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Huang B, Fei F, Wen H, Zhu Y, Wang Z, Zhang S, Hu L, Chen W, Zheng Q. Impacts of gender and age on meibomian gland in aged people using artificial intelligence. Front Cell Dev Biol 2023; 11:1199440. [PMID: 37397262 PMCID: PMC10309028 DOI: 10.3389/fcell.2023.1199440] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/07/2023] [Indexed: 07/04/2023] Open
Abstract
Purpose: To evaluate the effects of age and gender on meibomian gland (MG) parameters and the associations among MG parameters in aged people using a deep-learning based artificial intelligence (AI). Methods: A total of 119 subjects aged ≥60 were enrolled. Subjects completed an ocular surface disease index (OSDI) questionnaire, received ocular surface examinations including Meibography images captured by Keratograph 5M, diagnosis of meibomian gland dysfunction (MGD) and assessment of lid margin and meibum. Images were analyzed using an AI system to evaluate the MG area, density, number, height, width and tortuosity. Results: The mean age of the subjects was 71.61 ± 7.36 years. The prevalence of severe MGD and meibomian gland loss (MGL) increased with age, as well as the lid margin abnormities. Gender differences of MG morphological parameters were most significant in subjects less than 70 years old. The MG morphological parameters detected by AI system had strong relationship with the traditional manual evaluation of MGL and lid margin parameters. Lid margin abnormities were significantly correlated with MG height and MGL. OSDI was related to MGL, MG area, MG height, plugging and lipid extrusion test (LET). Male subjects, especially the ones who smoke or drink, had severe lid margin abnormities, and significantly decreased MG number, height, and area than the females. Conclusion: The AI system is a reliable and high-efficient method for evaluating MG morphology and function. MG morphological abnormities developed with age and were worse in the aging males, and smoking and drinking were risk factors.
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Affiliation(s)
- Binge Huang
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Fangrong Fei
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Han Wen
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Ye Zhu
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Zhenzhen Wang
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Shuwen Zhang
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Liang Hu
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Wei Chen
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Qinxiang Zheng
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
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Latest developments in meibography: A review. Ocul Surf 2022; 25:119-128. [PMID: 35724917 DOI: 10.1016/j.jtos.2022.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 04/11/2022] [Accepted: 06/08/2022] [Indexed: 11/21/2022]
Abstract
Meibography is a visualisation technique that has been used for over 40 years. There have been significant improvements in image quality, examination technique and image interpretation over this period. Although meibography has received sporadic reviews in the past, an updated review is timely due to the rapid recent rise of relevant technology and advances in both image processing and artificial intelligence. The primary aim of this paper is to review recent research into Meibomian gland imaging and update the community about the most relevant technologies and approaches used in the field.
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Martínez-Alberquilla I, Gasull X, Pérez-Luna P, Seco-Mera R, Ruiz-Alcocer J, Crooke A. Neutrophils and neutrophil extracellular trap components: Emerging biomarkers and therapeutic targets for age-related eye diseases. Ageing Res Rev 2022; 74:101553. [PMID: 34971794 DOI: 10.1016/j.arr.2021.101553] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/17/2021] [Accepted: 12/23/2021] [Indexed: 12/14/2022]
Abstract
Age-related eye diseases, including dry eye, glaucoma, age-related macular degeneration, and diabetic retinopathy, represent a major global health issue based on their increasing prevalence and disabling action. Unraveling the molecular mechanisms underlying these diseases will provide novel opportunities to reduce the burden of age-related eye diseases and improve eye health, contributing to sustainable development goals achievement. The impairment of neutrophil extracellular traps formation/degradation processes seems to be one of these mechanisms. These traps formed by a meshwork of DNA and neutrophil cytosolic granule proteins may exacerbate the inflammatory response promoting chronic inflammation, a pivotal cause of age-related diseases. In this review, we describe current findings that suggest the role of neutrophils and their traps in the pathogenesis of the above-mentioned age-related eye diseases. Furthermore, we discuss why these cells and their constituents could be biomarkers and therapeutic targets for dry eye, glaucoma, age-related macular degeneration, and diabetic retinopathy. We also examine the therapeutic potential of some neutrophil function modulators and provide several recommendations for future research in age-related eye diseases.
