EKSPRESI MMP-8 PADA AIR MATA SEBAGAI PENANDA INFLAMASI PASCA BEDAH PHOTOREFRACTIVE KERATECTOMY

AGUNG NUGROHO, Prof.dr. Suhardjo, SU, SpM(K).; dr. Angela Nurini Agni, Sp. M (KVR), M.Kes.; Jajah Fachiroh, S.P., M.Si, Ph.D.

2017 | Tesis-Spesialis | SP ILMU PENYAKIT MATA

Pendahuluan: Photorefractive keratectomy (PRK)sampai saat ini tetap menjadi salah satu modalitas utama terapi bedah refraktif. Kelemahan photorefractive keratectomy (PRK)yaitu terjadinya inflamasi pasca operasi. Proses inflamasi ini melibatkan banyak factor (multifaktorial)diantaranya adalah matrix metalloproteinase 8 (MMP-8) Tujuan penelitian: Mengetahui perbedaan konsentrasi ekspresi MMP-8 pada air mata pasien pasca bedah photorefractive keratectomy yang memiliki inflamasi berat dibandingkan dengan inflamasi ringan Rancangan penelitian : Penelitian nested case control pada 36 mata (dari total 55 mata) yang menjalani PRK. Data diambil sebelum dan setelah operasi berupa karakteristik pasien, parameter inflamasi (nyeri, blepharospasme, lakrimasi, hiperemia limbus and haze kornea) dan konsentrasi MMP-8 air mata diperiksa menggunakan ELISA. Pasien dalam persentil ke 33 dimasukkan dalam kelompok inflamasi ringan, sedangkan pasien lebih dari persentil ke-66 berada di kelompok inflamasi berat, masing-masing kelompok terdiri dari 18 sampel. Hasil penelitian : Kedua kelompok menunjukkan distribusi yang sama pada karakteristik usia, jenis kelamin, gangguan refraksi, uji Schirmer, retinometry, ketebalan pra-operasi, ketebalan sisa, waktu operasi, ketebalan ablasi, nadi dan skor peradangan pre-operasi, IOP dan konsentrasi MMP-8 pre operasi. Setelah dilakukan tindakan operasi PRK, didapatkan peningkatan kadar MMP-8, baik pada kelompok inflamasi ringan (p=0,025) maupun kelompok inflamasi berat (p=0,005). Terdapat perbedaan bermakna dalam hal konsentrasi MMP-8 pada air mata pada kedua kelompok setelah dilakukan tindakan operasi PRK (p=0,006). Kelompok inflamasi berat mengalami kenaikan kadar MMP lebih tinggi dibandingkan kelompok inflamasi ringan (p=0,000). Konsentrasi MMP-8 post op > 2.5 mcgg/mL merupakan faktor risiko kejadian inflamasi berat. Pasien dengan konsentrasi MMP-8 post op > 2.5 mcgg/mL memiliki kemungkinan sekira 4.7 kali lebih besar (OR = 4.767 (95% CI 1.137- 19.977)untuk mengalami inflamasi berat, sedangkan pasien dengan konsentrasi MMP-8 post op > 3.0 mcgg/mL memiliki kemungkinan sekira 6.4 kali lebih besar (OR = 6.417 (95% CI 1.444-28.511)untuk mengalami inflamasi berat. Simpulan : Penelitian ini menunjukkan bahwa pasca PRK, konsentrasi MMP-8 lebih tinggi pada inflamasi berat dibanding kelompok inflamasiringan Konsentrasi MMP-8 post op > 2.5 mcg/mL merupakan faktor risiko kejadian inflamasi berat.

Introduction: Photorefractive keratectomy (PRK) still remains as one of main refractive surgery modality. Post-operative inflammation is one of its disadvantages. Inflammation process was known involved multifactorial events, including the role of matrix metalloproteinase 8 (MMP-8) Purpose: The purpose of this study was to compare tear fluid MMP-8 concentration of eyes with mild-inflammation and severe-inflammation after photorefractive keratectomy (PRK) Study design: A nested case control study of 36 eyes (of 55 eyes) who underwent PRK. Data including patient characteristics, inflammation parameters (pain, blepharospasm, lacrimation, limbal hyperemia and corneal haze) and tear fluid MMP-8 concentration were collected before and after surgery. Tear fluid MMP-8 concentration was examined using ELISA.Patients within 33th percentile were included in mild-inflammation group, while those more than 66th percentiles were in severeinflammation group; each group contain 18 samples Result: Both group showed similar distribution in age, gender, refractive error, Schirmer test, retinometry, pre-operative thickness, residual thickness, surgery time, ablation thickness, pulse and pre-operative inflammation score, IOP and MMP-8 concentration. After PRK, MMP-8 concentration was significantly increased in both of mild- (p=0,025) and severe-inflammation (p=0,005) group. Severe-inflammation group has higher concentration of MMP-8 than the mild-inflammation group (p=0,006). Severe-inflammation group has higher MMP-8 increasing than mild group (p=0.000). Post-operative MMP-8 > 2.5 mcg/mL was revealed as risk factor for severe inflammation. The odd ratio for severe inflammation was 4.767 (95% CI 1.137 -19.977) when post operative MMP-8 > 2.5 mcg/L, and 6.417 (95% CI 1.444-28.511) when post-operative MMP-8 > 3.0 mcg/mL consecutively. Conclusion: This study demonstrated that after PRK, MMP-8 concentration was higher in severeinflammation than in mild-inflammation group. Post-operative MMP-8 > 2.5 mcg/mL was revealed as risk factor for severe inflammation.

Kata Kunci : Photorefractive Keratectomy, proses inflamasi, MMP-8, factor risiko, odd ratio, Photorefractive keratectomy, inflammation, MMP-8, risk factor, odd ratio