Topical steroids are known to be effective in quickly tamping down the inflammatory component of dry eye disease (DED), but could in-office biomarker testing guide their use more effectively? Sort of, says a recent retrospective chart review conducted in Korea. 

In this study, researchers compared the short-term therapeutic effects of topical corticosteroids according to tear matrix metalloproteinase-9 testing (MMP-9) level in patients with DED who showed no signs of improvement despite previous treatment with artificial tears, cyclosporine and diquafosol, a dry eye drug approved in Japan and Korea.

The 137 patients in the study were referred from other eye clinics for unresponsive DED or acute flares despite routine treatment. They received treatment with topical corticosteroids QID for one month (either fluorometholone or loteprednol) and were evaluated using the Symptom Assessment in Dry Eye (SANDE) questionnaire, tear film breakup time, ocular surface staining (OSS) score and meibomian gland dysfunction stage. The InflammaDry MMP-9 immunoassay was conducted in more symptomatic eyes of all patients, and the change in the subjective symptoms were scored as well.

The mean age of the patients was 57.8±13.4 years, and the tear MMP-9 positivity was 73%. Steroid treatment showed significant improvement in signs and symptoms of refractory patients irrespective of MMP-9 positivity rate. However, the changes in the SANDE score, OSS and symptom improvement score were higher in the MMP-9 positive group (79%) than the MMP-9 negative group (62.1%). The overall rates of symptom improvement and SANDE reduction were 73% and 90.6% after topical corticosteroids treatment, respectively.

Topical corticosteroids showed a greater improvement in the symptoms of DED in the MMP-9 positive group compared to that of the MMP-9 negative group, the authors found.

“Our study also demonstrated that treatment with topical corticosteroids improved the symptoms of DED even in the MMP-9 negative group, although the rate of improvement was lower than that of the MMP-9 positive group,” they noted in their study. “This could imply that the inflammation of the ocular surface is somewhat etiological even in MMP-9 negative patients. Although there are several factors for adjusting and verifying the InflammaDry test, we believe that the tear MMP-9 positivity may serve as a reliable biomarker in therapeutic response with topical corticosteroids in patients with DED.”

Ryu KJ, Kim S, Kim MK, et al. Short-Term Therapeutic Effects of Topical Corticosteriods on Refractory Dry Eye Disease: Clinical Usefulness of Matrix Metalloproteinase 9 Testing as a Response Prediction Maker. Clin Ophthalmol. 2021:15:759-767.