title: In vivo confocal microscopy of meibomian glands in glaucoma.
abstract: OBJECTIVE
  To investigate, using laser scanning confocal microscopy (LSCM), the morphological changes of meibomian glands (MGs) in patients with glaucoma.
  
  
  METHODS
  A total of 80 patients who were glaucomatous were enrolled, and 20 healthy subjects were used as controls. After completing an Ocular Surface Disease Index (OSDI) questionnaire, all subjects underwent tear film break-up time (BUT), fluorescein staining, Schirmer test I (STI) and LSCM examination of the MGs. The main outcome measures were: eyelid margin epithelial cell density, mean acinar density (MAD) and area (MAA), glandular orifice area, secretion reflectivity and inhomogeneous appearance of interstice and acinar wall.
  
  
  RESULTS
  According to the number of anti-glaucoma medications they were taking, patients were divided into three groups: group 1 (30 eyes), one drug; group 2 (23 eyes), two drugs; group 3 (27 eyes), three or more drugs. LSCM showed lower MAD and MAA, greater secretion reflectivity and glandular orifice area in groups 2 and 3 than in controls (p<0.05). The inhomogeneity of the interstice and acinar wall was significantly greater in all groups compared to controls (p<0.05). Preserved prostaglandin analogues (PGAs) induced more pronounced modifications of all parameters than preservative free (PF)-PGAs (p<0.05). No significant differences were found between preserved and PF-β-blockers. Significant relations were found among MAD, MAA, secretion reflectivity and OSDI score, BUT and ST (p<0.05) and between secretion reflectivity and orifice area (p<0.001).
  
  
  CONCLUSIONS
  In vivo LSCM is an effective tool in revealing morphological changes of MGs induced by anti-glaucoma medications. Given the key role in the ocular surface health, the evaluation of MG status in patients who are glaucomatous is worthwhile.
authors.affiliation: Department of Medicine and Aging Science, Ophthalmic Clinic. University G d'Annunzio of Chieti-Pescara, Via dei Frentani, 114, Chieti 66100, Italy. l.agnifili@unich.it
authors.forename: Luca
authors.initials: L
authors.lastname: Agnifili
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Fasanella
authors.forename: Ciro
authors.initials: C
authors.lastname: Costagliola
authors.forename: Cristina
authors.initials: C
authors.lastname: Ciabattoni
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Mastropasqua
authors.forename: Paolo
authors.initials: P
authors.lastname: Frezzotti
authors.forename: Leonardo
authors.initials: L
authors.lastname: Mastropasqua
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D002452:Cell Count; D005260:Female; D005901:Glaucoma / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D008297:Male; D008537:Meibomian Glands / Q000187:drug effects / Q000378:metabolism / Q000473:pathology*; D018613:Microscopy, Confocal; D008875:Middle Aged; D012189:Retrospective Studies; D013666:Tears / Q000737:chemistry*
chemical_list: D000959:Antihypertensive Agents