Increased Tear TNF-alpha and MMP-9 in Patients with Necrotizing Scleritis after Pterygium Excision

Purpose: We collected tear or scleral tissues of necrotizing scleritis after pterygium excision, and evaluated them for tumor necrosis factor (TNF)-alpha and matrix metalloproteinase (MMP)-9 to elucidate the molecular basis and seek for treatment of this disease. Methods: Three patients with necrotizing scleritis after pterygium excision were evaluated for MMP-9 and TNF-alpha in tear and scleral tissue by Western blot analysis. Results: Before treatment with corticosteroid, the patients´ tear samples showed increased expression of TNF-alpha and MMP-9 compared to those of the contralateral eye. After treatment, the expression of TNF-alpha and MMP-9 was decreased compared to those of the pre-treated tear samples. The patients´ sclera showed increased expression of MMP-9 compared to that of the donors sclera and the patients conjunctiva. Conclusions: Our results: suggest that cytokine-related inflammation plays role in the pathophysiology of necrotizing scleritis and strongly supports, under the guarantee of negative microbiological culture, the prompt use of corticosteroid and immunosuppressive agents to help suppress the progression of this disease.ope