Latest developments in meibography: A review

Meibography is a visualisation technique that has been used for over 40 years. There have been significant improvements in image quality, examination technique and image interpretation over this period. Although meibography has received sporadic reviews in the past, an updated review is timely due to the rapid recent rise of relevant technology and advances in both image processing and artificial intelligence. The primary aim of this paper is to review recent research into Meibomian gland imaging and update the community about the most relevant technologies and approaches used in the field.     

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...     

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。     

A randomized,sham-controlled trial of intraductal meibomian gland probing with or without topical antibiotic/steroid for obstructive meibomian gland dysfunction

ImportanceObstructive meibomian gland dysfunction (MGD) can be refractory to medical therapy. Intraductal meibomian gland (MG) probing may offer a potential therapeutic approach for these patients, but no randomized trials have been conducted to date.ObjectiveTo assess clinical changes after intraductal MG probing for patients with refractory obstructive meibomian gland dysfunction.DesignRandomized, double-masked, sham-controlled clinical trial.SettingSingle-center, tertiary referral center.Participants42 patients with refractory obstructive MGD associated with lid tenderness.InterventionsEnrolled patients received one of the following treatments: 1) MG probing plus post-procedural topical sulfacetamide/prednisolone ointment (Blephamide®), 2) MG probing plus post-procedural lubricating ointment (GenTeal), or 3) sham probing plus GenTeal ointment. The probing was performed on the upper lids of both eyes.Main outcome measuresPrimary outcome measures were symptoms as measured by Ocular Surface Disease Index (OSDI) and Symptom Assessment iN Dry Eye (SANDE), as well as tear break-up time (TBUT). Secondary outcome measures were other clinical signs. Safety of the procedure was also evaluated by investigating the treatment-related adverse events. At baseline and 4 weeks after the procedure a masked observer evaluated the following outcome measures: symptom questionnaires, including OSDI and SANDE, upper lid tenderness, lid margin telangiectasia, corneal fluorescein staining, conjunctival lissamine green staining, TBUT, Schirmer's test, and meibomian glands yielding liquid secretion (MGYLS).ResultsCompared to baseline, the MG probing/Blephamide® group showed significant improvements in both OSDI and SANDE scores and the MG probing/GenTeal group demonstrated a significant improvement only in SANDE score. In contrast, the Sham/GenTeal group did not show any statistically significant changes in symptoms. There were no statistically significant changes in clinical signs in any group at the 4-week visit, except for improvement of lid tenderness in the sham probing group.ConclusionsMG probing/Blephamide® results in a significant improvement in symptoms in patients with refractory obstructive MGD without any significant effect on clinical signs. Larger studies are warranted to determine the efficacy of MG probing.Trial registrationClinicaltrials.gov(identifier NCT02256969, Filed on 08/13/2014)     

睑板腺热脉动系统与热敷疗法治疗睑板腺功能障碍的疗效比较

目的：对比分析LipiFlow睑板腺热脉动系统与传统的热敷疗法(warm compress)对睑板腺功能障碍(meibomian gland dysfunction,MGD)患者治疗的有效性及安全性。

方法：选取MGD患者50例,随机分为试验组及对照组。试验组进行单独一次LipiFlow睑板腺热脉动系统治疗; 对照组受试者每日在医生指导下使用热敷眼罩热敷治疗15min,每天1次,共2wk。对两组受试者在治疗前、治疗后4、8、12wk进行包括主观症状、泪膜破裂时间(TBUT)、脂质层厚度(LLT)、睑板腺缺失情况等8项指标的评估。采用重复测量数据的方差分析对两组的组间差异性及时间差异性进行分析。若两组存在组间差异性,进一步采用独立样本t检验; 若组内存在时间差异性,则采用LSD-t检验分析。

结果：两组受试者眼表疾病主观症状评分、睑板腺分泌物性状、Schirmer试验的改变差异均有统计学意义(P<0.05)。治疗后第12wk,试验组与对照组在OSDI、MGYSS、LLT、眼表染色评分、TBUT这些方面,改善程度的差值也具有统计学意义(P<0.05)。安全性方面,两组均未出现严重并发症或者不良医疗事件。

