A novel transillumination meibography device for in vivo imaging of mouse meibomian glands

PurposeWhile mouse models of dry eye disease (DED) have been developed, studies evaluating the role of the meibomian glands limited by the inability to temporally document changes. In this report we describe the development of a novel mouse transillumination meibography device and assess the ability of this device to detect age-related changes in the meibomian glands of young and old mice.MethodsThe mouse meibography device was comprised of a 3 mm wide right angle prism attached to broad spectrum light source by an optical fiber. Eyelids were then pulled over the prism using double tooth forceps and imaged using a stereomicroscope and low light level camera. Meibomian glands from four young and four old male, BALB/c mice were then imaged and analyzed using ImageJ.ResultsIn young mice, meibography documented the presence of 7–8 meibomian glands appearing as black and distinct eyelid structures with the length shorter in the lower eyelid compared to the upper eyelids. Eyelids of old mice showed apparent dropout of meibomian glands along with smaller and more irregularly shaped acini. The mean acini area of one meibomian gland was 0.088 ± 0.025 mm² in young mice and 0.080 ± 0.020 mm² in old mice (p = 0.564), but the Meibomian gland density was significantly lower in older mice (41.7 ± 6.4%, 27.3 ± 4.2%) (p = 0.021).ConclusionWe have developed an in vivo meibography device that may prove useful in sequentially documenting changes during development of meibomian gland dysfunction and following treatment.     

The impact of contact lenses on meibomian gland morphology

Despite years of experience with contact lenses, controversy remains as to whether contact lenses adversely impact the meibomian glands (MG). This review summarizes the present body of evidence, showing that contact lens wear is associated with alterations in MG morphology (up to 80% higher gland atrophy compared to non-wearers) and qualitative changes in MG secretion. Key factors such as duration of contact lens wear, contact lens type (e.g., soft vs. rigid), edge design, and material modulus of elasticity are discussed in relation to the extent of MG morphological changes, the quality of MG secretion and other ocular surface parameters. Longitudinal studies of sufficient statistical power are needed to better understand how contact lens wear affects the MG, risk factors, and the clinical sequelae of these changes.     

睑缘炎患者睑板腺形态变化及其与干眼的关系

背景 睑缘炎是一种常见的眼表疾病,常累及睑板腺体,而睑板腺体所分泌的脂质是泪膜的重要组成成分之一.泪膜稳定性的破坏可导致干眼相关症状,可以说睑缘炎是干眼发病的因素之一,但二者之间的关系有待进一步研究. 目的 使用非接触式红外线睑板腺观察仪观察睑缘炎患者睑板腺腺体的形态,并与干眼相关检查进行相关性分析. 方法 采用病例观察的设计方法对睑缘炎患者睑板腺形态改变与干眼症的关系进行研究.选取2010年9月至2011年4月于河南省眼科研究所眼科门诊依据PPP标准诊断为睑缘炎的患者83例83眼,取得患者的知情同意后,在裂隙灯下行眼前节检查睑缘畸形评分、泪液分泌( Schirmer Ⅰ)试验、泪膜破裂时间(BUT)、角膜荧光素染色评分及结膜充血评分,采用泪膜干涉仪行泪膜形态分级,采用非接触式红外线睑板腺摄像仪行睑板腺腺体缺失分级,对睑缘炎睑板腺腺体缺失分级与上述检查结果的关系进行评估.结果 不同年龄组不同性别间睑缘炎的频数分布差异无统计学意义(x2=2.69,P=0.75).睑缘炎患者的睑板腺腺体缺失分级与年龄星弱的正相关(r=0.58,P=0.00),但与性别无明显相关性(r=-0.09,P=0.99);患者睑板腺体缺失与睑缘畸形评分及结膜充血评分均呈弱的正相关(r=0.64,P=0.00;r=0.50,P=0.00);与泪膜影像分级及角膜染色评分均呈弱的正相关(r=0.23,P=0.04;r=0.50,P=0.00),与BUT呈弱的负相关(r=-0.32,P=0.00),但与Schirmer Ⅰ试验结果无明显相关性(r=-0.05,P=0.69).不同年龄组男性和女性的睑板腺缺失分级评分差异无统计学意义(Z=-0.09,P=0.93).结论 睑缘炎可引起蒸发过强型干眼,且患者的睑板腺体随年龄的增长缺失程度加重.非接触式红外线睑板腺观察仪作为一种有效、快速、无刺激地观察睑板腺体形态的仪器,可作为一项常规检查来辅助诊断睑缘炎.     