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Affiliation(s)
- Irene Martínez-Alberquilla
- Department of Optometry and Vision, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain; Clinical and Experimental Eye Research Group, UCM 971009, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Xavier Gasull
- Neurophysiology Laboratory, Department of Biomedicine, Medical School, Institute of Neurosciences, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Patricia Pérez-Luna
- Department of Biochemistry and Molecular Biology, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Rubén Seco-Mera
- Department of Biochemistry and Molecular Biology, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Javier Ruiz-Alcocer
- Department of Optometry and Vision, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain; Clinical and Experimental Eye Research Group, UCM 971009, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Almudena Crooke
- Department of Biochemistry and Molecular Biology, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain; Clinical and Experimental Eye Research Group, UCM 971009, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain.
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Zhang YY, Zhao H, Lin JY, Wu SN, Liu XW, Zhang HD, Shao Y, Yang WF. Artificial Intelligence to Detect Meibomian Gland Dysfunction From in-vivo Laser Confocal Microscopy. Front Med (Lausanne) 2021; 8:774344. [PMID: 34901091 PMCID: PMC8655877 DOI: 10.3389/fmed.2021.774344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 11/04/2021] [Indexed: 02/05/2023] Open
Abstract
Background: In recent years, deep learning has been widely used in a variety of ophthalmic diseases. As a common ophthalmic disease, meibomian gland dysfunction (MGD) has a unique phenotype in in-vivo laser confocal microscope imaging (VLCMI). The purpose of our study was to investigate a deep learning algorithm to differentiate and classify obstructive MGD (OMGD), atrophic MGD (AMGD) and normal groups. Methods: In this study, a multi-layer deep convolution neural network (CNN) was trained using VLCMI from OMGD, AMGD and healthy subjects as verified by medical experts. The automatic differential diagnosis of OMGD, AMGD and healthy people was tested by comparing its image-based identification of each group with the medical expert diagnosis. The CNN was trained and validated with 4,985 and 1,663 VLCMI images, respectively. By using established enhancement techniques, 1,663 untrained VLCMI images were tested. Results: In this study, we included 2,766 healthy control VLCMIs, 2,744 from OMGD and 2,801 from AMGD. Of the three models, differential diagnostic accuracy of the DenseNet169 CNN was highest at over 97%. The sensitivity and specificity of the DenseNet169 model for OMGD were 88.8 and 95.4%, respectively; and for AMGD 89.4 and 98.4%, respectively. Conclusion: This study described a deep learning algorithm to automatically check and classify VLCMI images of MGD. By optimizing the algorithm, the classifier model displayed excellent accuracy. With further development, this model may become an effective tool for the differential diagnosis of MGD.
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Affiliation(s)
- Ye-Ye Zhang
- Department of Electronic Engineering, School of Science, Hainan University, Haikou, China.,Department of Electronic Engineering, College of Engineering, Shantou University, Shantou, China
| | - Hui Zhao
- Department of Ophthalmology, Shanghai First People's Hospital, Shanghai Jiao Tong University, National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Jin-Yan Lin
- Research Center for Advanced Optics and Photoelectronics, Department of Physics, College of Science, Shantou University, Shantou, China
| | - Shi-Nan Wu
- Jiangxi Centre of National Ophthalmology Clinical Research Center, Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xi-Wang Liu
- Research Center for Advanced Optics and Photoelectronics, Department of Physics, College of Science, Shantou University, Shantou, China.,Department of Mathematics, College of Science, Shantou University, Shantou, China
| | - Hong-Dan Zhang
- Research Center for Advanced Optics and Photoelectronics, Department of Physics, College of Science, Shantou University, Shantou, China.,Department of Mathematics, College of Science, Shantou University, Shantou, China
| | - Yi Shao
- Jiangxi Centre of National Ophthalmology Clinical Research Center, Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei-Feng Yang
- Department of Electronic Engineering, College of Engineering, Shantou University, Shantou, China.,Research Center for Advanced Optics and Photoelectronics, Department of Physics, College of Science, Shantou University, Shantou, China.,Department of Mathematics, College of Science, Shantou University, Shantou, China
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Vision through Healthy Aging Eyes. Vision (Basel) 2021; 5:vision5040046. [PMID: 34698313 PMCID: PMC8544709 DOI: 10.3390/vision5040046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 01/04/2023] Open
Abstract
As life expectancy grows, so too will the number of people adversely affected by age. Although it is acknowledged that many conditions and diseases are associated with age, this mini-review will present a current update of the various visual changes that generally occur in healthy individuals disregarding the possible effects of illness. These alterations influence how the world is perceived and in turn can affect efficiency or the ability to perform ordinary daily tasks such as driving or reading. The most common physical developments include a decreased pupil size and retinal luminance as well as changes both in intercellular and intracellular connections within the retina along the pathway to the visual cortex and within the visual cortex. The quantity and the physical location of retinal cells including photoreceptors, ganglion and bipolar retinal cells are modified. The clarity of intraocular organs, such as the intraocular lens, decreases. These all result in common visual manifestations that include reduced visual acuity, dry eyes, motility changes, a contraction of the visual field, presbyopia, reduced contrast sensitivity, slow dark adaptation, recovery from glare, variation in color vision and a decreased visual processing speed. Highlighting these prevalent issues as well as current and possible future innovations will assist providers to formulate treatments and thereby conserve maximum independence and mobility in the modern mature population.
