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Concentration and Fluorescein Clearance in Ocular Rosacea
From the Ocular Surface and Tear Center, 1 Bascom Palmer Eye Institute and 2 Department of Urology, University of Miami School of Medicine, Florida.
PURPOSE. To correlate tear fluorescein clearance with interleukin-1
(IL-1)
concentration and gelatinase B (matrix metalloproteinase [MMP]-9)
activity in the tear fluid of patients with ocular rosacea and normal
control subjects.
METHODS. Gelatinase activity was evaluated by gelatin zymography in tear fluid
obtained from 13 patients with ocular rosacea (including 1 patient with
recurrent epithelial erosion, 2 with recurrent peripheral corneal
infiltrates and vascularization, and 2 patients with epithelial
basement membrane dystrophy) and 13 normal subjects with normal aqueous
tear production and no irritation symptoms. Tear fluorescein clearance
was evaluated by measuring fluorescence in tear fluid collected from
the inferior meniscus 15 minutes after instillation of 5 µl of 2%
Na–fluorescein with a CytoFluor II fluorometer. Pro–MMP-9 and
IL-1 concentrations in the tear fluid were measured by enzyme-linked
immunosorbent assay (ELISA).
RESULTS. Compared with normal control subjects, patients with ocular rosacea had
a greater delay of tear fluorescein clearance (P <
0.001), a higher tear IL-1 concentration (P <
0.001), and a greater pro–gelatinase B (92 kDa) activity
(P < 0.001) in their tear fluid. The 84-kDa active
form of gelatinase B was observed in 46% of the rosacea tear samples
and none of the controls. The zymographic results were confirmed by
ELISA that showed a significantly greater concentration of pro–MMP-9
(92 kDa) in the tear fluid of rosacea patients than controls. Delayed
tear clearance was correlated with elevated tear IL-1 concentration
(
=0.67, P < 0.001) and increased tear
gelatinase B activity (=0.84, P < 0.001). Tear
IL-1 concentration was correlated with tear gelatinase B activity
(=0.58, P < 0.002).
CONCLUSIONS. Gelatinase B (MMP-9) activity is greater in patients with ocular
rosacea than in normal eyes. The majority of this activity is due to
92-kDa proform of this enzyme. This activity is correlated with delayed
tear clearance and tear fluid concentration of interleukin-1, a
proinflammatory cytokine that has been reported to stimulate gelatinase
B production. Elevated gelatinase B activity in ocular rosacea may be
involved in the pathogenesis of the irritation symptoms, recurrent
epithelial erosions, vascularization, and epithelial basement membrane
dystrophy that develops in the corneas of patients with this
condition.
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