我国江浙沪正常人上睑板腺特征的年龄相关性研究

目的观察分析不同年龄组正常国人上睑板腺（UMG）的临床特征。方法横断面研究。对792例（1 584眼）江浙沪地区汉族健康志愿者依年龄分10组（自1岁开始,10岁为一组）。收集UMG图像评级（Grade）、UMG形态学指标[数目（n）、密度（d）、平均宽度（WA）、平均长度（LA）、所占面积比（RA）]、睑缘形态异常评分（LAS）、睑板腺评分（M）、睑板腺分泌评分（MS）、角膜荧光素钠染色积分（FI）、泪膜破裂时间（BUT）和泪液分泌试验（SⅠT）等指标。各指标与年龄制作统计图行描述性分析,并运用相关性分析观察各参数与年龄的相关性;不同性别间指标行非参数检验或t检验分析。结果UMG各形态学及临床学指标在性别间除51～60岁组的M和71～80岁组的n外（t＝-3.162、-2.291,P＜0.05）,余差异无统计学意义（P>0.05）。n、d、LA、RA、M和BUT均与年龄呈负相关（r=-0.625、-0.493、-0.593、-0.862、-0.322、-0.521,P均<0.05）;Grade、WA、LAS、MS、FI均与年龄呈正相关（r=0.296、0.255、0.527、0.303、0.228,P均<0.05）;SⅠT与年龄无相关性（r=-0.125,P＞0.05）。结论正常江浙沪汉族国人存在与年龄相关的上睑板腺形态学及临床学参数改变的趋势。     

Meibography: A review of techniques and technologies

Meibomian glands play a significant role in tear production by contributing lipids to the superficial tear film.¹ Dysfunction of the meibomian glands destabilizes tears resulting in evaporative dry eye.2, 3 Historically, the meibomian glands were assessed in an ex vivo fashion through histologic studies. However, innovations in ocular imaging have advanced significantly in recent decades to include meibography. Meibography is an imaging study developed 35 years ago exclusively for the purpose of observing the morphology of meibomian glands in vivo.4, 5 In this review of meibography, we briefly describe the etiology of meibomian gland dysfunction and then discuss various meibography techniques, technologies, and methods of image analysis. We close with a review of the literature, crediting various studies for the significant contributions made toward our current understanding of the meibomian glands.     

Spontaneous acinar and ductal regrowth after meibomian gland atrophy induced by deletion of FGFR2 in a mouse model

PurposeWe have demonstrated that deletion of fibroblast growth factor receptor 2 gene (Fgfr2) leads to Meibomian gland (MG) atrophy in an inducible conditional knockout mouse model, referred as Fgfr2^CKO. Herein, we investigated whether MG spontaneously recovers after atrophy in this model.MethodsTwo months old Fgfr2^CKO mice were injected peritoneally once or twice of doxycycline (Dox) at 80 μg/gm of body weight to induce MG atrophy of various severities via Fgfr2 deletion. Recovery of acinar and ductal tissues was monitored by meibography, lipid staining and immunofluorescence against keratin-6a in MG whole-mount. Biomarkers for acinar and ductal differentiation and proliferation were also examined by immunostaining.ResultsSingle Dox injection in Fgfr2^CKO mice caused severe acinar and moderate ductal atrophy. Severe ductal shortening or loss occurred after second Dox injection, presumably related to the reported slower cycling of the ductal epithelia. Spontaneous acinar regrowth after atrophy was observed over a period of 60 days in both injection regimens. However, less robust acinar recovery was associated with more disrupted ductal structures in twice injected Fgfr2^CKO mice.ConclusionsOur current findings further substantiate the role of FGFR2 in MG homeostasis, and suggest that FGFR2-signaling may provide a potential strategy for regenerating acini from age-related MG dysfunction in humans. Our data demonstrated that spontaneous MG recovery depends on the extent of ductal atrophy, suggesting that ductal epithelia may provide the progenitor cells for acinar regeneration. Nonetheless, the role of ductal tissue as the source of acinar progenitors awaits further investigation.     

