Transcript Morphologic Evaluation of Meibomian Glands Using Noncontact

Morphologic Evaluation of Meibomian Glands
Using Noncontact Infrared Meibography
Yumiko Ban,1,2,3) Seika Den,2) Jun Shimazaki,2,3)
1) Department of Ophthalmology, Hino Municipal Hospital,
Tokyo, Japan
2) Department of Ophthalmology, Tokyo Dental College,
School of Dental Medicine, Chiba, Japan
3) Department of Ophthalmology, School of Medicine,
Keio University, Tokyo, Japan
Authors have no financial interest.
World Cornea Congress Ⅵ Boston, Massachusetts, April 7-9, 2010
Background
・ Recently, noncontact infrared meibography (NIM) has been
developed1-3, which allows easy observation of the meibomian
glands (MG) structure over a wide area encompassing both the
upper and lower eyelids.
・ To date, only semi-quantitative criteria of gland destruction
(gland drop-out) have been used to evaluate the MG.
Purpose
・ To evaluate the morphologic assessment of the MG using NIM
and investigate the quantitative evaluation
・ To investigate the relationship between MG morphology and the
condition of the tear film and ocular surface epithelia
1, Arita R, et al. Noncontact infrared meibography to document age-related changes of the meibomian
glands in a normal population. Ophthalmology. 2008 ;115:911-5
2, Arita R, et al. Contact lens wear is associated with decrease of meibomian glands. Ophthalmology.
2009 ;116:379-84.
3, Arita R, et al. Proposed diagnostic criteria for obstructive meibomian gland dysfunction. Ophthalmology.
2009 ;116:2058-63
Study Design
Subjects recruited in this study
・ 37 eyes of 37 subjects
(The data used in this study were obtained from the right eye
in each subject.)
・ males: 23 cases, females: 14 cases
・ Mean age 46.5 ±15.4 years (range 19～75 years）
Exclusion criteria
・ Obvious eyelid or ocular surface disorders, contact lens wear,
history of ocular surgery, and dry eye according to
the 2007 International Dry Eye Workshop Report
Methods
Meibography
The meibography apparatus comprised a slit lamp (RO 5000, Rodenstock)
with a magnifying power of 12 and an infrared charge-coupled device video
camera (XC-EI50, Sony). The digital images obtained by meibography were
recorded and analyzed using image J (free software).
Morphometric indices which we conducted morphologic assessment of the MG
・ Length of MG duct
・ Percent area of MG acini
・ Number of gland drop-outs
Tear function
Schirmer test Ⅰ
Break-up time of tear film (BUT)
Tear film lipid layer interferometry (TFLLI) (Yokoi’s grading system) 4
Evaluation of ocular surface
Fluorescein staining score (FS)
Expression of meibum (Shimazaki’s grading system) 5
4, Yokoi N , et al. Correlation of tear lipid layer interference patterns with the diagnosis
and severity of dry eye. Am J Ophthalmol. 1996 ;122:818-24
5, Shimazaki J, et al. Meibomian gland dysfunction in patients with Sjögren syndrome
Ophthalmology. 1998 ;105:1485-8
Upper eyelid
10mm
The white lesion was considered to be
the lipid of MG. It seemed to be the MG
acini.
13mm
4mm
5mm
We measured and calculated the mean
value for the length of the 5 selected
central MG ducts.
We defined a rectangle measuring 5x4
mm in the central upper eyelid. We
measured the percent area of MG acini
contained within the selected rectangle.
( In the lower eyelid, a square measuring
4x4 mm along the central lid margin was
defined.)
The number of gland drop-outs
The white lesion was reversed to the black contained in the image was counted.
lesion. We calculated the black area, and
found the percent area of MG acini.
Statistical analysis
・ The unpaired t test was used to compare the upper and lower eyelid.
・ The Pearson and Spearman rank sum tests were performed to determine correlations
between MG morphologic values and tear film or ocular surface.
