PONE-D-22-11297Tear matrix metalloproteinase-9 levels may help to follow a ocular surface injury in lagophthalmic eyesPLOS ONE

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PLOS ONE

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Reviewers' comments:

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Reviewer #1: Partly

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: The manuscript (PONE-D-22-11297) looks technically in shape with some caveats. For example, in lines 234-237, it's not entirely clear how author is concluding 'the MMP-9 may also reflect the compliance of patients with treatment ...' based on the association between MMP-9 and degree of lagophthalmos. A clearer explanation would have been better. The statistical analysis looks okay, though use of paired t-test raises some doubt since the sample size is small 16 and use of parametric test is not justifiable. Wilcoxon signed-rank test would've been a better option. The article could've been structured better by including a section with results/conclusion. Numerous articles have been published previously, which suggest measurement of ocular surface MMP-9 level provides a useful marker for ocular inflammation. Hence, some of the suggestions/ findings made in this manuscript seem repetitive and hence not novel.

The study is a step in the right direction but findings need to evaluated with larger sample sizes.

Reviewer #2: In the manuscript titled “Tear matrix metalloproteinase-9 levels may help to follow a ocular surface injury in lagophthalmic eyes”, the authors have evaluated the possible usefulness of measuring tear film levels of MMP-9 in patients with lagophthalmos and suggest that tear MMP-9 levels correlate with ocular surface damage and will help in timely clinical assessment and changes in treatment regimen.

Here are some minor concerns:

1. The study is well done though the sample size is rather small at n=16 (7 men and 9 women).

2. The manuscript needs to be re-checked for English grammar and sentence construction.

3. Although the authors have explained this in the “Methods” section, the term “Oxford Score” in the “Results” section appears very vague since this score is used for multiple measurements in different disease conditions, Oxford grading score for ocular surface staining, knees, muscles, etc. The authors need to specify throughout the manuscript the term “Oxford Scheme for Ocular Surface Fluorescein Staining” for ease of understanding for the reader.

4. The authors are advised to calculate the “Mean + SEM”. This is recommended since the “Standard Deviation value” for Tear MMP-9 values in lagophthalmic eyes is higher than the “Mean value” (Line 175).

5. The “Standard Deviation value” is almost as high as the Mean value for TBUT as well as “Oxford Score” in lagophthalmic eyes (Line 165 and Line 166)

6. The word “Mean + SEM” should precede the values for the same mentioned in the “Results section”. It is not easy for the reader to know what the numbers in parenthesis actually signify.

7. The authors admit that there is considerable variance in the MMP-9 values within the lagophthalmic group but do not discuss the possible reasons for this. This needs to be discussed in greater detail along with relevant references, which will enhance the quality of the manuscript.

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Reviewer #1: No

Reviewer #2: No

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Tear matrix metalloproteinase-9 levels may help to follow a ocular surface injury in lagophthalmic eyes

PONE-D-22-11297R1

Dear Dr. Mahelkova,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Deepak Shukla

Academic Editor

PLOS ONE

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