睑板腺功能障碍患者睑缘形态与睑板腺形态学的相关性研究

目的 研究睑板腺功能障碍（MGD）患者睑缘形态与睑板腺形态的相关性。设计 横断面研究。研究对象 2019年北京同仁医院行Lipiflow热脉冲治疗前的MGD患者30例（30眼）。方法 通过眼前节照相技术和Oculus眼表分析仪拍摄睑缘和睑板腺，并依据睑缘形态、睑板腺主体部形态、睑板腺开口和分泌物性状进行分类。睑缘形态分为肥厚、充血、角化和变形；睑板腺主体部形态分为缺失、白色节段、导管膨胀、萎缩、扭曲和分叉；睑板腺开口形态分为圆形、脂帽、脂塞和脂栓。依上述形态进行评分，运用Spearman相关分析研究睑缘形态与睑板腺形态的相关性。主要指标 睑缘及睑板腺形态评分，睑缘及睑板腺形态学相关系数（r）。结果 睑板腺开口形态与分泌物性状之间呈正相关（r=0.590，P=0.001），睑板腺白色节段与睑板腺开口形态呈正相关（r=0.439，P=0.015）；睑板腺萎缩和分叉与睑板腺的分泌物性状呈负相关（r=-0.349，-0.374；P=0.048，0.042）。在睑缘形态中，睑缘角化的评分与睑缘形态总评分呈正相关，且相关关系最强（r=0.842，P＝0.000）；睑缘角化与睑板腺开口形态改变呈正相关（r=0.517，P=0.003）。在睑板腺形态中，睑板腺白色节段评分与睑板腺总评分呈正相关，且相关关系最强（r=0.535，P＝0.002）。结论 MGD患者睑缘形态与睑板腺形态部分存在相关关系。睑板腺白色节段作为睑板腺主体部的形态评估指标更为合理；睑缘角化作为睑缘的形态评估指标更为合理，且睑缘角化与睑板腺开口的形态改变相关。（眼科， 2020， 29： 355-360）

Morphological correlation between sacral margin and meibomian gland in patients with meibomian gland dysfunction

Objective To investigate the morphology correlation between palpebral margins and meibomian glands in patients with meibomian gland dysfunction (MGD) based on the established morphology scoring system. Design Cross-sectional study. Participants A total of 30 MGD patients before Lipiflow heat pulse treatment in Tongren Hospital were classified and included. Methods The meibomian glands were photographed using the Keratograph 5M, and the eyelid margins were photographed using an anterior segment bioslit lamp microscope. The lid margin abnormalities were recorded: oriflces, Marx line, quality of exPressed excreta, rounding of lid margin, vascularity, telanglectasia and irregularity. The meibomian glands abnormalities were recorded: dropout, white patches, cystoid dilation, atrophy, tortuous and bifurcation. White patches refer to the hyper reflexive changes in meibomian glands taken by oculus keratgraph 5M which may indicate possible acinar changes and aging changes. Oriflces was graded as normal circular oriflces, capping in the oriflces, pouing in the oriflces and epithelial plugging in the oriflces. Morphological scores were calculated by the morphological classification methods. This cross-sectional study was figured out correlations by Spearman to calculate the P values. Main Outcome Measures The scores of lid margins and meibomian glands morphological characters, the correlation coefficient (r) of lid margins and meibomian glands morphologies. Results There was a positive correlation between meibomian gland opening morphology and secretion characteristics (r=0.590, P=0.001). There was a positive morphology correlation between the calcification and the openings of meibomian glands (r=0.439, P＝0.015). There was a negative correlation between the atrophy or bifurcation and the secretion traits of the meibomian glands (r=-0.349, -0.374，P=0.048, 0.042). Other items were not correlated. In the palpebral margin morphologies, the correlation between the keratinization scores and the total scores of the palpebral margins was the strongest (r=0.842，P=0.000). There was a significant positive correlation between the keratinization and the morphological changes of the meibomian glands openings (r=0.517, P=0.003). In the meibomian gland morphology, the correlation between the calcification scores and the total meibomian gland scores was the strongest (r=0.535, P=0.002). Conclusion There were morphological correlations between meibomian glands and lid margins. For morphological assessment of MGD patients, white patches were more reasonable for the assessment of meibomian glands. Telanglectasia was more reasonable for the assessment of lid margins, which is associated with the changes of the meibomian gland openings. (Ophthalmol CHN, 2020, 29: 355-360）