Ocular surface alkali injury damages meibomian glands in mice

Purpose

To examine effects of alkali injury of the ocular surface on meibomian gland pathology in mice.

围绝经期综合征睑板腺功能障碍患者的眼表及睑板腺形态和功能表现

背景 围绝经期综合征(PMS)是女性必经的重要时期,可伴随生理、病理及雌性激素水平的改变,同时会伴随一系列眼部及全身健康问题.眼部病变主要体现在眼表系统,影响患者的视觉和生活质量.目的 探讨PMS睑板腺功能障碍(MGD)患者眼表及睑板腺的形态和功能改变. 方法 采用病例对照研究方法,收集2015年1-8月在武警后勤学院附属医院42例确诊为PMS-MGD的患者,进行眼表疾病指数评估(OSDI)问卷、裂隙灯显微镜检查、干眼相关指标检查、睑板腺相关指标检查等,全身检查包括妇科基本检查及评分、围绝经期特征的性激素水平检查等,以48名同龄健康妇女作为对照组,均将右眼检查数据纳入统计分析,比较PMS-MGD组患者与对照组受检者的眼表及睑板腺形态和功能改变.结果 与对照组受检者比较,PMS-MGD组患者血液卵泡刺激素(FSH)、黄体生成激素(LH)水平明显高于对照组,差异均有统计学意义(t=55.217、76.769,均P＜0.01);患者外周血中雌二醇(E2)水平明显低于对照组,差异有统计学意义(t=-46.358,P＜0.01).PMS-MGD组患者OSDI评分为25.00(18.00,32.00),对照组为1.00(1.00,2.00),差异有统计学意义(Z=-8.043,P＜0.05).OSDI问卷调查显示PMS-MGD组患者的主要主观症状为异物感,其次依次为视物模糊、畏光、眼酸眼痛和视力下降;调查还显示患者中看电视时症状加重者16例,占38.10％,使用计算机或自助提款机时加重者10例,占23.81％,阅读困难者6例,占14.29％,夜间开车困难者4例,占9.52％,有风时症状加重者4例,占9.52％,干燥环境下加重者14例,占33.33％,空调环境下加重者16例,占38.10％,有10例患者在上述状况下未出现症状加重的表现,占23.81％,2例患者在有风环境及空调环境下同时有自觉症状加重.PMS-MGD组OSDI评分、角膜荧光染色评分均明显高于对照组,差异均有统计学意义(均P＜0.05);患者泪膜破裂时间(BUT)短于对照组,差异有统计学意义(t=-10.276,P＜0.05).PMS-MGD组患者睑缘异常评分、睑板腺缺失评分、睑板腺开口评分及睑板腺分泌物性质评分均明显高于对照组,差异均有统计学意义(Z=-7.258、-6.517、-6.195、-6.973,P＜0.05).2个组间受检眼泪液分泌试验比较差异无统计学意义(P＞0.05).结论 PMS-MGD组患者MGD功能发生改变,眼表刺激症状明显,并影响正常生活,主诉以异物感最多,看电视时及空调环境下症状加重的患者比例高,睑板腺形态明显异常.     

干眼患者睑板腺状况的分析

目的 探讨临床诊断为干眼症患者的睑板腺状态。方法 非干预性、观察性研究。2010年3至12月在北京大学第三医院眼科诊断为干眼的194例（388只眼）作为研究对象。其中男性69例（138只眼）,女性125例(250只眼),总体年龄范围7～ 85岁,平均年龄（44±18）岁,男性平均年龄(39±18)岁,女性平均年龄(47±17)岁。检查指标包括主观症状评分、泪液分泌试验、泪膜破裂时间(BUT)及角膜荧光染色情况,同时利用非接触红外线睑板腺照相系统进行睑板腺检查。结果 观察的194例（388只眼）主观症状平均(5.47±2.14)分,SIaT值为(5.58±4.22) mm,BUT为(3.09±2.34)s,角膜荧光素染色评分(4.10±3.79)分。睑板腺照相评分为1分占3.09％（12只眼）,2分占9.28％（36只眼）,3分占20.10％（78只眼）,4分占26.03％（101只眼）,5分占21.91％（85只眼）,6分占19.59％（76只眼）。结论 睑板腺功能障碍是干眼症的重要病因之一。非接触红外线睑板腺照相系统可以客观评价睑板腺形态。     