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Carnevale C, Riva I, Roberti G, Michelessi M, Tanga L, Verticchio Vercellin AC, Agnifili L, Manni G, Harris A, Quaranta L, Oddone F. Confocal Microscopy and Anterior Segment Optical Coherence Tomography Imaging of the Ocular Surface and Bleb Morphology in Medically and Surgically Treated Glaucoma Patients: A Review. Pharmaceuticals (Basel) 2021; 14:581. [PMID: 34207162 PMCID: PMC8234834 DOI: 10.3390/ph14060581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 01/21/2023] Open
Abstract
Glaucoma patients often suffer from ocular surface disease (OSD) caused by the chronic administration of topical anti-glaucoma medications, especially in cases of long-term therapy with preserved or multiple drugs. Additionally, glaucoma surgery may determine ocular surface changes related to the formation and location of the filtering bleb, the application of anti-mitotic agents, and the post-operative wound-healing processes within the conjunctiva. Recently, several studies have evaluated the role of advanced diagnostic imaging technologies such as in vivo confocal microscopy (IVCM) and anterior segment-optical coherence tomography (AS-OCT) in detecting microscopic and macroscopic features of glaucoma therapy-related OSD. Their clinical applications are still being explored, with recent particular attention paid to analyzing the effects of new drug formulations and of minimally invasive surgical procedures on the ocular surface status. In this review, we summarize the current knowledge about the main changes of the ocular surface identified at IVCM and AS-OCT in glaucoma patients under medical therapy, or after surgical treatment.
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Affiliation(s)
- Carmela Carnevale
- IRCCS-Fondazione Bietti, Rome, Via Livenza, 3, 00198 Rome, Italy; (C.C.); (G.R.); (M.M.); (L.T.); (G.M.)
| | - Ivano Riva
- Department of Surgical & Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia—IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy; (I.R.); (L.Q.)
| | - Gloria Roberti
- IRCCS-Fondazione Bietti, Rome, Via Livenza, 3, 00198 Rome, Italy; (C.C.); (G.R.); (M.M.); (L.T.); (G.M.)
| | - Manuele Michelessi
- IRCCS-Fondazione Bietti, Rome, Via Livenza, 3, 00198 Rome, Italy; (C.C.); (G.R.); (M.M.); (L.T.); (G.M.)
| | - Lucia Tanga
- IRCCS-Fondazione Bietti, Rome, Via Livenza, 3, 00198 Rome, Italy; (C.C.); (G.R.); (M.M.); (L.T.); (G.M.)
| | - Alice C. Verticchio Vercellin
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY 10029, USA; (A.C.V.V.); (A.H.)
| | - Luca Agnifili
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. d’Annunzio of Chieti—Pescara, 66100 Chieti, Italy;
| | - Gianluca Manni
- IRCCS-Fondazione Bietti, Rome, Via Livenza, 3, 00198 Rome, Italy; (C.C.); (G.R.); (M.M.); (L.T.); (G.M.)
