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In vivo confocal microscopy classification in the diagnosis of meibomian gland dysfunction
摘要： Aim Meibomian gland dysfunction (MGD) is one of the most common disorders in ophthalmology. The aim of this study was to evaluate the use of this in vivo confocal microscopy (IVCM)-MGD description to classify patients affected by clinical MGD and measure the correlation with standard clinical criteria and subjective symptoms. Methods One hundred eyes of 100 patients suffering from MGD and 15 eyes of normal subjects were included. A comprehensive evaluation with the ocular surface disease index (OSDI), Schirmer test, tear break-up time (TBUT), tear osmolarity, Oxford score, Meibomian gland expression, palpebral IVCM, and meibography was performed. Then each patient was classi?ed using a new IVCM classi?cation: type 0 for normality, type 1 for meibum obstruction, type 2 for in?ammation, and type 3 for ?brosis. Results The mean age of patients was 52 ± 20 years old, the OSDI was 38 ± 23, the BUT 5 ± 2.6 s, the Schirmer test 13 ± 7 mm, tear osmolarity 300 ± 11 osmol/L, the Oxford score 0.5 ± 0.6, the meibum expression score 1.7 ± 1.02, and the meibography score 1.3 ± 0.9. The IVCM MG classi?cation of the 15 normal subjects was 0. For MGD patients, 29% were in type 1, 40% were type 2, and 31% were type 3. The patients in IVCM MG type 2 had a higher OSDI (p = 0.001) compared with the other types. There was a strong correlation between the IVCM score and the meibography score (r = 0.71 p < 0.0001). Conclusion This new IVCM classi?cation provided a practical pathophysiological system for MGD. By giving objective criteria, this IVCM classi?cation may help advance the understanding of patients’ symptoms and enhance treatment effectiveness in MGD.
关键词： classification,Meibomian gland dysfunction,diagnosis,in vivo confocal microscopy
更新于2025-09-23 15:19:57
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Efficacy and Safety of Intense Pulsed Light in Patients With Meibomian Gland Dysfunction—A Randomized, Double-Masked, Sham-Controlled Clinical Trial
摘要： To study the efficacy and safety of intense pulsed light (IPL) in patients with meibomian gland dysfunction (MGD). This prospective randomized double-masked sham-controlled trial included 114 patients with MGD. Patients were randomized into the IPL or sham group. Either the IPL or sham procedure was performed on days 0, 15, and 45. Ocular Surface Disease Index (OSDI), visual analog scale, visual acuity, tear breakup time, meibum quality and expressibility, meibography grade, ocular surface staining, tear film lipid layer thickness, tear osmolarity, Schirmer test, tear interleukin-1 receptor agonist, and interleukin-6 levels were examined on days 0, 15, and 45 and at months 3 and 6. Subgroup analysis according to stage and the patient’s compliance to conventional treatment were also analyzed. Any adverse events during the study were recorded. A multilevel mixed-effect linear regression model was used. P value less than 0.05 was considered statistically significant. At 6 months, tear breakup time, meibum quality grades, expressibility grades, and OSDI were better in the IPL group (5.23 6 2.91 vs. 3.11 6 0.99 seconds, P , 0.001; 8.74 6 4.74 vs. 13.19 6 5.01, P , 0.001; 0.50 6 0.67 vs. 1.12 6 0.70, P , 0.001; 24.29 6 16.92 vs. 32.71 6 20.07, P , 0.05). OSDI, meibum quality, and expressibility in the IPL group began to improve at day 15 (P , 0.001), whereas the results in the sham group began to improve at day 45 (P , 0001). No adverse event occurred after IPL. IPL is effective and safe for MGD treatment in all stages regardless of compliance.
关键词： intense pulsed light,meibomian gland dysfunction,meibomian gland,dry eye,cytokines
更新于2025-09-12 10:27:22
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Clinical results of Intraductal Meibomian gland probing combined with intense pulsed light in treating patients with refractory obstructive Meibomian gland dysfunction: a randomized controlled trial
摘要： Background: This study aims to optimize the therapeutic regimen for refractory obstructive meibomian gland dysfunction (o-MGD) patients by combining intraductal meibomian gland probing (MGP) and intense pulsed light (IPL) to enhance their positive effects and reduce their limitations. Methods: This randomized, assessor blind study includes 45 patients (90 eyes) with refractory o-MGD who were divided into 3 groups via allocation concealment: IPL (group I, received an IPL treatment course: 3 times at 3-week intervals), MGP (group II, received MGP one time), and combined MGP-IPL (group III, MGP first followed by an IPL treatment course). Standard Patient Evaluation of Eye Dryness score (SPEED), tear break-up time (TBUT), corneal fluorescein staining (CFS), meibum grade, and lid margin finding results were assessed at baseline, 3 weeks after final treatment for groups I and III, 3 and 12 weeks after MGP for group II. Six months after final treatment, the SPEED and willingness to receive any treatment again were also collected for all groups. Paired Wilcoxon, Mann-Whitney U with Bonferroni correction, and Kruskal-Wallis tests were used for data analysis. Results: For all 3 groups, all previously mentioned indexes improved significantly following treatment (P<0.01). MGP-IPL was better than IPL and MGP in terms of post-treatment SPEED, TBUT, meibum grade, and lid telangiectasia (P<0.05/3). Furthermore, the MGP-IPL was better than IPL in terms of lid tenderness and better than MGP in terms of orifice abnormality (P< 0.05/3). Six months later, the SPEED for the MGP-IPL was also significantly lower than other groups (P<0.05/3). Moreover, no patients in the MGP-IPL group expressed the need to be treated again compared to 35.7% or 20% of patients in the IPL or MGP groups, respectively. Conclusions: Compared with IPL or MGP alone, the combination MGP-IPL produced best results in relieving all signs and symptoms and helping patients attain long-lasting symptom relief.