结论：单独一次睑板腺热脉动系统疗法和热敷疗法均能够有效且安全地治疗MGD。前者的疗效优于后者。     

Relationship between eyelid margin irregularity and meibomian gland dropout

PurposeTo examine the relationship between lid margin abnormalities and meibomian gland loss in infrared meibography.MethodsThis study was a retrospective chart review of 170 patients with dry eye disease. A correlation analysis between eyelid margin abnormalities and meibomian gland dropout in infrared meibography was performed using data from 141 eyes. We graded the following eyelid margin abnormalities: irregular lid margin, vascular engorgement, plugging, anterior placement of the mucocutaneous junction, exposed terminal duct, and presence of tattoos. Multiple regression analyses were performed with meiboscore (meibomian gland dropout grade) as the dependent variable and age, sex, lid margin abnormality grades, and total grading score of lid margin abnormalities as the covariates. In addition, Meibomian glands structure were examined in those with eyelid margin dimpling using meibography in 25 eyes.ResultsIn the multiple regression analysis, an irregular lid margin in the upper eyelid was associated with a higher meiboscore after controlling for age and sex (coefficients B = 1.379, p = 0.025). Other lid margin abnormalities did not significantly affect the meiboscore. In the lower eyelids, irregular lid margin (coefficients B = 0.602, p = 0.009) and total grading score of lid margin abnormality were associated with higher meiboscores (coefficients B = 0.100, p = 0.022). Of the 25 eyes with dimples, 21 (84%) showed focal or complete meibomian gland loss at the site.ConclusionsLid margin abnormalities were found to be associated with meibomian gland dropout.     

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.     

白内障超声乳化术前睑板腺按摩对合并睑板腺功能障碍患者术后眼表的影响

目的：：探讨合并有睑板腺功能障碍( Meibomian gland dysfunction,MGD)的白内障患者在术前行睑板腺按摩对术后眼表的影响。方法：选取合并MGD的白内障患者90例93眼,随机分为两组,试验组在术前1 wk每天行眼睑部热敷及睑板腺按摩,对照组不采取措施。两组患者均行白内障超声乳化联合人工晶状体植入术。分别于术前、术后1 wk进行裂隙灯显微镜检查,记录并比较两组的睑缘形态评分、睑板腺分泌物评分、泪液分泌试验( Schirmer Ⅰ test,SⅠt)、泪膜破裂时间( break-up time,BUT)结果。结果：与术前相比,对照组的睑缘形态评分、睑板腺分泌物评分显著提高,BUT和SⅠt显著下降。而试验组的术后睑缘形态评分、睑板腺分泌物评分、BUT和SⅠt均较对照组显著改善(P<0.05)。结论：超声乳化手术可以加重合并MGD患者的睑板腺功能,破坏眼表状态,而术前行睑板腺按摩可以显著改善白内障术后MGD患者的眼表状态。     

睑板腺形态及功能与阻塞性睡眠呼吸暂停综合征的关系

目的探讨阻塞性睡眠呼吸暂停综合征（OSAHS）患者睑板腺形态结构及其泪膜稳定性的改变。方法描述性研究。选取2013年11月至2014年6月期间于我院呼吸内科确诊为OSAHS的患者63例（126眼）作为OSAHS组,同期体检中心健康体检人群44例（88眼）作为对照组。对全部纳入对象询问个人基本信息及病史,并对眼表疾病指数（OSDI）进行评分后,再进行裂隙灯显微镜、非接触式红外线睑板腺成像仪、泪膜破裂时间（BUT）、睑板腺分泌物性状等眼部检查。结果睑板腺缺失发生率在对照组,轻度、中度、重度OSAHS患者中分别为12/88（14%）、7/18（39%）、14/30（47%）、53/78（68%）,组间差异有统计学意义（χ²=50.62,P＜0.01）;轻度、中度、重度OSAHS患者睑板腺缺失评分分别为2.29±1.25、2.29±0.91、2.64±1.18,差异无统计学意义。对照组,轻度、中度、重度OSAHS患者中睑板腺扭曲发生率分别为8/88（9%）、6/18（33%）、12/30（40%）,49/78（63%）,组间差异有统计学意义（χ²=51.96,P＜0.01）。OSAHS组睑板腺开口堵塞发生率（69%）、分泌物性状改变发生率（72%）较对照组高（分别为36%、39%）,差异均有统计学意义（χ²=22.42、27.26,P＜0.01）。结论与正常人群比较,OSAHS患者泪膜稳定性较低,睑板腺萎缩及腺体的形态异常发生率较高,并且睑板腺的形态改变与OSAHS严重程度有关。     

