In vivo confocal microscopy evaluation of meibomian gland dysfunction in atopic-keratoconjunctivitis patients.
OBJECTIVE
To clarify meibomian gland (MG) alterations in atopic keratoconjunctivitis (AKC) patients and compare the findings with obstructive MG dysfunction (MGD) patients and control subjects using in vivo confocal microscopy (CM).


METHODS
Prospective, controlled, single-center study.


METHODS
Twelve AKC patients (10 males, 2 females; mean age, 31.0±16.5 years), 12 obstructive MGD patients (7 males, 5 females; mean age, 37.6±5.6 years), and 26 control subjects (13 males, 13 females; mean age, 32.9±5.7 years) were recruited. No significant age or gender differences were observed between the 3 groups.


METHODS
All subjects underwent assessment of tear evaporation rate from the ocular surface (TEROS), slit-lamp examinations, tear break-up time (BUT) measurements, vital staining, Schirmer test I, meibography, MG expressibility, and CM examination of the MG (HRTII-RCM). Statistical analysis was performed using the Mann-Whitney test.


METHODS
The MG acinar unit density, inflammatory cell density, MG acinar unit longest diameter, MG acinar unit shortest diameter, and MG acinar unit area as observed by in vivo CM, MG drop-out, MG expressibility grading, tear stability, tear evaporation, and vital staining scores.


RESULTS
The TEROS values, mean BUT, vital staining scores, MG expressibility, and MG dropout grades were significantly worse in AKC patients compared with those in obstructive MGD patients and controls (P<0.05). The mean values of the CM parameters in AKC patients were significantly worse than those observed in the obstructive MGD patients and controls (P<0.001).


CONCLUSIONS
Changes in MG in AKC patients seem to be more severe than in patients with obstructive MGD and controls. In vivo CM is a noninvasive, efficient tool in the assessment of MG status and ocular surface disease in AKC.
Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
Osama M A
OM
Ibrahim
Yukihiro
Y
Matsumoto
Murat
M
Dogru
Enrique Sato
ES
Adan
Tais Hitomi
TH
Wakamatsu
Jun
J
Shimazaki
Hiroshi
H
Fujishima
Kazuo
K
Tsubota
D061354:Acinar Cells / Q000473:pathology; D000328:Adult; D002452:Cell Count; D003233:Conjunctivitis, Allergic / Q000175:diagnosis* / Q000503:physiopathology; D005141:Eyelid Diseases / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D020397:Goblet Cells / Q000473:pathology; D006801:Humans; D008297:Male; D008537:Meibomian Glands / Q000000981:diagnostic imaging / Q000473:pathology*; D018613:Microscopy, Confocal; D011446:Prospective Studies; D011859:Radiography; D013666:Tears / Q000502:physiology