Matrix Metalloproteinase-9 and Topical Cyclosporine Are Associated with Conjunctival Microbiota Culture Positivity in Korean Patients with Stevens-Johnson Syndrome

BackgroundStevens-Johnson syndrome (SJS) is an abnormal immune-response causing extensive exfoliation of the mucocutaneous tissue including conjunctiva. While several factors are associated with the alteration of conjunctival microbiota, the conjunctiva of SJS patients are found to harbor a different microbiota compared to healthy subjects. We investigated the conjunctival microbiota of Korean SJS patients, and identified factors associated with the conjunctival microbiota and its positive culture.MethodsMedical records were retrospectively reviewed in 30 SJS patients who had undergone conjunctival swab culture sampling. Chronic ocular surface complications score (COCS), tear break-up time (TBUT), tear matrix metalloproteinase 9 (MMP9), and results of conjunctival swab culture were assessed.Results Positive culture was seen in 58.1%. Gram positive bacteria was most commonly isolated, among which Coagulase-negative Staphylococci (45.5%) and Corynebacterium species (40.9%) were predominantly observed. Tear MMP9 positivity was observed significantly more in the positive culture group (100%) compared to the negative culture group (75%) (P = 0.040). In patients who had repetitive cultures, positive- persistence group had more patients using topical cyclosporine compared to the negative-transition group (90.0% vs 33.3%, respectively, P = 0.041). No significant difference was found between COCS and conjunctival swab culture result, and the same as in TBUT and conjunctival swab culture result.ConclusionOur study suggest that tear MMP9 positivity may reflect the presence of an abnormal ocular surface microbiota and topical cyclosporine may be related to persistent culture positivity in SJS patients.

Changes in Tear Osmolarity and Matrix Metalloproteinase-9 Relative to Ocular Discomfort after Femtosecond Laser-Assisted Cataract Surgery

The aim of this study was to evaluate the changes in tear osmolarity and matrix metalloproteinase-9 (MMP-9) and their relationships with ocular discomfort in patients after femtosecond laser-assisted cataract surgery (FLACS). This retrospective observational case series reviewed medical records of 51 eyes of 51 patients who underwent FLACS. Tear osmolarity and MMP-9 were evaluated preoperatively and at 1 day, 1 week, and 1 month postoperatively. Tear osmolarity ≥ 310 mOsm/L and MMP-9 ≥ trace positive were defined as abnormal results. The ocular surface disease index (OSDI) was evaluated preoperatively and postoperatively at 1 month. Tear osmolarity level and the number of eyes with abnormal tear osmolarity results did not change significantly up to 1 month after surgery. MMP-9 level and the number of eyes with abnormal MMP-9 results increased at 1-day postoperatively and then decreased at 1-month postoperatively (all p < 0.001). Among the OSDI subscales, ocular discomfort was aggravated (p < 0.001) but the visual function score improved at 1 month postoperatively (p < 0.001). Ocular discomfort aggravated after FLACS without an increase in either tear osmolarity or MMP-9. Ocular discomfort which patients commonly experience after FLACS may be due to etiology other than development or aggravation of dry eye disease.