Role of instrumental factors in Meibomian gland contrast assessment

Purpose

Meibomian gland contrast has been suggested as a potential biomarker in Meibomian gland dysfunction. This study analysed the instrumental factors related to contrast. The objectives were to determine whether the mathematical equations used to compute gland contrast (e.g., Michelson or Yeh and Lin), impact the ability to identify abnormal individuals, to ascertain whether contrast between the gland and the background could be an effective biomarker and to assess whether using contrast-enhancement on the gland image improves its diagnostic efficacy.

Methods

A total of 240 meibography images from 40 participants (20 controls and 20 having Meibomian gland dysfunction or blepharitis), were included. The Oculus Keratograph 5M was used to capture images from the upper and lower eyelids of each eye. The contrast of unprocessed images and those pre-processed with contrast-enhancement algorithms were analysed. Contrast was measured on the eight central glands. Two equations for contrast computation were used, and the contrast both between glands and within a gland were calculated.

Results

Significant differences were found between the groups for inter-gland area in the upper (p = 0.01) and lower eyelids (p = 0.001) for contrast measured with the Michelson formula. Similar effects were observed when using the Yeh and Lin method in the upper (p = 0.01) and lower eyelids (p = 0.04). These results were obtained for images enhanced with the Keratograph 5M algorithm.

Conclusions

Meibomian gland contrast is a useful biomarker of disease related to the Meibomian glands. Contrast measurement should be determined using contrast-enhanced images in the inter-gland area. However, the method used to compute contrast did not influence the results.     

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.     

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.     

Luz pulsada intensa combinada con expresión de las glándulas de Meibomio para el tratamiento del chalación

ObjectiveTo investigate the efficacy and safety of an intense pulsed light (IPL) combined IPL treatment protocol for meibomian gland dysfunction (MGD)/dry eye disease (DED) with IPL applied directly to the eyelids, associated with meibomian gland (MG) expression for the treatment of chalazion.Material and MethodsRetrospective case series study. Patients presenting with chalazion received a combined IPL therapy treatment consisting of using the usual IPL protocol for DGM/EOS using a fluence according to skin type according to Fitzpatrick, followed by a second phase (in the same session) of IPL application directly on the eyelids of both eyes using a fluence of 10 J/cm2. All patients then received GM expression, eyelid hygiene, topical antibiotic and topical ocular anti-inflammatory medication. Adverse effects related to this protocol were assessed at each IPL session.ResultsTwenty-six chalazions from nineteen patients (24 eyes) with a mean age of 49.89 ± 20.43 years were included. An average of 2.07 ± 0.97 IPL sessions were required for chalazion resolution. The combined treatment of IPL protocol and GM expression showed 96.15% efficacy and no adverse effects were observed.ConclusionsCombined IPL treatment for DGM/EOS with IPL applied directly on the eyelids and GM expression could be effective and safe for the treatment of chalazions.     

