The application of in vivo laser confocal microscopy to the diagnosis and evaluation of meibomian gland dysfunction
The application of in vivo laser confocal microscopy to the diagnosis and evaluation of meibomian gland dysfunction
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发表时间：
2008-07
期刊：
影响因子：
2.2
通讯作者：
Y. Matsumoto;E. Sato;O. Ibrahim;M. Doğru;K. Tsubota
中科院分区：
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作者：
Y. Matsumoto;E. Sato;O. Ibrahim;M. Doğru;K. Tsubota
目的通过活体共聚焦显微镜观察眉板腺功能障碍(MGD)患者泪腺的形态变化，并探讨其与临床眼表表现及泪液功能的关系。方法对20例MGD患者和15例正常人进行前瞻性研究。患者和对照组接受裂隙灯检查、泪膜破裂时间(BUT)测定、荧光素和Rose-Bengal染色、Schirmer试验I(无麻醉)、泪液蒸发率评估(Teros)、泪膜脂层干涉(DR-1)、眼睑透光(Meibograph)、MG表达试验和活体激光共聚焦显微镜(HRTII-RCM)。结果MGD组BUT、DR-1泪膜脂层干涉分级、荧光素和Rose-Bengal染色评分、尿沉渣微球脱落分级、MG表达分级均明显低于正常对照组(p<；0.05)。MG退出的严重程度和MG的表达与BUT、DR-1分级和Teros显著相关(p<；0.05)。用HRT II-RCM方法测定的MG腺泡单位平均密度(47.6±26.6个/mm~2)显著低于对照组(101.3±33.8个/mm~2，P<0.05)。腺泡单位直径在MGD组(98.2±53.3μm)显著大于对照组(41.6±11.9μm；p<；0.05)。MG腺泡单位的密度和直径与MG脱落的严重程度和MG的表达分级显著相关(p<；0.05)。结论体内共聚焦显微镜能有效显示MGD患者MG的形态变化。腺泡密度和腺泡单位直径可作为活体共焦显微镜检查的新参数，与MGD的临床眼表和泪液功能表现密切相关。
Purpose To evaluate the morphological changes of the meibomian glands (MG) in patients with meibomian gland dysfunction (MGD) compared to normal subjects by in vivo confocal microscopy and to investigate the relation of these changes to the clinical ocular surface findings and tear functions. Methods Twenty MGD patients and 15 normal subjects were recruited into this prospective study. Patients and controls underwent slit lamp examinations, tear film break-up time (BUT) measurements, fluorescein and Rose-Bengal stainings, Schirmer test I without anesthesia, tear evaporation rate assessment (TEROS), tear film lipid layer interferometry (DR-1), transillumination of the lids (meibography), MG expressibility test, and in vivo laser confocal microscopy of the lids (HRTII-RCM). Results The BUT, DR-1 tear film lipid layer interferometry grades, fluorescein and Rose-Bengal staining scores, MG drop out grade in meibography, and MG expressibility grades were significantly worse in MGD patients compared to normal controls (p<0.05). The severity of both MG dropout and MG expressibility related significantly with the BUT, DR-1 grades, and TEROS (p<0.05). The mean density of acinar units of MGs as measured by HRTII-RCM was significantly lower in MGD patients (47.6±26.6/mm2) than in control subjects (101.3±33.8/mm2; p<0.05). The mean acinar unit diameter as determined by HRTII-RCM was significantly larger in MGD patients (98.2±53.3 μm) than in controls (41.6±11.9 μm; p<0.05). Both the density and diameter of MG acinar units related significantly with the severity of MG dropout and MG expression grades (p<0.05). Conclusions In vivo confocal microscopy can effectively demonstrate the morphological changes of the MG in patients with MGD. Glandular acinar density and acinar unit diameter seemed to be promising new parameters of in vivo confocal microscopy, which is significantly related to the clinical ocular surface and tear function findings of MGD.