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Alon Harris
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY 10029, USA; (A.C.V.V.); (A.H.)
| | - Luciano Quaranta
- Department of Surgical & Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia—IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy; (I.R.); (L.Q.)
| | - Francesco Oddone
- IRCCS-Fondazione Bietti, Rome, Via Livenza, 3, 00198 Rome, Italy; (C.C.); (G.R.); (M.M.); (L.T.); (G.M.)
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Li J, Luo X, Liao Y, Liang L. Age differences in ocular demodicosis: Demodex profiles and clinical manifestations. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:791. [PMID: 34268404 PMCID: PMC8246181 DOI: 10.21037/atm-20-7715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 02/16/2021] [Indexed: 11/12/2022]
Abstract
Background Demodex infestation is highly age-dependent. Intriguingly, our previous studies that focused on children and young adult patients suggested that the clinical features of young patients were different from those studies enrolling mainly elderly patients. Whether age plays a role between young and elderly patients with ocular demodicosis remains unclear. Methods This prospective comparative study included 91 patients younger than 35 years and 92 older than 45 years with ocular demodicosis. Demodex mite count, symptoms, tear film, and ocular changes were compared between the two groups. Risk factors of meibomian gland loss (MGL) and corneal changes were analysed in the two groups. Results Demodex counts were comparable between the two groups. Young patients had higher D. brevis counts and overall percentage of D. brevis, while elderly patients had more D. folliculorum (all P<0.05). Irritation and blurred vision were more common in young patients, while eye fatigue and photophobia were more common in elderly patients (both P<0.05). The two groups had comparable tear volume and tear break-up time. Meibomian gland dysfunction was the most common sign in both groups but MGL was significantly more severe in young patients. More prevalent corneal changes and more eyelash disorders were found in young patients (both P<0.05). Female sex, a higher D. brevis percentage, lid margin anomalies, and MGL were associated with corneal change, while a higher D. brevis percentage and lid margin anomalies were related to MGL in young patients. MGL was associated with corneal change, but age was the only predictor of MGL in the elderly group. Conclusions Young patients with ocular demodicosis tend to have more D. brevis infestation, more MGL, and more corneal involvement.
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Affiliation(s)
- Jing Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaohui Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yinglin Liao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lingyi Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Abstract
A biomarker is a "characteristic that is measured as an indicator of normal biological processes, pathogenic processes, or responses to an exposure or intervention, including therapeutic interventions." Recently, calls for biomarkers for ocular surface diseases have increased, and advancements in imaging technologies have aided in allowing imaging biomarkers to serve as a potential solution for this need. This review focuses on the state of imaging biomarkers for ocular surface diseases, specifically non-invasive tear break-up time (NIBUT), tear meniscus measurement and corneal epithelial thickness with anterior segment optical coherence tomography (OCT), meibomian gland morphology with infrared meibography and in vivo confocal microscopy (IVCM), ocular redness with grading scales, and cellular corneal immune cells and nerve assessment by IVCM. Extensive literature review was performed for analytical and clinical validation that currently exists for potential imaging biomarkers. Our summary suggests that the reported analytical and clinical validation state for potential imaging biomarkers is broad, with some having good to excellent intra- and intergrader agreement to date. Examples of these include NIBUT for dry eye disease, ocular redness grading scales, and detection of corneal immune cells by IVCM for grading and monitoring inflammation. Further examples are nerve assessment by IVCM for monitoring severity of diabetes mellitus and neurotrophic keratitis, and corneal epithelial thickness assessment with anterior segment OCT for the diagnosis of early keratoconus. However, additional analytical validation for these biomarkers is required before clinical application as a biomarker.
