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Evaluation of Optical Coherence Tomography Meibography in Patients with Obstructive Meibomian Gland Dysfunction

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Evaluation of Optical Coherence Tomography Meibography in Patients with Obstructive Meibomian Gland Dysfunction CLINICAL SCIENCE Evaluation of Optical Coherence Tomography Meibography in Patients With Obstructive Meibomian Gland Dysfunction Qingfeng Liang, MD, PhD,* Zhiqiang Pan, MD, PhD,* Min Zhou, MD,* Yang Zhang, MD,* Ningli Wang, MD, PhD,* Bin Li, MD, PhD,* Christophe Baudouin, MD, PhD,†‡ and Antoine Labbé, MD, PhD*‡ parameters were correlated to both ocular surface symptoms and Purpose: To evaluate optical coherence tomography meibography clinical signs. This new imaging technique may be a useful tool for (OCT-M) in patients with and without obstructive meibomian gland MGD evaluation. dysfunction (MGD) and to determine the relationship between OCT- M and ocular surface clinical tests. Key Words: optical coherence tomography, meibography, meibo- mian gland dysfunction, meibomian glands Methods: Twenty-two patients with MGD and 16 control subjects – were included. Each patient underwent an evaluation of ocular (Cornea 2015;34:1193 1199) surface disease symptoms, lid margin abnormality score, lipid layer thickness evaluation, and meibomian gland (MG) morphological changes using noncontact infrared meibography and OCT-M. OCT- bstructive meibomian gland dysfunction (MGD) is fi M scans were acquired in 4 different locations. OCT-M parameters Ode ned as a chronic diffuse abnormality of the meibomian including the MG length and width and palpebral conjunctival glands (MGs) commonly characterized by terminal duct thickness were evaluated. obstruction and/or qualitative and quantitative changes in glandular secretion.1 Obstructive MGD can cause alteration and Results: Within the OCT-M parameters, the mean length and width reduction of tear lipid secretions, decreased tear film stability, fi 6 of MGs were signi cantly decreased in patients with MGD (310 loss of lubrication, and damage to the ocular surface epithelia.2 m 6 m 60 m and 214 30 m, respectively) compared with the control MGD is a frequent ocular surface disorder in ophthalmic practice 6 m 6 m group (361 53 m, P = 0.041 and 264 41 m, P = 0.021, with prevalence up to 69.3%, and it is considered the most respectively). The mean conjunctival thickness was also significantly 3,4 6 m common cause of evaporative dry eye syndrome. However, the increased in patients with MGD (448 68 m) than in the control natural history of MGD, includingtheetiologyandanatomical group (356 6 59 mm, P = 0.03). The mean length of MGs was changes, remains poorly understood.1 Therefore, the evaluation correlated with symptoms (r = 0.34, P = 0.034), and the mean MG of the anatomical changes of MGs and their consequences for the width was correlated with tear film breakup time (r = 20.412, P = ocular surface is of critical importance in MGD. 0.009) and the lid margin abnormality score (r = 0.334, P = 0.038). In patients with a clinical presentation suggesting Conclusions: The MG length and width were significantly evaporative dry eye, obstructive MGD is currently diagnosed decreased in patients with MGD than in the control group. These by slit-lamp examination of the eyelids looking for evidence of hyperemia, telangiectasias, vascular engorgement, MG orifice plugging, and expression of the MGs to evaluate the Received for publication February 2, 2015; revision received June 16, 2015; meibum volume and quality.5 However, this clinical exam- accepted June 16, 2015. Published online ahead of print July 30, 2015. From the *Department of Ophthalmology, Beijing Institute of Ophthalmology, ination is limited because it is an indirect evaluation of the Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical structure and function of the MG, and precise quantification University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, of the degree and severity of MGD remains complex in † Beijing, China; Department of Ophthalmology, Quinze-Vingts National clinical practice. Numerous techniques such as meibography, Ophthalmology Hospital, Paris, and Versailles Saint-Quentin-en-Yvelines fi University, Versailles, France; and ‡INSERM, U968, UPMC Univ Paris meibometry, tear lm lipid layer interferometry, tear osmo- 06, UMR_S 968, Institut de la Vision, CNRS, UMR_7210, Paris, France. larity, and the evaluation of the tear film evaporation rate have Supported by Capital Health Research Project Fund (CHRP-2011-1016-04), been developed to assess the structure or function of MGs and China. also to improve the diagnosis of MGD.6 Nevertheless, within The authors have no conflicts of interest to disclose. Supplemental digital content is available for this article. Direct URL citations these techniques, meibography is the only method available appear in the