The role of matrix metalloproteinases in ulcerative keratolysis associatedwith perioperative diclofenac use

Objective: To investigate the role of matrix metalloproteinases (MMPs) in t he pathogenesis of ulcerative keratolysis associated with topical use of ge neric diclofenac preoperatively and postoperatively. To characterize the in flammatory response of the cornea in this case of ulcerative keratolysis. Design: Case report with clinicopathologic correlation. Main Outcome Measures: Corneal culture for microbial growth. Clinical and h istopathologic examinations including routine histolopathologic, immunofluo rescent, and immunohistochemical studies. Results: Microscopic examination of the corneal button disclosed fibrinous material with neutrophils and mononuclear inflammatory cells. The corneal e pithelial basement membrane was irregularly thickened and patchy. Immunohis tochemical staining detected weak staining of MMP-1 and a strong presence o f MMP-8 in the epithelium. MMP-8 and 9 were also present in areas of leukoc ytic infiltration. MMP-2 appeared in a few stromal cells. Macrophages and l eukocytes were the predominant infiltrating cells. Conclusions: A nonspecific inflammatory response occurred in this case of u lcerative keratolysis. Corneal epithelial cells are capable of secreting MM P-1 and 8 and may participate in the stromal degradation and repair process of the ulcerative keratolysis associated with topical nonsteroidol antiinf lammatory use. (C) 2001 by the American Academy of Ophthalmology.