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Meibomian Glands or Not? Identification of In Vivo and Ex Vivo Confocal Microscopy Features and Histological Correlates in the Eyelid Margin. J Ophthalmol 2020; 2020:7516286. [PMID: 32676204 PMCID: PMC7345604 DOI: 10.1155/2020/7516286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/19/2020] [Indexed: 12/28/2022] Open
Abstract
Purpose In vivo confocal laser scanning microscopy (CLSM) is an emerging diagnostic tool allowing fast and easy microscopic tissue examination. For the diagnostics of pathological eyelid margin lesions, the knowledge of the normal eyelid margin is essential. Methods We examined 18 eyelid margins of healthy humans using the in vivo CLSM device and 10 samples of healthy eyelid margins from donor sites with ex vivo CLSM and compared the findings to the corresponding histological sections of donor sites. Cross-section images of different depths and depths of different skin appendages were measured. Results The depth observed by in vivo CLSM is less than 150 μm into the eyelid. Images of the epidermis and superficial dermis skin, appendages including hair follicle, and sebaceous catheters can be captured associated with histopathology and ex vivo confocal microscopy. In correlation with histopathology, we identified different layers of the eyelid margin, different layers of the epidermis, and skin appendages by ex vivo confocal microscopy. Conclusions The study offers an overview of the in vivo confocal microscopy human eyelid margin characteristics in comparison to the standard histological examination and confirms that in vivo CLSM could not observe the meibomian gland acini structure.
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Guo Y, Ha JY, Piao HL, Sung MS, Park SW. The protective effect of 3% diquafosol on meibomian gland morphology in glaucoma patients treated with prostaglandin analogs: a 12-month follow-up study. BMC Ophthalmol 2020; 20:277. [PMID: 32650746 PMCID: PMC7350718 DOI: 10.1186/s12886-020-01550-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/06/2020] [Indexed: 01/04/2023] Open
Abstract
Background To determine if 3% diquafosol (DQS) can preserve the meibomian gland morphology in glaucoma patients treated with prostaglandin analogs (PGA) for a 12-month follow-up period. Methods This study included 84 eyes of 46 normal tension glaucoma (NTG) patients who were treated with either preservative-containing PGA (PC-PGA; 16 patients, 28 eyes), preservative-free PGA (PF-PGA; 21 patients, 39 eyes), or a combination of PC-PGA and 3% DQS (PC-PGA + DQS; 9 patients, 17 eyes). The meibography of the upper eyelid was acquired using Keratograph® 5 M at baseline and at each follow-up (1, 3, 6, 9, and 12 months). Meibomian gland loss (MGL) was quantitatively analyzed by using ImageJ software. Results In the PC-PGA group, MGL increased significantly from baseline to month 9 and month 12, whereas no significant changes were observed in the PF-PGA and PC-PGA + DQS groups during the entire 12 months. All groups showed similar MGL at each follow-up time from baseline to six months. However, MGL in the PC-PGA group was significantly higher than those in the PF-PGA and PC-PGA + DQS groups at the 9 and 12 months. Conclusions Combining 3% DQS with PC-PGA was as effective as PF-PGA in preserving the meibomian gland morphology for at least 12 months. Our results suggest that 3% DQS may be a promising strategy for managing glaucoma patients with a high risk of developing meibomian gland dysfunction due to preservative-containing topical medications.
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Affiliation(s)
- Yue Guo
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-Gu, Gwangju, 61469, South Korea.,Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jun Young Ha
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-Gu, Gwangju, 61469, South Korea
| | - He Long Piao
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-Gu, Gwangju, 61469, South Korea.,Department of Ophthalmology, Yanbian University Hospital, Yanji, Jilin, China
| | - Mi Sun Sung
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-Gu, Gwangju, 61469, South Korea
| | - Sang Woo Park
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-Gu, Gwangju, 61469, South Korea.
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In Vivo Confocal Microscopy Morphometric Analysis of Meibomian Glands in Patients With Graves Ophthalmopathy. Cornea 2020; 40:425-429. [PMID: 32618852 DOI: 10.1097/ico.0000000000002404] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To characterize meibomian glands (MGs) features in patients with Graves ophthalmopathy (GO) by in vivo confocal microscopy (IVCM) and to further investigate possible correlations with ocular surface characteristics. METHODS Consecutive patients with GO and controls were enrolled. The following ocular surface parameters were measured: tear break-up time, Schirmer test, and corneal fluorescein staining (Oxford score) were performed on each subject. IVCM of MGs was performed, and the scans were analyzed with ImageJ software for the calculation of the following: acinar unit density, total gland area, total lumen area (TLA), acinar longest diameter, and acinar shortest diameter. A nonparametric Mann-Whitney U test was used to compare variables between patients with GO and controls. The Spearman correlation analysis was used to evaluate the correlations between ocular surface and IVCM parameters. RESULTS Twenty-one patients with GO and 24 sex- and age-matched healthy controls were included. Acinar unit density was significantly lower in patients with GO compared with controls (24.5 ± 8.1 vs. 34.2 ± 7.5 U/mm; P < 0.001). In addition, patients with GO showed significantly higher values of TLA, acinar longest diameter, and acinar shortest diameter compared with controls (respectively, 3104.7 ± 1713.3 vs. 1393.8 ± 448.0 μm, 94.4 ± 21.2 vs. 64.3 ± 10.1 µm and 56.6 ± 15.3 vs. 42.2 ± 12.3 μm; always P < 0.05). In patients with GO, TLA showed a significant inverse correlation with Schirmer test (Rs = -0.467; P = 0.038). CONCLUSIONS IVCM allowed to detect distinctive features of MGs in patients with GO and could represent a surrogate tool for the assessment of MG status in these patients.