printed text and are provided in the HTML and PDF for directly observing MG structures in vivo and quantifying versions of this article on the journal’s Web site (www.corneajrnl.com). their changes over time.1,6,7 Reprints: Zhiqiang Pan, MD, PhD, Beijing Tongren Eye Center, Beijing Key Meibography was developed in the late 1970s to image Laboratory of Ophthalmology and Visual Science, Beijing Tongren 7 Hospital, Capital Medical University (e-mail: [email protected]). MG tissue morphology in vivo. Initially performed using Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. a contact light probe applied on the skin side of the everted Cornea Volume 34, Number 10, October 2015 www.corneajrnl.com | 1193 Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. Liang et al Cornea Volume 34, Number 10, October 2015 eyelid, the use of noncontact infrared (IR) meibography consecutive measurements were recorded, and the average of systems currently represents the mainstay of this technique.8,9 both breakup times was calculated. After instillation of Recently, Hwang et al10 presented a novel noncontact fluorescein, corneal and conjunctival staining was evaluated meibography approach using 1310-nm wavelength anterior through a yellow filter using the Oxford scale.1 Tear film lipid segment optical coherence tomography (AS-OCT)11 and layer analysis was performed using an interferometer (DR-1; high-speed Fourier-Domain OCT. Interestingly, these authors Kowa, Tokyo, Japan) a minimum of 1 hour after instillation demonstrated the usefulness of OCT for the analysis of MGs, of fluorescein, and the tear film lipid layer was evaluated which could be identified and quantified beneath the palpebral semiquantitatively from 1 (normal) to 5 (severe alteration) conjunctiva. according to a photographic score (grade 1: grayish color and The objective of this study was to compare for the first uniform distribution; grade 2: grayish color and nonuniform time the results of MG analysis with optical coherence distribution; grade 3: a few colors with nonuniform distribu- tomography meibography (OCT-M) in normal subjects and tion; grade 4: many colors and nonuniform distribution; grade patients with obstructive MGD and to evaluate the relation- 5: the corneal surface is partially exposed with no lipid layer ship between OCT-M and ocular surface clinical tests interference).13 The Schirmer test (Tianjin Jingming Co, Ltd, including IR noncontact meibography. China) was performed without anesthesia for 5 minutes with the patient’s eyes closed. The Schirmer test strips were placed between the lateral and middle third of the lower eyelid. Four PATIENTS AND METHODS lid margin abnormalities (irregular lid margin, vascular fi Patients engorgement, plugged MG ori ces, and anterior or posterior displacement of the mucocutaneous junction) were scored from This research was done at the Department of Ophthal- 0 to 4 according to the number of these abnormalities present in mology, Beijing Institute of Ophthalmology (Beijing, China), the upper eyelid of each eye.12 Irregularity of the lid margin with approval from the Medical Ethics Committee of the included distortion of lid architecture and thickening or Beijing Tongren Hospital. All patients were informed of the rounding of the posterior margin. Vascular engorgement was aims of the study and their consent was obtained according to defined as increased vascularization of the posterior lid margin. the Declaration of Helsinki. Twenty-two patients (7 men and Plugged meibomian orifices had elevations (mixture of lipids 15 women; mean age, 38.2 6 16.5 years) with MGD and 16 and keratinized cell debris) above the surface level of the lid. age-matched control subjects (6 men and 10 women; mean age, 35.7 6 11.5 years) were included in this study. Patients were diagnosed with obstructive MGD by an experienced IR and OCT-M ophthalmologist (Q.L.) based on the presence of ocular MGs morphological changes were assessed using a non- surface–related symptoms, one or more lid margin abnormal- contact IR meibography system (BG-4M; Topcon, Tokyo, ities (irregular lid margin, vascular engorgement, plugged Japan). This system uses a background illumination device MG orifices, and anterior or posterior displacement of the with an IR light transmittance filter that illuminates the MGs mucocutaneous junction), and poor meibum expression as to assess their integrity. Meibography photographs of the previously described.12 All control subjects had no complaint upper eyelids were then analyzed using ImageJ (National of ocular surface irritation and no anterior segment abnor- Institutes of Health, Bethesda, MD) as previously described.14 mality on biomicroscopic examination and ocular surface MG loss (expressed as %), representing the ratio of the MG tests. Exclusion criteria for both groups were age less than 18 dropout area over the total
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