角膜接触镜相关性干眼与睑板腺形态变化的关系

目的:探讨软性角膜接触镜(CL)长期配戴者睑板腺形态改变与干眼观察指标的关系。方法:采用横断面研究方法,连续纳入2014年5月至2015年6月就诊于天津医科大学眼科医院拟行屈光性手术的患者157例314眼,其中长期配戴软性CL者91例182眼作为CL组,未配戴CL者66例132眼作为对照组。收集并比较2个组患者眼表疾病...     

Emerging strategies for the diagnosis and treatment of meibomian gland dysfunction: Proceedings of the OCEAN group meeting

Meibomian gland dysfunction (MGD) is a common and chronic disorder that has a significant adverse impact on patients' quality of life. It is a leading cause of evaporative dry eye disease (DED), as meibomian glands play an important role in providing lipids to the tear film, which helps to retard the evaporation of tears from the ocular surface. MGD is also often present in conjunction with primary aqueous-deficient DED. Obstructive MGD, the most commonly observed type of MGD, is the main focus of this article. MGD is probably caused by a combination of separate conditions: primary obstructive hyperkeratinization of the meibomian gland, abnormal meibomian gland secretion, eyelid inflammation, corneal inflammation and damage, microbiological changes, and DED. Furthermore, skin diseases such as rosacea may play a part in its pathology. Accurate diagnosis is challenging, as it is difficult to differentiate between ocular surface diseases, but is crucial when choosing treatment options. Ocular imaging has advanced in recent years, providing ophthalmologists with a better understanding of ocular diseases. This review presents a literature update on the 2011 MGD workshop and an optimized approach to accurate diagnosis of MGD using currently available methods and tests. It also outlines the emerging technologies of interferometry, non-contact meibography, keratography and in vivo confocal laser microscopy, which offer exciting possibilities for the future. Selected treatment options for MGD are also discussed.     

提高对睑板腺功能障碍的认识 重视睑板腺功能障碍相关性干眼的药物治疗

睑板腺功能障碍（MGD）是临床常见的眼表疾病,以睑板腺终末导管的阻塞和／或睑板腺分泌物质或量的改变为特征,导致脂质向泪膜的排出减少,引起泪液蒸发过强。睑缘和睑板腺的炎症是引起睑板腺阻塞,进而导致MGD的直接原因,可引起眼表功能的异常。MGD的诊断主要依靠临床症状与体征,其症状与干眼的症状相似,因此无诊断特异性。体征主要包括睑缘形态的变化、睑板腺分泌异常和睑板腺缺失。MGD的治疗方法包括热敷、清洁睑缘、促进睑板腺的分泌、抗菌、抗炎治疗及润滑眼表,中度、重度MGD患者可给予必要的抗炎治疗,常用的抗炎药物有糖皮质激素、非甾体类抗炎药及免疫抑制剂。临床医师在进行眼部疾病的检查时应重视睑板腺的功能状态,尤其在角膜屈光手术及内眼手术前更应重视MGD的筛查,以免术后引起严重的眼表并发症,有效规避医疗风险。     

睑板腺功能障碍药物治疗研究进展北大核心CSCD

睑板腺功能障碍(MGD)是一种慢性、弥漫性睑板腺异常,其病因众多,发病机制复杂且患病率高,已经成为临床上常见的眼表疾病之一。MGD的治疗是近年来临床研究的热点和难点,主要包括改善生活方式、物理治疗、药物治疗、手术治疗,其中药物治疗占重要地位。按照作用机制可将治疗MGD的药物大致分为3大类:第1类是改善泪液质量和泪膜稳定性的药物,包括人工泪液和眼表润滑剂、促泌剂(促进脂质、水液以及黏蛋白分泌)和雄激素等;第2类是改善眼表微环境的药物,包括局部及全身应用抗生素、糖皮质激素类滴眼液、非甾体类抗炎药、免疫抑制剂、除螨药物等;第3类是营养补充剂和神经保护剂,包括维生素D3、ω-3脂肪酸、自体血清等。本文就目前临床常用及研究较多的MGD治疗药物进行综述,为MGD临床治疗和研究提供参考。     