关键词： Intraductal meibomian gland probing,Tear film,Intense pulsed light,Obstructive meibomian gland dysfunction,Meibum
更新于2025-09-11 14:15:04
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Therapeutic efficacy of intense pulsed light in patients with refractory meibomian gland dysfunction
摘要： Purpose: To evaluate the efficacy and safety of intense pulsed light (IPL) combined with meibomian gland expression (MGX) for treatment of refractory meibomian gland dysfunction (MGD). Methods: Ninety eyes of 45 patients were randomly assigned to receive either the combination of IPL and MGX or MGX alone (control). Each eye underwent eight treatment sessions at 3-week intervals. Parameters were evaluated before and during treatment as well as at 3–11 weeks after the last treatment session. Measured parameters included the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire score, noninvasive breakup time (NIBUT), fluorescein breakup time (BUT), lipid layer grade, lipid layer thickness (LLT), lid margin abnormalities, corneal and conjunctival fluorescein staining (CFS) score, meibum grade, and meiboscore. Results: A significant improvement in lipid layer grade was apparent in the IPL-MGX group from 6 to 32 weeks after treatment onset (adjusted P < 0.001) but was not observed in the control group. The IPL-MGX group also showed significant improvements in LLT, NIBUT, BUT, lid margin abnormalities, and meibum grade compared with the control group at 24 and 32 weeks (adjusted P <0.001) as well as significant improvements in the SPEED score at 32 weeks (adjusted P = 0.044) and in CFS score at 24 (adjusted P =0.015) and 32 (adjusted P =0.006) weeks. Conclusions: The combination of IPL and MGX improved homeostasis of the tear film and ameliorated ocular symptoms in patients with refractory MGD and is thus a promising modality for treatment of this condition.
关键词： Meibomian gland expression,Meibomian gland dysfunction,Meibum,Intense pulsed light,Dry eye
更新于2025-09-09 09:28:46
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Multicenter Study of Intense Pulsed Light Therapy for Patients With Refractory Meibomian Gland Dysfunction
摘要： To evaluate the efficacy of intense pulsed light (IPL) therapy combined with meibomian gland expression (MGX) for refractory meibomian gland dysfunction (MGD) in a prospective study conducted at 3 sites in Japan. Methods: Patients with refractory obstructive MGD were enrolled and underwent 4 to 8 IPL-MGX treatment sessions at 3-week intervals. Clinical assessment included the Standard Patient Evaluation of Eye Dryness questionnaire; noninvasive breakup time of the tear film and interferometric fringe pattern as determined by tear interferometry; lid margin abnormalities, fluorescein breakup time of the tear film, corneal and conjunctival fluorescein staining (CFS), and meibum grade as evaluated with a slit-lamp microscope; meibomian gland morphology (meiboscore); and tear production as measured by the Schirmer test without anesthesia. Results: Sixty-two eyes of 31 patients (17 women, 14 men; mean age 6 SD, 47.6 6 16.8 years) were enrolled. The Standard Patient Evaluation of Eye Dryness score (P , 0.001), noninvasive breakup time (P , 0.001), and interferometric fringe pattern (P , 0.001) were significantly improved after therapy, with 74% of eyes showing a change in the interferometric fringe pattern from 1 characteristic of lipid deficiency to the normal condition. Meibum grade, lid margin abnormality scores, fluorescein breakup time, and CFS were also significantly improved (P , 0.001, P , 0.001, P , 0.001, and P = 0.002, respectively) after treatment, whereas the meiboscore and Schirmer test value remained unchanged. Conclusions: IPL-MGX ameliorated symptoms and improved the condition of the tear film in patients with refractory MGD and is therefore a promising treatment option for this disorder.
关键词： meibomian gland dysfunction,intense pulsed light,meibomian gland
更新于2025-09-09 09:28:46
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Evaluation of Dry Eye and Meibomian Gland Dysfunction in Teenagers with Myopia through Noninvasive Keratograph
摘要： Purpose. This study aims to evaluate dry eye and ocular surface conditions of myopic teenagers by using questionnaire and clinical examinations. Methods. A total of 496 eyes from 248 myopic teenagers (7–18 years old) were studied. We administered Ocular Surface Disease Index (OSDI) questionnaire, slit-lamp examination, and Keratograph 5M. The patients were divided into 2 groups based on OSDI dry eye standard, and their ocular surfaces and meibomian gland conditions were evaluated. Results. The tear meniscus heights of the dry eye and normal groups were in normal range. Corneal fluorescein scores were significantly higher whereas noninvasive break-up time was dramatically shorter in the dry eye group than in the normal group. All three meibomian gland dysfunction parameters (i.e., meibomian gland orifice scores, meibomian gland secretion scores, and meibomian gland dropout scores) of the dry eye group were significantly higher than those of the normal group (??<0.0001). Conclusions. The prevalence of dry eye in myopic teenagers is 18.95%. Meibomian gland dysfunction plays an important role in dry eye in myopic teenagers. The Keratograph 5M appears to provide an effective noninvasive method for assessing ocular surface situation of myopic teenagers.
关键词： ocular surface,dry eye,meibomian gland dysfunction,myopic teenagers,Keratograph 5M
更新于2025-09-04 15:30:14