Matrix metalloproteinase 9 positivity predicts long term decreased tear production

Matias Soifer, Hazem M. Mousa, Sandra S. Stinnett, Anat Galor, Victor L. Perez

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Purpose: To investigate long-term correlations between Matrix Metalloproteinase-9 (MMP-9) testing and dry eye (DE) parameters. Additionally, to evaluate variability in MMP-9 results over time and with anti-inflammatory treatment. Methods: Retrospective cohort study of DE patients with equal MMP-9 testing results (positive or negative) in both eyes and a minimum of 6 months of follow up. Our main outcome measure was to examine whether initial MMP-9 status affected change in DE parameters over time. Secondarily, we evaluated the frequency of MMP-9 status change over time and examined whether MMP-9 status change was impacted by treatment. Results: 67 patients (76% female) fit the inclusion criteria. Mean age was 63 years with a mean follow up of 10.6 months. The majority (37/67, 55%) had concomitant systemic immune disease. MMP-9 testing was positive in both eyes in 39 individuals (58%) and negative in both eyes in 27 (42%) individuals. Of all DE parameters, initial MMP status predicted change in tear production. Individuals in the MMP-9 positive group had a greater decrease in production from baseline to final visit compared to the negative group (−2.6 vs 2.1, P = 0.013). In those initially MMP-9 positive, the frequency of becoming MMP-9 negative was higher in eyes treated with anti-inflammatory therapy compared to artificial tears (22.9% vs 3.3%, P = 0.106). However, only Lifitegrast 5% showed statistical significance compared to artificial tears (31.3% vs 3.3%, P = 0.044). Conclusions: Eyes with detectable MMP-9 had significantly decreased tear production over time compared to those without detectable MMP-9. Anti-inflammatory treatment more frequently normalized MMP-9 compared to PFATs.

Original languageEnglish (US)
Pages (from-to)270-274
Number of pages5
JournalOcular Surface
StatePublished - Jan 2021


  • Anti-inflammatory therapy
  • Diagnosis dry eye
  • Inflammatory dry eye
  • Matrix Metalloproteinase-9
  • Ocular surface inflammation
  • Tear production

ASJC Scopus subject areas

  • Ophthalmology


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