Association of meibomian gland morphology with symptoms and signs of dry eye disease in the Dry Eye Assessment and Management (DREAM) study

PurposeTo describe associations between symptoms and signs of dry eye disease (DED) and meibomian gland (MG) morphology.MethodsCross-sectional study utilizing data from the Dry Eye Assessment and Management (DREAM) Study. Readers graded MG features in the middle third of upper and lower lids on infrared meibography images. Associations with signs and symptoms of DED were evaluated with adjustment for age and sex.ResultsAmong 268 patients, no MG features were associated with symptom scores (p > 0.08). Among 394 upper eyelids, better tear break-up times (<2, >2- <3.2and ≥ 3.2 s) were associated with more tortuous glands (mean (SD) 0.58(0.95), 0.83(1.2) and 1.14 (1.4), p = 0.01) and with higher scores on a composite score of MG features (21.90 (9.76), 23.29 (9.50), 26.26 (10.27); p = 0.02). Longer Schirmer test wetting lengths (0–5, >5–10, and >10 mm) were associated with increasing composite scores (22.02 (9.29), 23.80 (10.34), 24.96 (9.96), p = 0.03). Patients with Sjogren syndrome compared to other patients had fewer distorted MGs (mean 3.4 (2.3) vs 4.3 (2.3), p = 0.03) and fewer ghost glands (mean 0.33 (0.88) vs 0.89 (1.8), p = 0.006) in the upper lid.ConclusionIn the DREAM study, most MG morphologic features were not associated with the severity of DED symptoms or signs. Tortuous glands and a higher composite score for MG features were associated with longer tear break-up times and longer Schirmer test length in the upper eyelid only. Patients with Sjogren syndrome had fewer distorted and ghost glands.     

Clinical evaluation of the efficacy and safety of heating physiotherapy goggles in the treatment of meibomian gland dysfunction

