title: Changes of meibomian glands in patients with type 2 diabetes mellitus.
abstract: OBJECTIVE
  To investigate the morphological changes of meibomian glands in patients with type 2 diabetes mellitus (DM).
  
  
  METHODS
  Of 118 eyes (118 patients) with type 2 DM (DM group) and 100 eyes of 100 control subjects (control group) were enrolled. After completing an ocular surface disease index (OSDI) questionnaire, the non-invasive tear film break-up time (NI-BUT) and the structure of the meibomian glands (MGs, meibography) were assessed by the Keratograph 5M system. Partial or complete loss of MG was scored for each eyelid from grade 0 (no loss) to grade 3 (lost area was >2/3 of the total MG area), which were also examined by laser scanning confocal microscopy (LSCM). The primary outcomes were meibomian gland acinar unit density (MGAUD), meibomian gland acinar longest diameter (MGALD) and meibomian gland acinar shortest diameter (MGASD).
  
  
  RESULTS
  Compared with control group, the OSDI was significantly higher in DM group (Z=-5.916;P<0.001), while the NI-BUT was significantly lower (Z=-7.765;P<0.001). Keratograph showed that there were more MGs dropout in DM group than that in control group. The meiboscore was significantly higher in DM group compared with control group (Z=-3.937;P<0.001). LSCM revealed that there were cytological alterations of MGs in DM group compared with control group, which included enlargement of MG acinar units and decreased in density of MG acinar units. Specifically, there were lower MGAUD, larger MGALD and MGASD in DM group than control group (Z=-10.120, -9.4442, -7.771;P<0.001).
  
  
  CONCLUSIONS
  Compared with the normal control participants, the patients with type 2 DM had more unstable tear films and severe symptoms of dry eye. Using Keratograph 5M system and LSCM, we found that the patients with type 2 DM had more significant morphological and cytological changes and dysfunction in MGs.
authors.affiliation: Qingdao University, Qingdao 266071, Shandong Province, China; Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong Province, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Yu
authors.affiliation: Shandong Eye Hospital, Shandong Eye Institute, Jinan 250021, Shandong Province, China.
authors.forename: Wei-Yun
authors.initials: WY
authors.lastname: Shi
authors.affiliation: Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong Province, China.
authors.forename: Ai-Ping
authors.initials: AP
authors.lastname: Song
authors.affiliation: Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong Province, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Gao
authors.affiliation: Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong Province, China.
authors.forename: Guang-Fu
authors.initials: GF
authors.lastname: Dang
authors.affiliation: Jinan Second People's Hospital, Jinan 250012, Shandong Province, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Ding
keywords: diabetes; keratograph; laser scanning confocal microscopy; meibomian glands; tear films