Short-Term Therapeutic Effects of Topical Corticosteroids on Refractory Dry Eye Disease: Clinical Usefulness of Matrix Metalloproteinase 9 Testing as a Response Prediction Marker

Abstract

Purpose To compare the short-term therapeutic effects of topical corticosteroids in patients with refractory dry eye disease (DED) according to the tear matrix metalloproteinase 9 (MMP-9) point-of-care positivity. Methods This study was conducted on 137 patients who were referred from other eye clinics, complaining of irresponsive DED or acute DED flares despite routine treatment with topical cyclosporin or diquafosol. The patients received treatment with topical corticosteroids for 1 month. DED was evaluated by SANDE (Symptom Assessment in Dry Eye) questionnaire, tear film breakup time, ocular surface staining score, and meibomian gland dysfunction stage. The InflammaDry MMP-9 immunoassay was conducted in more symptomatic eyes of all patients. The changes in the subjective symptoms were additionally surveyed as symptom improvement score. Results The mean age of the patients was 57.8±13.4 years, and the tear MMP-9 positivity was 73.0%. Topical corticosteroids treatment showed significant improvement of symptoms and signs in the patients with refractory DED irrespective of the positivity of MMP-9 (each p <0.001). The changes in SANDE score and OSS, and symptom improvement score were higher in the MMP-9 positive group than in the MMP-9 negative group ( p =0.002/0.010/0.011). The overall rates of subjective symptoms improvement and SANDE reduction were 73.0% and 90.6% after topical corticosteroids treatment, respectively. Conclusion Short-term topical corticosteroids had excellent therapeutic effects in patients with refractory DED or acute DED flares, irrespective of the tear MMP-9 level. Tear MMP-9 positivity may serve as a reliable response predictor of topical corticosteroids treatment in DED.

Improved accuracy of intraocular lens power calculation by preoperative management of dry eye disease

“…Pretreatment protocols of DED for 2 weeks comprised topical LE and CsA and eyelid scrub with warm compression. In our previous study, we have shown excellent effects of short-term topical corticosteroids in patients with refractory DED [13]. In this study, most patients stated improvement in symptoms after 2 weeks at inpatient clinic.…”

“…Hovanesian et al showed that treatment with lifitegrast for 1 month prior to cataract surgery increased the accuracy of IOL power prediction, thereby highlighting the importance of preoperative treatment of DED [10,12]. In addition, we have recently shown the excellent effects of short-term corticosteroid therapy in refractive DED patients [13]. In this study, we investigated whether shortterm pretreatment of DED using topical loteprednol etabonate (LE) and cyclosporin A (CsA) before cataract surgery improves the accuracy of IOL power calculation.…”

Comparison of Consecutive Therapeutic Effects of Nanoemulsion and Emulsion Cyclosporin in Dry Eye Patients after Short-Term Treatment with Topical Fluorometholone

“…Rye et al showed that short-term corticosteroids can effectively improve objective findings and subjective symptoms in patients with acute exacerbation of DED or refractory DED [ 12 ]. One hundred thirty-seven DED patients treated with topical steroids for 4 weeks showed a significant improvement in SANDE score, TBUT, ocular surface staining, and MGD grade [ 12 ]. In particular, those effects were superior in tear MMP-9-positive patients [ 12 ].…”

“…One hundred thirty-seven DED patients treated with topical steroids for 4 weeks showed a significant improvement in SANDE score, TBUT, ocular surface staining, and MGD grade [ 12 ]. In particular, those effects were superior in tear MMP-9-positive patients [ 12 ]. CsA can also improve the symptoms and signs of DED, but improvement takes more than 2-3 months [ 12 , 27 ].…”

“…Meanwhile, topical corticosteroids are generally indicated for the treatment of ocular inflammatory diseases because they can inhibit proinflammatory cytokines and chemokines, stabilize macrophages and neutrophils, and repress the key enzymes involved in the initiation or maintenance of the inflammatory response [ 11 ]. Short-term topical 0.1% fluorometholone showed excellent therapeutic effects in patients with refractory DED or acute DED flares in our previous study [ 12 ].…”