Objective: To evaluate the efficacy and safety of heating physiotherapy goggles in the treatment of meibomian gland dysfunction (MGD). Methods: A randomized controlled study was performed. Forty-four MGD patients were recruited in Wenzhou Medical University Eye Hospital from July 2021 to January 2022. Two patients were lost to follow-up. The patients were randomly divided into experimental group treated with heating physiotherapy goggles and control group treated with hot towels according to the random envelope method, with 21 patients (21 eyes) in each group. Throughout the study, the examiner was blinded. The data of the worse eye were analyzed. At baseline, 2 weeks and 4 weeks after treatment, the Ocular Surface Disease Index (OSDI), tear meniscus height (TMH), fluorescein breakup time (FBUT), corneal fluorescein staining score (CFS), lid margin hyperemia score and meibomian gland function scores were measured to evaluate the efficacy; visual acuity, intraocular pressure and slit lamp microscopy were examined to assess the safety. This study adhered to the Declaration of Helsinki. The study protocol was approved by the Ethics Committee of Wenzhou Medical University Eye Hospital (No. 2021-177-K-153-01). Results: There were significant differences in OSDI scores between before and after treatment (Ftime = 16.528, P<0.001). No significant difference was found in OSDI scores between 30.46 ± 17.31 at 2 weeks after treatment and 35.43 ± 18.22 before treatment in control group (P = 0.405). The OSDI score at 2 weeks after treatment was 26.27 ± 16.47, which was significantly lower than 39.24 ± 17.96 before treatment in experimental group (P = 0.001). The eyelid margin hyperemia score was 0.0 (1.0, 2.0) at 4 weeks after treatment in experimental group, which was significantly lower than 2.0 (1.0, 3.0) in control group (Wald χ2 = 11.444, P = 0.001). The morphologic scores of meibomian gland orifices at 2 and 4 weeks after treatment were both 1.0 (0.0, 1.0) in experimental group, which were significantly lower than 2.0 (1.0, 3.0) and 2.0 (1.0, 2.5) in control group (Wald χ2 = 15.082, 23.172; both at P<0.001). The scores of meibum quality at 2 and 4 weeks after treatment were 1.0 (0.5, 2.0) and 1.0 (0.0, 1.5) in experimental group, which were significantly lower than 2.0 (1.0, 2.0) and 2.0 (1.0, 2.5) in control group (Wald χ2 = 4.638, 9.395; both at P< 0.05). The scores of upper meibomian gland expressibility at 2 and 4 weeks after treatment were both 2.0 (1.0, 2.0) in experimental group, which were significantly lower than 3.0 (2.0, 3.0) and 2.0) 2.0, 2.5) in control group (Wald χ2 = 6.489, 11.562; both at P< 0.05). The score of lower meibomian gland expressibility at 4 weeks after treatment in experimental group was 1.0 (0.5, 2.0), which was significantly lower than 2.0 (2.0, 3.0) in control group (Wald χ2 = 24.085, P<0.001). The FBUT at 2 and 4 weeks after treatment were 3.00 (1.75, 3.50) and 3.00 (2.00, 4.00) seconds in experimental group, which were significantly longer than 1.00 (0.75, 2.00) and 2.00 (1.00, 3.00) seconds in control group (Wald χ2 = 8.576, 8.539; both at P<0.05). There were significant differences in TMH among different time points (Ftime = 8.874, P<0.001). In control group, the TMH at 4 weeks after treatment was (0.24 ± 0.09) mm, which was significantly higher than (0.18 ± 0.05) mm before treatment (P<0.05). In experimental group, the TMH at 4 weeks after treatment was (0.23 ± 0.09) mm, which was significantly higher than (0.17 ± 0.05) mm before treatment (P<0.05). Significant differences were found in CFS score among different time points (Wald χ2time = 10.116, p = 0.006). There was no statistically significant diferencs in CFS score between before and after treatment in control group experimental group, the CFS scores at 2 and 4 weeks after treatment were 0.0 (0.0, 1.5) and 0.0 (0.0, 0.0), which were significantly decreased in comparison with 0.00) 0.00, 4.00) before treatment (both at P<0.05). In experimental group, the visual acuiiy converted to the logarithm of the minimum angle of resolution at 2 and 4 weeks after treatment were 0.10 (0.00, 0.22) and 0.10) 0.00, 0.22), which was significantly better than 0.10 (0.00, 0.40) before treatment (both at P<0.05). There was no significant change in intraocular pressure at diferent time points between the two groups (Fgroup = 0.432, P = 0.515; Ftime = 0.329, P = 0.721). No serious adverse effects occurred in both groups during the follow-up period. Conclusions: Compared with hot towel therapy, the use of heating physiotherapy goggles can relieve ocular discomfort of MGD patients more rapidly and improve the function and status of the meibomian gland more significantly. Heating physiotherapy goggles can treat MGD safely and effectively. © 2023 Henan Institute of Ophthalmology. All rights reserved.     

Association of meibomian gland architecture and body mass index in a pediatric population

PurposeTo determine if meibomian gland architecture in a pediatric population is impacted by body mass index (BMI).MethodsProspective evaluation of 175 eyes of 175 pediatric patients from two clinics. Demographic and clinical information were reviewed. Symptoms of dry eye were assessed with the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire. Meibography was performed and grading of images was performed by a masked rater using a previously validated 5-point meiboscale (0–4) for gland atrophy and a 3-point score (0–2) for gland tortuosity.Results175 eyes of 175 participants aged 4–17 years (11.6 ± 3.7 years) were imaged. The mean meiboscore was 0.82 ± 0.94 (range 0–4) and the mean gland tortuosity score was 0.53 ± 0.70 (range 0–2). Ninety-six patients (56%) showed evidence of gland atrophy (meiboscore greater than 0) and the majority of patients (n=50, 29%) had a gland tortuosity score of 1. The mean BMI was 20.5 ± 4.86 kg/m² with 39.4% of patients (n = 69) above the 85th percentile. BMI percentile was not found to be a significant predictor of a meiboscore greater than 0 (odds ratio (OR) 1.004 95% confidence interval (CI) (0.99–1.10, p = 0.41). However, BMI percentile was found to be a significant predictor of gland tortuosity score (OR 1.01 95% CI (1.00–1.02), p = 0.02). Patients with BMI percentiles between 41 and 60 were 3.79 times more likely to have a gland tortuosity score of greater than 0 than patients with BMI percentiles between 0 and 20 (OR 3.789 CI (1.17–12.24)). No significant associations were found between age, race, or sex and meiboscore or tortuosity. There was a trend towards reduction in lipid layer thickness with increasing BMI percentile (p = 0.028, r² = 0.04).ConclusionIn this pediatric population, there was an association between meibomian gland tortuosity and higher percentiles of BMI. Future studies are needed to elucidate the pathogenesis of meibomian gland tortuosity and atrophy in pediatric patients.     

