods to evaluate the impact of simultaneous poor transportation factors and worse air quality on the same outcomes. We found that increased county-level particulate matter air pollution and nitrogen dioxide along with reduced public transportation usage and lower walkability were all associated with increased diabetes prevalence. The minority proportion of the population influences some of these relationships as some of the effects of air pollution and the transportation related environment are worse among counties with more minority residents. Furthermore, the transportation and air quality mixtures were found to be associated with increased diabetes prevalence and reduced diabetes control. These data further support the burgeoning evidence that poor environments amplify diabetes risk. Future cohort studies should explore the utility of environmental policies and urban planning as tools for improving metabolic health.
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