The role of matrix metalloproteinases in ulcerative keratolysis associated with perioperative diclofenac use.
OBJECTIVE
To investigate the role of matrix metalloproteinases (MMPs) in the pathogenesis of ulcerative keratolysis associated with topical use of generic diclofenac preoperatively and postoperatively. To characterize the inflammatory response of the cornea in this case of ulcerative keratolysis.


METHODS
Case report with clinicopathologic correlation.


METHODS
Corneal culture for microbial growth. Clinical and histopathologic examinations including routine histolopathologic, immunofluorescent, and immunohistochemical studies.


RESULTS
Microscopic examination of the corneal button disclosed fibrinous material with neutrophils and mononuclear inflammatory cells. The corneal epithelial basement membrane was irregularly thickened and patchy. Immunohistochemical staining detected weak staining of MMP-1 and a strong presence of MMP-8 in the epithelium. MMP-8 and 9 were also present in areas of leukocytic infiltration. MMP-2 appeared in a few stromal cells. Macrophages and leukocytes were the predominant infiltrating cells.


CONCLUSIONS
A nonspecific inflammatory response occurred in this case of ulcerative keratolysis. Corneal epithelial cells are capable of secreting MMP-1 and 8 and may participate in the stromal degradation and repair process of the ulcerative keratolysis associated with topical nonsteroidol antiinflammatory use.
O'Brien
T P
TP
Ocular Microbiology and Immunology Laboratory, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Woods Bldg./Rm. 259, Baltimore, MD 21287-9121, USA.
Li
Q J
QJ
Sauerburger
F
F
Reviglio
V E
VE
Rana
T
T
Ashraf
M F
MF
D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D003315:Cornea / Q000187:drug effects / Q000201:enzymology* / Q000473:pathology / Q000601:surgery; D003320:Corneal Ulcer / Q000139:chemically induced / Q000201:enzymology* / Q000473:pathology / Q000601:surgery; D004008:Diclofenac / Q000009:adverse effects*; D006801:Humans; D007124:Immunoenzyme Techniques; D015948:Keratoplasty, Penetrating; D008297:Male; D008666:Metalloendopeptidases / Q000378:metabolism*; D019990:Perioperative Care
D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac; D008666:Metalloendopeptidases