Matrix metalloproteinases and their tissue inhibitors after selective laser trabeculoplasty in pseudoexfoliative secondary glaucomaReportar como inadecuado

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BMC Ophthalmology

, 8:20

First Online: 21 October 2008Received: 26 August 2008Accepted: 21 October 2008


BackgroundThe aim of this study was to assess changes in metalloproteinases MMP-2 and tissue inhibitor of metalloproteinases TIMP-2 following selective laser trabeculoplasty SLT in patients with pseudoexfoliative glaucoma PEXG.

MethodsWe enrolled 15 patients with PEXG and cataracts PEXG-C group and good intraocular pressure IOP controlled with β-blockers and dorzolamide eye drops who were treated by cataract phacoemulsification and 15 patients with pseudoexfoliative glaucoma PEXG-SLT group. The PEXG-SLT patients underwent a trabeculectomy for uncontrolled IOP in the eye that showed increased IOP despite the maximum drug treatment with β-blockers and dorzolamide eye drops and after ineffective selective laser trabeculoplasty SLT. The control group consisted of 15 subjects with cataracts. Aqueous humor was aspirated during surgery from patients with PEXG-C, PEXG-SLT and from matched control patients with cataracts during cataract surgery or trabeculectomy. The concentrations of MMP-2 and TIMP-2 in the aqueous humor were assessed with commercially available ELISA kits.

ResultsIn PEXG-SLT group in the first 10 days after SLT treatment a significant reduction in IOP was observed: 25.8 ± 1.9 vs 18.1.0 ± 1.4 mm-Hg p < 0.001, but after a mean time of 31.5 ± 7.6 days IOP increased and returned to pretreatment levels: 25.4 ± 1.6 mm-Hg p < 0.591. Therefore a trabeculectomy was considered necessary.

The MMP-2 in PEXG-C was 57.77 ± 9.25 μg-ml and in PEXG-SLT was 58.52 ± 9.66 μg-ml p < 0.066. TIMP-2 was 105.19 ± 28.53 μg-ml in PEXG-C and 105.96 ± 27.65 μg-ml in PEXG-SLT p < 0.202. The MMP-2-TIMP-2 ratio in the normal subjects was 1.11 ± 0.44. This ratio increase to 1.88 ± 0.65 in PEXG-C p < 0.001 and to 1.87 ± 0.64 in PEXG-SLT p < 0.001. There was no statistically significant difference between the PEXG-C and PEXG-SLT ratios p < 0.671.

ConclusionThis case series suggest that IOP elevation after SLT can be a serious adverse event in some PEXG patients. The IOP increase in these cases would be correlated to the failure to decrease the TIMP-2-MMP-2 ratio.

Trial registrationCurrent Controlled Trials ISRCTN79745214

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Autor: Mauro Cellini - Pietro Leonetti - Ernesto Strobbe - Emilio C Campos


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