| Objective:To observe the morphological,structural and functional changes of meibomian glands(MGs)in patients with type 2 diabetes mellitus,and to explore its correlation with the duration of diabetes and diabetic retinopathy.Materials and methods:This was a comparative study which evaluated 118 eyes of 118 patients with type 2 DM(DM group)and 100 eyes of 100 control participants(NDM group)seen in the Department of Ophthalmology of Shandong Provincial Qianfoshan Hospital during the period from October 2014 to November 2015.The DM group including 58 cases of men and 60 cases of women,the average age was 58.68±7.26 years old,the age range was44-68 years old.The NDM group including 52 cases of men and 48 cases of women,the average age was 59.27±7.59 years old,the age range was 42-70 years old.After completing an Ocular Surface Disease Index(OSDI)questionnaire,we assessed the non-invasive tear film break-up time(NI-BUT)and the structure of the meibomian glands(meibography)by the Keratograph 5M system.The MGs and its glandular tube were also examined by laser scanning confocal microscopy(LSCM).The primary outcomes were MG acinar unit density(MGAUD),MG acinar longest diameter(MGALD)and MG acinar shortest diameter(MGASD).The right eye was examined in each subject.Statistical analysis was performed to determine the differences of the examinations(OSDI,NI-BUT,meibography score,MGAUD,MGALD,MGASD)among DM patients and NDM subjects.The correlation study was used to determine the correlation of the indexes above between diabetes duration and diabetic retinopathy.The statistical analysis was used to determine the correlation of BUT and the changes of the meibomian gland.Results:1.The OSDI of DM group and NDM group were 23.02±13.13 and 12.11±6.48 respectively.Compared with NDM group,the OSDI was significantly higher in DM group(Z=-5.916,P<0.001).The NI-BUT measurements of DM group and NDM group were 4.44±2.40(range,0.4~10.3)seconds and 8.42±3.79(range,1.7~17.5)seconds respectively(Z=-7.765,P<0.001).2.Keratograph 5M showed more MGs dropout in DM group than that in NDM group.57.63% of patients in DM group had deficiencies in meibomian gland,and the proportion in NDM group of patients was 33%;The dropout area score of DM group was significantly higher than the NDM group.The differences between the two groups were significant(Z =-3.937,P<0.001).3.LSCM showed that the cell structure of the meibomian gland of DM and NDM group.In addition to the normal form,we also define the dilated,fibrosis,atrophy kinds as the abnormal morphology.We found that 77% of the patients in non-diabetic group were normal performance,20% of the patients appeared dilated change,fibrosis,and atrophy of both types were rare,accounting for 2% and 1% respectively;But only 21.19% of the patients in diabetes group meibomian gland structure were normal,the rest were abnormal change,60.17% of the patients appeared meibomian gland expansion,fibrosis and atrophy were a rare two types,11.02% and 7.62%,respectively.The parameters of meibomian gland calculated by Image J software: Compared with the NDM group,the MGAUD mean value was significantly lower in DM group(77.55±25.66 U/mm2 vs.115.38±19.05 U/mm2).The differences between the two groups were significant(Z=-10.120,P<0.001).While the MGALD mean value was significantly longer(89.30±21.99 um vs.47.00±12.33 um).The differences between the two groups were significant(Z=-9.4442,P<0.001).The MGASD mean value was significantly longer(47.00±12.33 um vs.31.34±34 um).The differences between the two groups were significant(Z=-7.771,P<0.001).4.Comparison between different duration of diabetes: The OSDI score was higher with the duration of diabetes,the score was significantly positively correlated with the duration of diabetes(r=0.955,P<0.001);BUT shortened with the duration of diabetes,and BUT was significantly negatively correlated with the duration of diabetes(r = 0.885,P<0.001);The proportion of patients with lack of meibomian gland increased,in the short duration group the proportion was 35.56%,in the course of group the proportion was 52.63%,and in the long duration group the proportion was 91.43%.The dropout area of meibomian gland increased with the duration of diabetes,the meibomian gland dropout score also increased accordingly.And the score was significantly positively correlated with the duration of diabetes(r=0.596,P<0.001);The proportion of patients with abnormal meibomian gland structure increased,in the short duration group was 64.44%,in the course of group was 84.21%,the long course of the disease group was 91.43%.Most of the changes were dilated type,the atrophy and fibrosis mostly occured in patients with longer duration of diabetes;MGAUD reduced with the duration of diabetes,and MGAUD was significantly negatively correlated with the duration of diabetes(r=0.860,P<0.001);MGALD has no correlation with diabetic duration(r=0.133,P=0.133).MGASD increased with the diabetic duration,and MGASD was significantly positively correlated with the duration of diabetes(r=0.364,P<0.001).5.Comparison between the degree of diabetic retinopathy: The OSDI score of NPDR group was significantly higher than the NDR group.The differences between the two groups were significant(Z = 8.618,P<0.001).The BUT of NPDR group was significantly shorter than the NDR group.The differences between the two groups were significant(Z= 8.322,P<0.001);The dropout area of meibomian gland increased with the degree of diabetic retinopathy,the dropout score also increased accordingly.47.7% of the patients in NDR group had deficiencies in meibomian gland,and the proportion in NPDR group of patients was 69.81%;The dropout area score of NPDR group was significantly higher than the NDR group.The differences between the two groups were significant(Z=-5.528,P<0.001).92.46% of the patients in NPDR group had abnormal meibomian gland structure,and the proportion in NDR groups was 67.69%.The main abnormal changes were dilated type,and fibrosis and atrophy type were mostly occur in the patients in NPDR group;Compared with the NDR group,the MGAUD mean value in NPDR group was significantly lower(55.36±19.84 U/mm2 vs.95.04±12.03 U/mm2).The differences between the two groups were significant(Z=-6.326,P<0.001).While the MGALD mean value was no significantly differences(90.94±20.68 um vs.89.85±21.95 um;Z=-0.337,P=0.736)and the MGASD mean value was significantly longer(52.17±12.04 um vs.41.30±8.76 um).The differences between the two groups were significant(Z=-4.622,P<0.001).6.Comparison between the index of meibomian gland and the stability of tear :BUT shortened with the increase of MD score,and BUT was significantly negatively correlated with MD score(r=0.669,P<0.001);BUT shortened with the decreasing of MGAUD,and BUT was significantly positively correlated with MGAUD(r=0.854,P<0.001);BUT had no significant correlation with MGALD(r=0.046,P=0.046);BUT shortened with the increase of MGASD,and BUT was significantly negatively correlated with MGASD(r=0.359,P<0.001).Conclusion:1.Compared with non-diabetic patients,there were more morphological and structural alterations of meibomian glands in patients with diabetes.The unstablity of tear film had a closely relationship with the abnormalities of morphology and structure of the meibomian gland.And all the indicators became worse with the progress of diabetes duration and diabetic retinopathy.2.The morphological and structural alterations of meibomian glands in patients with diabetes were closely related to dry eye symptoms and unstable tear film,and the proportion of dry eye symptoms and unstable tear film became serious with the progress of the degree of abnormal meibomian gland.3.Keratograph 5M and LSCM could observe the microscopic structure changes directly in the meibomian glands of patients with diabetes.The two devices have many advantages such as: objective,noninvasive and good repeatability.They could help doctors to know the pathological and physiological alterations of meibomian glands in patients with diabetes,and provide a guidance for diagnosis,treatment and curative effect judgment about the meibomian gland disease. |
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