In Vivo Confocal Microscopy Evaluation Of Meibomian Glands In Meibomian Gland Dysfunction Patients

Objective:To observe the morphology,fibrosis grade and inflammatory infiltration of meibomian gland using in vivo confocal microscopy(IVCM)in meibomian gland dysfunction(MGD)patients.Methods :A prospective case-controlled study.According to the diagnostic criteria of MGD,40 MGD patients were included in our study from August to December 2015.20 normal subjects were also studied.All subjects were underwent the Ocular Surface Disease Index(OSDI);lid margin and ocular surface examination by slit lamp microscrope;tear film breakup time(TBUT);corneal and conjunctival staining(Oxford scale);Schirmer I test;infrared meibomian photography and IVCM.Main outcome 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 MGD group and the control group were compared using the independent samples T test.Results :OSDI score(39.20±23.83 points),1id margin abnormality score(3.63 ± 0.30points),miss rate of meibomian glands(39.15 ±17.49)and corneal and conjunctival staining score(0.98±1.46 points)in MGD group were obviously higher than those in control group(8.65±6.44 points,0.30 ± 0.57 points,18.50 ± 6.89 %,0.25 ± 0.44 points)(P=0.001,P<0.001,P<0.001,P=0.035,respectively).TBUT were significantly lower in MGD group(2.98 ± 1.87s)than those in control group(6.40 ± 2.52 s,P<0.001).According to schirmer I test,there weren’t significant differences in the two group(P>0.05).The mean MGALD(156.80 ± 46.10 μm),MGAUA(10113.84 ± 5531.21 μm 2)in the distal segments of the MGs about MGD patients were larger than those in the proximal segments of the MGs(67.47 ± 9.117 μm,3102.13 ± 1111.97μm~2)(P<0.05,respectively).The mean MGALD(156.80 ± 46.10 μm),MGASD(38.75 ± 11.72 μm),MGAUA(10113.84 ± 5531.21 μm 2),MG inflammatory cell density(621.90 ± 405.63 cells/mm~2)and fibrosis degree(1.05 ± 0.759)about the distal segments of the MGs in MGD patients were larger than those in control group(67.47 ± 9.117 μm,22.00 ± 2.95μm,3102.13 ± 1111.97μm~2,188.80 ± 72.25 cells/mm~2,0.3 ± 0.48)(P <0.001,respectively).The mean MGAUD about the distal segments of the MGs was lower in MGD patients(61.10 ± 34.97 glands/mm~2)than in control group(105.07 ± 18.58 glands/mm~2)(P<0.001).Conclusions :In vivo confocal microscopy(IVCM)was pertinent to investigate the meibomian gland by detecting the irregularity of meibomian orifices,the diameter and area,and inflammation and fibrosis levels in MGD patients.It may have potential clinical applications value for the diagnosis of MGD.