In vivo confocal microscopy evaluation of meibomian glands in meibomian gland dysfunction patients

Abstract

To observe the morphology, fibrosis grade and inflammatory infiltration of meibomian glands using in vivo confocal microscopy(IVCM)in meibomian gland dysfunction(MGD)patients. A prospective case-controlled study. According to the diagnostic criteria of MGD, 20 MGD patients(20 eyes)were included in our study from August to October 2015. Fifteen normal subjects(15 eyes)were also studied. METHODS All subjects completed the questionnaire of the Ocular Surface Disease Index(OSDI), lid margin and ocular surface examination by slit lamp microscropy, tear film break-up time(TBUT)test, corneal and conjunctival staining(Oxford scale), Schirmer I test, infrared meibomian photography and IVCM. Main outcomes in IVCM included meibomian gland acinar longest diameter(MGALD), meibomian gland acinar shortest diameter(MGASD), meibomian gland acinar unit density(MGAUD), meibomian gland acinar unit area(MGAUA), meibomian gland inflammatory cell density and fibrosis degree. The parameters between the MGD group and the control group were compared using the independent samples t test. The OSDI score[(31.80±22.97)points], 1id margin abnormality score[(3.10±0.31)points], loss rate of meibomian glands(38.31%±19.94%)and corneal and conjunctival staining score[1.00(2.75)points]in the MGD group were obviously higher than those in the control group[(7.93±6.51)points,(0.33±0.31)points, 21.31% ± 7.70%, and 0.00(1.00)points, P=0.001, P<0.001, P=0.004, and P=0.037, respectively]. The TBUT was significantly lower in the MGD group[(3.35±2.28)s]than in the control group[(6.67±2.51)s, P<0.001]. According to Schirmer I test, there was no significant difference in the two groups(P=0.139). The mean values of MGALD[(156.80 ± 46.10)μm], MGASD[(38.75 ± 11 .72)μm], MGAUA[(10 113.84 ± 5 531.21)μm(2)], meibomian gland inflammatory cell density[(621.90 ± 405.63)cells/mm(2)]and fibrosis degree 1.50(1.00)in the MGD patients were larger than those in the control group[(67.47 ± 9.117)μm,(22.00 ± 2.95)μm,(3 102.13 ± 1111.97)μm(2),(188.80 ± 72.25)cells/mm(2), and 0.00(0.00), all P<0.001, respectively]. The mean MGAUD was lower in the MGD patients[(61.10 ± 34.97)glands/mm(2)]than in the control group[(105.07±18.58)glands/mm(2), P<0.001]. IVCM was pertinent to investigate the meibomian glands by detecting the irregularity of meibomian orifices, the diameter and area, and the inflammation and fibrosis levels in MGD patients. It may have a potential clinical value for the diagnosis of MGD. (Chin J Ophthalmol, 2016, 52: 649-656).