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Mastropasqua R, Agnifili L, Mastropasqua L. Structural and Molecular Tear Film Changes in Glaucoma. Curr Med Chem 2019; 26:4225-4240. [PMID: 30306854 DOI: 10.2174/0929867325666181009153212] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 07/13/2018] [Accepted: 09/19/2018] [Indexed: 12/31/2022]
Abstract
The Tear Film (TF) is a trilaminar and dynamic fluid covering the entire Ocular Surface (OS), consisting of a mucus, aqueous, and lipid layer deeply interacting between them. Because of its structure and functions, TF plays a pivotal role in the preservation of the OS integrity and the quality of vision. Medical therapy for glaucoma is recognized to profoundly disturb the OS homeostasis by altering all components of the ocular surface unit, including TF. The presence of preservatives, the number of daily eye drops instillations, and the duration of therapy are the main contributors to TF changes. From the physio-pathological side, TF alterations are induced by toxic and allergic mechanisms and result from goblet cell and Meibomian gland loss, dysfunction of accessory lacrimal glands, and epithelial disruption. In detail, TF changes are represented by mucus layer thinning, reduced mucin concentration, aqueous layer volume reduction, and lipid layer thinning with increased tear evaporation. Hyper- osmolarity and instability represent the main hallmarks of these changes and are an expression of a iatrogenic form of dry eye. TF undergoes also molecular modifications that primarily reflect a therapy- or disease-induced inflammatory status of the OS. Over the last years, this field of research aimed a progressively growing interest since molecular variations may be considered as potential candidate biomarkers of glaucoma. The aim of this review is to report the main TF changes occurring during glaucoma, exploring the relationship they may have with the glaucoma-related ocular surface disease and the patient quality of life, and their utility as potential biomarkers of disease.
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Affiliation(s)
| | - Luca Agnifili
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Leonardo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
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Meibomian Gland Features and Conjunctival Goblet Cell Density in Glaucomatous Patients Controlled With Prostaglandin/Timolol Fixed Combinations: A Case Control, Cross-sectional Study. J Glaucoma 2019; 27:364-370. [PMID: 29401160 DOI: 10.1097/ijg.0000000000000899] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE To investigate, using in vivo confocal microscopy (IVCM), the Meibomian gland (MG) features and conjunctival goblet cell density (GCD) in glaucomatous patients controlled with prostaglandin/timolol fixed combinations (PTFCs). MATERIALS AND METHODS In this cross-sectional study, 60 white patients were treated with PTFCs, 15 with latanoprost+timolol (L+T) unfixed combination, and 15 controls were enrolled. Patients underwent the Ocular Surface Disease Index questionnaire, tear film breakup time, corneal staining, Schirmer test I, and IVCM of MGs and goblet cells. The main outcome measures were: mean Meibomian acinar density (MMAD) and area (MMAA), inhomogeneity of glandular interstice (InI) and acinar wall (InAW), and GCD. RESULTS PTFCs were: latanoprost/timolol (LTFC, 15 eyes), travoprost/timolol (TTFC, 15), bimatoprost/timolol (BTFC, 15), and preservative-free bimatoprost/timolol (PF-BTFC, 15) fixed combinations. Mean time on therapy did not differ among treatments. IVCM documented lower GCD, MMAD, and MMAA (P<0.001), and greater InI and InAW (P<0.05) in glaucoma patients compared with controls. L+T showed worse values compared with PTFCs and PF-BTFC (P<0.05). Preserved PTFCs showed lower MMAD, MMAA, GCD, and greater InI and InAW compared with PF-BTFC (P<0.05) and controls (P<0.001). Differences were not found among PTFCs. InI and InAW significantly correlated with Ocular Surface Disease Index and breakup time (P<0.001), corneal staining (P<0.05), and GCD (P<0.001); GCD correlated with MMAD (P<0.05). CONCLUSIONS PTFCs were less toxic towards MGs and goblet cells compared with the L+T unfixed combination, with PF-BTFC presenting the most tolerated profile. These findings should be carefully considered given the role of these structures in the induction of the glaucoma-related ocular surface disease.
