title: Conjunctival matrix metalloproteinases and their inhibitors in glaucoma patients.
abstract: OBJECTIVE
  Chronic conjunctival inflammation, caused by various reasons, for example long-term use of topical drugs and/or their preservatives, affects the outcome of glaucoma surgery by interfering with wound healing. Matrix metalloproteinases (MMPs) remodel extracellular matrix (ECM) and are involved in the wound healing process. This study was designed to evaluate the conjunctival expression of MMPs and their tissue inhibitors (TIMPs) in the normal eye, primary open-angle glaucoma (POAG) and exfoliation glaucoma (ExG) and whether there is an association between staining intensities and deep sclerectomy outcome.
  
  
  METHODS
  Immunohistochemical procedures were performed on conjunctival samples which were obtained from POAG (n=11) and ExG (n=14) patients as well as normal (n=7) subjects. Antibodies against MMPs (MMP-1, -2, -3 and -9) and TIMPs (TIMP-1, -2 and -3) were used.
  
  
  RESULTS
  In conjunctival stroma, expression levels of MMP-2 (p=0.047), MMP-3 (p=0.009), MMP-9 (p<0.001), TIMP-1 (p=0.003), TIMP-2 (p<0.001) and TIMP-3 (p<0.001) in ExG and MMP-9 (p=0.008), TIMP-2 (p=0.02) and TIMP-3 (p=0.002) in POAG were significantly increased compared to control. We further found correlations between expression of MMP-1 and MMP-3 and the length of pilocarpine treatment.
  
  
  CONCLUSIONS
  The expression of MMPs and TIMPs is increased in the conjunctiva of POAG and ExG patients having a long history of topical antiglaucoma drops. Antiglaucoma agents and/or their preservatives alter the remodelling balance of ECM in conjunctiva of POAG and ExG eyes. The balance between MMPs and TIMPs may play a crucial role in the conjunctival wound healing process and the outcome of glaucoma surgery.
authors.affiliation: Department of Ophthalmology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
authors.forename: Minna
authors.initials: M
authors.lastname: Helin-Toiviainen
authors.forename: Seppo
authors.initials: S
authors.lastname: Rönkkö
authors.forename: Tuomo
authors.initials: T
authors.lastname: Puustjärvi
authors.forename: Petri
authors.initials: P
authors.lastname: Rekonen
authors.forename: Minna
authors.initials: M
authors.lastname: Ollikainen
authors.forename: Hannu
authors.initials: H
authors.lastname: Uusitalo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003228:Conjunctiva / Q000201:enzymology*; D017889:Exfoliation Syndrome / Q000201:enzymology* / Q000601:surgery; D005260:Female; D005902:Glaucoma, Open-Angle / Q000201:enzymology* / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D061965:Matrix Metalloproteinase Inhibitors / Q000378:metabolism*; D020782:Matrix Metalloproteinases / Q000378:metabolism*; D008875:Middle Aged; D012599:Sclerostomy; D014945:Wound Healing / Q000502:physiology
chemical_list: D061965:Matrix Metalloproteinase Inhibitors; D020782:Matrix Metalloproteinases
keywords: conjunctiva; deep sclerectomy; exfoliation glaucoma; primary open-angle glaucoma; scarring