阻塞型睑板腺功能障碍患者睑板腺的形态学观察

背景 阻塞型睑板腺功能障碍(OMGD)是睑板腺功能障碍的常见类型,目前认为OMGD是由于睑板腺导管的阻塞和/或睑脂分泌异常导致,因此睑板腺形态学的改变具有重要的临床意义. 目的 运用Keratograph 5M眼表综合分析仪观察OMGD患者睑板腺的形态学改变并对其进行分析. 方法 采用前瞻性病例观察研究方法.纳入2015年1-6月在天津医科大学眼科医院确诊的OMGD患者60例60眼,同时选择60名健康体检者作为正常对照组.分别对2个组受检者进行眼表疾病指数(OSDI)问卷调查、泪膜破裂时间(BUT)、Keratograph 5M眼表综合分析仪观察睑板腺缺失情况、睑板腺开口评分及睑脂评分.根据OSDI评分分为轻度OMGD组(12.0＜ OSDI≤22.0) 23例、中度OMGD组(22.0＜OSDI≤32.0)21例和重度OMGD组(32.0＜OSDI≤100.0) 16例.分别对3个组患者的睑板腺状况进行评估与分析. 结果 OMGD组OSDI评分、睑板腺缺失评分及睑脂评分均高于正常对照组,与正常对照组比较,差异均有统计学意义(Z=-9.425、-7.781、-8.954,均P＜0.05).OMGD组和正常对照组BUT分别为(6.10±1.91)s和(10.67±2.11)s,睑板腺开口评分分别为1.35±0.90和0.88 ±0.64,差异均有统计学意义(t=-12.418、3.276,均P＜0.05).轻度OMGD组、中度OMGD组和重度OMGD组间OSDI、睑板腺缺失评分及睑脂评分比较,差异均有统计学意义(H=52.121、37.180、13.642,均P＜0.05),BUT、睑板腺开口评分差异均有统计学意义(F=58.191、8.474,均P＜0.05).OSDI与睑板腺缺失评分、睑脂评分及睑板腺开口评分之间均呈正相关(r=0.708,P=0.000;r=0.759,P=0.000;r=0.270,P=0.003).BUT与睑板腺缺失评分、睑脂评分及睑板腺开口评分之间呈负相关(r=-0.692,P=0.000;r=-0.691,P=0.000;r=-0.192,P=0.036). 结论 Keratograph 5M眼表综合分析仪可以快速、精确地对睑板腺进行形态学观察.OMGD患者在眼表及睑板腺等方面与正常人存在差异.     

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。     

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.     

眼型玫瑰痤疮的研究进展

眼型玫瑰痤疮曾称为眼红斑痤疮,是一种累及眼表的慢性炎症性疾病。临床表现为睑缘炎和睑板腺功能障碍,严重者角膜受累,视力受损。近年关于发病机制的研究认为其是多种危险因素共同作用的结果。临床表现缺乏特异性,但早期诊断和规范治疗可以明显改善症状,恢复视力。本文重点介绍眼型玫瑰痤疮的最新研究进展。     

蠕形螨感染致睑板腺功能障碍的临床研究

目的：分析蠕形螨相关性睑板腺功能障碍(MGD)患者的临床情况及综合治疗对蠕形螨感染状态的影响。

方法：前瞻性病例对照研究。选取2016-01/2017-06在沈阳何氏眼科医院门诊就诊的MGD患者132例264眼(试验组)及基本资料相匹配的健康志愿者96例192眼(对照组)。试验组患者进行综合治疗。两组受检者均进行睫毛采样镜检蠕形螨感染情况,并进行泪膜破裂时间(BUT)、Schirmer Ⅰ试验(SⅠt)、角膜荧光染色(FL)评分检查; 试验组患者同时进行主观症状评分检查。

结果：治疗前,试验组和对照组受检者蠕形螨感染数量分别为7(6,9)、2(1,3)个/眼,差异有统计学意义(Z=5.264,P<0.01); 蠕形螨阳性率分别为100.0%和28.1%,差异有统计学意义(χ²=35.957,P<0.01); BUT分别为4.06±1.38、12.00±2.82s,FL评分分别为3.06±1.57、0.46±0.63分,SⅠt分别为6.93±2.08、11.13±2.38mm/5min,差异均有统计学意义(t=-9.825、5.978、-4.776,均P<0.01)。治疗前和治疗后4wk,试验组患者主观症状评分分别为6.57±2.93、3.27±1.89分,差异有统计学意义(t=5.443,P<0.01)。治疗后4wk,试验组患者蠕形螨阳性率为57.6%; 蠕形螨数量平均为3(0,5)个/眼,较治疗前明显减少(Z=3.937,P<0.01); BUT、FL评分分别为6.53±3.27s、1.67±0.54分,均较治疗前好转,差异有统计学意义(t=5.152、4.328,均P<0.01),而SⅠt(8.37±5.34mm/5min)较治疗前无明显改变,差异无统计学意义(t=-0.285,P=0.748)。

结论：蠕形螨感染可引起MGD,产生相应的临床症状。综合治疗能降低眼部蠕形螨寄生数量,有效缓解蠕形螨相关性MGD的临床症状。     

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.