活体共聚焦显微镜下睑板腺囊肿患者睑板腺形态分析

目的:分析睑板腺囊肿患者的睑板腺组织在活体共聚焦显微镜(IVCM)下的形态学改变及特点。方法:采用横断面研究方法,选取2018年9月至2019年4月在汕头大学·香港中文大学联合汕头国际眼科中心就诊的睑板腺囊肿患者34例34眼以及无睑板腺疾病患者18例18眼分别作为睑板腺囊肿组和对照组。对所有受检者进行眼科常规检查及IV...     

腺管探通术治疗睑板腺功能障碍的临床观察

目的探讨睑板腺腺管探通术治疗睑板腺功能障碍（MGD）的临床疗效及安全性。方法前瞻性配伍组设计。111例睑板腺功能障碍患者,按性别年龄相匹配分为3组,每组37人（37眼）,选择症状体征较重的眼作为观察眼。常规治疗组采用抗生素激素滴眼液+人工泪液+局部物理治疗;腺管探通术组在常规治疗组的治疗基础上用直径仅76 ?滋m的不锈钢探针（美国Rhein Medical公司）,每只眼探通6～9个睑板腺腺管;腺管探通联合管内注药组在腺管探通组治疗基础上,探通术中管内注入适量妥布霉素地塞米松滴眼液。分别于治疗前和治疗后1个月观察MGD患者主观症状指标眼表疾病指数（OSDI）量表、泪膜破裂时间（BUT）、基础泪液分泌试验（SIT）检查、角膜荧光素染色（CFS）、裂隙灯显微镜下睑缘评分共5项指标的变化并做对比分析。对实施探通术2组的MGD患者分别于探通前及探通后1个月进行共聚焦显微镜检查,观察睑板腺腺泡单位有无损伤改变,以评价探通术的安全性。组内定量指标比较采用配对t检验,多组之间比较采用配伍组设计的两因素方差分析,差异有显著性后采用 q检验进行两两比较。结果①3组MGD患者治疗前OSDI、BUT、CFS、SIT、裂隙灯下睑缘评分共5项观测指标基线值对比差异无统计学意义。②治疗后1个月3组之间5项检测指标差异有统计学意义（F=4.68、4.17、3.98、3.67、4.12,P＜0.05）;腺管探通术组与腺管探通联合管内注药组各项观测指标改善程度均优于常规治疗组,差异有统计学意义（P＜0.05）。腺管探通联合注药组经治疗后改善程度虽优于单纯探通术组,但差异无统计学意义。③实施探通术的2组MGD患者治疗后5项观测指标较治疗前均有显著改善,差异有统计学意义（腺管探通术组：t=2.543、2.343、2.456、2.132、2.237;腺管探通联合管内注药组：t=2.713、2.443、2.496、2.143、2.249,P均＜0.05）。常规治疗组MGD患者经治疗后与术前相比虽有改善,但差异无统计学意义。④共聚焦显微镜下睑板腺腺泡单位因光学切面不同,呈现不同形态,有圆形、卵圆形、长条形、不规则形等,腺泡外圈为轮胎样上皮细胞,伴有高亮反光颗粒,胞腔内呈灰色伴点状高反光分泌物,团块状聚集分布,排列不规整。探通后未见萎缩腺泡增加或疤痕形成。结论睑板腺腺管探通术能直接缓解睑板腺管阻塞,从而快速地缓解阻塞性MGD患者的症状和体征,是一种新的安全有效的治疗方法。