Abstract: Objective To investigate the relationship between changes in the levels of matrix metalloproteinase-2(MMP-2)and transforming growth factor -β1(TGF-β1)in tear fluid and dry eye following phacoemulsification for cataracts. Methods This study included 156 patients who underwent phacoemulsification for cataract surgery. All participants were followed up for 3 months and were classified into a dry eye group(36 patients)and a non-dry eye group(120 patients)based on the follow-up results. Clinical data were collected from the study participants, and level of MMP-2 and TGF-β1 in tears were measured using an enzyme-linked immunosorbent assay(ELISA). T-tests, chi-square tests, and unconditional logistic regression analysis were used to identify risk factors for the development of dry eye following phacoemulsification for cataracts. Receiver operating characteristic(ROC)curves were plotted to analyze the predictive value of tear MMP-2 and TGF-β1 levels for the development of dry eye following phacoemulsification. Results All 156 patients were fully followed up; 36 patients developed dry eye, resulting in an incidence rate of 23.08%(36/156). The prevalence of meibomian gland dysfunction was higher in the dry eye group than in the non-dry eye group(P=0.002). Compared with preoperative levels, at postoperative day 3, week 2, and month 1, tear fluid levels of MMP-2 and TGF-β1 were significantly elevated in the dry eye group(P< 0.001), while these markers generally showed a downward trend in the non-dry eye group. After adjustment, the postoperative levels of MMP-2 and TGF-β1 in tear fluid on day 3 were found to differ significantly between thetwo groups following a Bonferroni test(P<0.001). Logistic regression analysis revealed that risk factors for postoperative dry eye in patients included meibomian gland dysfunction ［OR(95% CI): 2.408(1.138-3.679)］, postoperative day 3 tear MMP-2 ［OR(95% CI): 4.943(2.468 - 7.418)］, and TGF-β1 ［OR(95% CI): 3.025(1.672-4.379)］(P<0.05). The ROC curve results showed that the area under the ROC curve(AUC), 95% CI, sensitivity, and specificity for predicting the occurrence of dry eye after phacoemulsification cataract surgery using combined postoperative day 3 tear MMP-2 and TGF-β1 testing were 0.917(0.874-0.960), 97.20%, and 83.30%, respectively, all of which were higher than those obtained when these markers were tested individually(DeLong test: Z-values=2.867 and 3.215, P=0.023 and <0.001). Conclusion Elevated levels of MMP-2 and TGF-β1 in tears are closely associated with the development of dry eye following phacoemulsification. Combined testing of these two markers demonstrates greater predictive value for dry eye following phacoemulsification, suggesting they may serve as potential biomarkers for assessing the risk of dry eye after this procedure and offering a new direction for research into the prevention of dry eye.

Key words: Matrix metalloproteinase-2, Transforming growth factor-β1, Cataracts, Ultrasonic emulsification, Dry eye syndrome