{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T04:48:24Z","timestamp":1791953304426,"version":"4.3.4"},"reference-count":31,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T00:00:00Z","timestamp":1790985600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["RS-2026-25489972"],"award-info":[{"award-number":["RS-2026-25489972"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]},{"award":["RS-2026-25489972"],"award-info":[{"award-number":["RS-2026-25489972"]}],"id":[{"id":"https:\/\/ror.org\/013aysd81","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: The objectives of this study were to investigate the association between tear matrix metalloproteinase-9 (MMP-9) grade and thyroid eye disease (TED) activity and to evaluate its discriminatory performance for active TED. Methods: This retrospective cross-sectional study included 322 patients with TED, including 188 with inactive disease and 134 with active disease. Tear MMP-9 reaction intensity was graded from 0 to 3 using InflammaDry, and active TED was defined as a Clinical Activity Score (CAS) of \u22653. Receiver operating characteristic analysis was used to assess discriminatory performance. Multivariable logistic regression was used to evaluate the independent association between a grade 3 result and active TED, adjusting for age, sex, and serum thyroid-stimulating hormone receptor antibody level. The main outcome measures were the association of tear MMP-9 grade with CAS, area under the receiver operating characteristic curve, adjusted odds ratio, and diagnostic performance for active TED. Results: Tear MMP-9 grade was significantly higher in active than in inactive TED and correlated positively with disease activity (Spearman\u2019s \u03c1 = 0.253, p &lt; 0.001). Its overall discriminatory performance for active TED was modest (area under the curve, 0.619; 95% confidence interval, 0.552\u20130.682). A grade 3 result was independently associated with active TED (adjusted odds ratio, 8.65; 95% confidence interval, 2.86\u201326.17; p &lt; 0.001) and demonstrated high specificity (97.9%) but low sensitivity (19.4%), with a positive predictive value of 86.7% and a positive likelihood ratio of 9.12. Conclusions: Tear MMP-9 grade was associated with TED activity and may provide clinically relevant information regarding ocular surface inflammation in TED.<\/jats:p>","DOI":"10.3390\/jcm15197671","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T10:57:46Z","timestamp":1791197866000},"page":"7671","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Significance of Tear Matrix Metalloproteinase-9 Reaction Intensity in Thyroid Eye Disease"],"prefix":"10.3390","volume":"15","author":[{"given":"Do Hee","family":"Jung","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan 50612, Republic of Korea"},{"name":"Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Ho","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan 50612, Republic of Korea"},{"name":"Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung Hyo","family":"Ahn","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan 50612, Republic of Korea"},{"name":"Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Eun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan 50612, Republic of Korea"},{"name":"Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,10,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"G43","DOI":"10.1530\/EJE-21-0479","article-title":"The 2021 European Group on Graves\u2019 orbitopathy (EUGOGO) clinical practice guidelines for the medical management of Graves\u2019 orbitopathy","volume":"185","author":"Bartalena","year":"2021","journal-title":"Eur. 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