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Prospective analysis of association of eye rubbing and MMP-9 positivity in patients with newly diagnosed keratoconus presenting for refractive surgery

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Session Details

Session Title: Corneal Biomechanics

Session Date/Time: Monday 09/10/2017 | 08:00-10:30

Paper Time: 08:31

Venue: Room 2.1

First Author: : S.Mohan INDIA

Co Author(s): :    M. Rajan   M. Rajarajan                 

Abstract Details


To investigate association of eye rubbing and expression of MMP9 in the tear film of newly diagnosed keratoconus as potential risk factors for keratoconus


* STUDY DESIGN-Prospective interventional case control study. * STUDY PERIOD- June 2016 – Dec 2016, 6 months * STUDY PLACE - RAJAN EYE CARE HOSPITAL, CHENNAI. * SAMPLE : 80 Patients


This is a prospective interventional case control study comparing 40 newly diagnosed keratoconus patients & topography suspects with other 40 normal patients who had also come for refractive surgery. History- Age, gender, history of atopy, eye rubbing, contact lens use, connective tissue disorders and family history of keratoconus was derived. Clinical examination- BCVA, Retinoscopy, Slit lamp biomicroscopy, Fundus examination . Ocular Surface disease index (OSDI) score, Tear film break up time (TBUT), Schirmer-I test, MMP-9 estimation with Inflamma Package Insert, Topography and Pentacam done.


The sample of 40 subjects with keratoconus included 15 males and 25 females, with a mean age of 22 (range 18 to 36). The control sample of 40 normal subjects comprised of 18 males and 22 females, for whom the mean age was 20 years (range 18 to 30 years).The eye rubbing rate was significantly higher in keratoconus group versus normal control group(65%[26/40] versus 7.5%[3/40]).The history of atopy was more in keratoconus subjects(52%). MMP-9 was found to be positive in 77.5% (31/40) keratoconus patients.


Tear fluid as a source of biomarkers in ocular conditions has been well studied and is shown to have translational potential. Moreover, the non-invasive way of collecting the tears makes it an optimal biological fluid to study with minimal discomfort to the patient. Eye rubbing is a proven factor that triggers the progression of the disease, through stimulation of inflammation mainly increased levels of MMP-9, IL-6, and TNF-α. Identification of inflammatory markers therefore, has paramount importance in Keratoconus patients, so that effective intervention can be done to prevent progression.

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