Success rate for evaluation and morphometric
values of MG in upper and lower eyelids
Upper eyelid
Lower eyelid
Length of MG ducts (mm)
5.53 ± 1.27 *
2.97 ± 0.90
Number of eyes with successful
35 (94.6%)
36 (97.3%)
Percent area of MG acini (%)
41.6 ± 12.4
41.0 ± 15.1
Number of eyes with successful
20 (54.1%)
31 (83.8%)
* = p < 0.05
evaluation (%)
evaluation (%)
Number of gland drop-outs
0
27
22
1
2
2
2
0
4
3≥
6
9
Uncountable
2
0
Data on tear function/ocular surface
Schirmer
BUT
FS
TFLLI
Meibum
(mm)
(seconds)
(points)
(grade)
(grade)
11.4±9.21 6.00±2.87
0.41±0.76 2.16±1.26 1.14±1.03
BUT = Break-up time of tear film
FS = Fluorescein staining score
TFLLI = Tear film lipid layer interferometry
Correlation between morphometric values of MG
and tear film or ocular surface epithelia
age
Schirmer
BUT
FS
TFLLI
Meibum
Length of MG
Upper
-0.485*
0.087
0.246
-0.223
-0.116
-0.345#
duct
Lower
-0.533**
-0.080
0.211
-0.438#
-0.241
-0.312
Percent area of
Upper
-0.600**
0.048
0.549*
-0.367
-0.601#
-0.641#
MG acini
Lower
-0.357*
-0.352
0.208
-0.069
-0.032
-0.207
Number of
Upper
0.518#
-0.254
-0.432#
0.212
0.457#
0.404#
gland drop-outs
Lower
0.399#
-0.018
-0.199
0.253
0.250
0.189
The number in the table represents the r value.
*p < 0.05, **p < 0.001, Pearson r
#p < 0.05, Spearman r
BUT = Break-up time of tear film
FS = Fluorescein staining score
TFLLI = Tear film lipid layer interferometry
Summary of the Results
Success rate for evaluation of MG
・ The length of the MG ducts could be evaluated in almost all cases
in both the upper and lower eyelids, but the percent area of MG
acini in the upper eyelid could be evaluated only in approximately
half of the eyes.
Morphometric values of MG
・ The length of the upper MG ducts was significantly longer than that
of the lower MG ducts.
Summary of the Results
Aging
・ Both the length of the MG ducts and percent area of MG acini in
the upper and lower eyelids showed a negative correlation with age.
・ The number of gland drop-outs in the upper and lower eyelids
showed a positive correlation with age.
Correlation between meibomian gland morphology and ocular surface
The groups which showed a positive correlation
・ Percent area of MG acini (upper) and BUT
・ Number of gland drop-outs (upper) and TFLLI
・ Number of gland drop-outs (upper) and meibum
The groups which showed a negative correlation
・ Length of MG ducts (upper) and meibum
・ Length of MG ducts (lower) and FS
・ Percent area of MG acini (upper) and TFLLI
・ Percent area of MG acini (upper) and meibum
・ Number of gland drop-outs (upper) and BUT
Discussion
・ We could conduct a morphologic assessment of the MG using new
indices including the length of the MG ducts and the percent area of
MG acini.
・ Improvement of the camera and video system may increase the
number of eyes with successful evaluation.
・ Age showed a strong correlation with the MG morphology.
Similar to the previous report,1,6,7 the structure of the MG increased
changes with aging.
・ The morphological values of the MG in the upper eyelid had a
stronger correlation with the condition of the tear film or ocular
surface epithelia than that in the lower eyelid.
The result suggests that it is important to observe the MG in the
upper eyelid.
6, Den S, et al. Association between meibomian gland changes and aging, sex, or tear function.
Cornea. 2006 ;25:651-5.
7, Obata H. Anatomy and histopathology of human meibomian gland. Cornea. 2002 ;21::S70-4
Conclusions
・ Noncontact infrared meibography offers a useful tool for
obtaining a morphological analysis of the MG in ocular
surface evaluation.
・ MG morphology is related to aging and various ocular
surface conditions.