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Ha JY, Sung MS, Park SW. Effects of Preservative on the Meibomian Gland in Glaucoma Patients Treated with Prostaglandin Analogues. Chonnam Med J 2019; 55:156-162. [PMID: 31598473 PMCID: PMC6769241 DOI: 10.4068/cmj.2019.55.3.156] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 05/31/2019] [Accepted: 06/11/2019] [Indexed: 12/31/2022] Open
Abstract
This study compared the effect of preservative-containing (PC) and preservative-free (PF) prostaglandin analogue (PGA) formulations on the ocular surface, especially on the meibomian gland (MG) in patients with open-angle glaucoma (OAG). This is a retrospective study of treatment-naïve patients with OAG (n=80) and healthy controls (n=40). OAG patients were randomized into groups using either PC-PGA or PF-PGA for 12 months. All participants underwent ocular surface and MG examinations including their meibum score, meiboscore, and lid margin abnormality score (LAS). Eighty OAG patients were randomized into two groups (n=42 in PC, n=38 in PF). All PGA and control groups showed similar ocular surface and MG parameters at the baseline. Both PC- and PF-PGA groups showed increased meibum scores, meiboscores, and LASs at 12 months compared to the baseline (all p<0.05). At the 12-months visit, PC-PGA group showed severe OSDI, shorter TBUT, greater OSS, and worse MG parameters than those of the other two groups (all p<0.05). In addition, PF-PGA group showed worse meiboscores, meibum scores, and severe OSS scores than those of the control group (all p<0.05). Both PC and PF formulations can cause damage to the MG in patients using PGA. However, PC formulations induced more ocular discomfort, poorer ocular surface, and more severe MG loss compared to PF formulations. Therefore, it would be advisable to use PF formulations in patients with a preexisting or concomitant ocular surface disease or MGD.
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Affiliation(s)
- Jun Young Ha
- Department of Ophthalmology, Chonnam National University Hospital, Gwangju, Korea
| | - Mi Sun Sung
- Department of Ophthalmology, Chonnam National University Hospital, Gwangju, Korea
| | - Sang Woo Park
- Department of Ophthalmology, Chonnam National University Hospital, Gwangju, Korea
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15
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Yu T, Han XG, Gao Y, Song AP, Dang GF. Morphological and cytological changes of meibomian glands in patients with type 2 diabetes mellitus. Int J Ophthalmol 2019; 12:1415-1419. [PMID: 31544036 DOI: 10.18240/ijo.2019.09.07] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/21/2019] [Indexed: 12/28/2022] Open
Abstract
AIM To observe the changes of microcellular structure of meibomian glands (MGs) in type 2 diabetes mellitus (DM), and to explore its correlation with the duration of diabetes. METHODS The study assessed 132 eyes of 132 patients with type 2 diabetes mellitus (DM group) and 100 eyes of 100 non-diabetic participants (NDM group). All patients underwent the examination of the Keratograph 5M system to obtain the meibography which were used to evaluate the structure dropout of the MGs. And then laser scanning confocal microscopy (LSCM) was performed for observing the acinar cells and ducts of the MGs to obtain the following parameters: the MG acinar unit density (MGAUD), MG acinar longest diameter (MGALD) and MG acinar shortest diameter (MGASD). The examination results of the right eye were selected for analysis. RESULTS Compared with that in NDM group, the meiboscore was significantly higher (Z=-4.057, P<0.001), and there were more MGs dropout in DM group. With the prolongation of the course of diabetes, the absence of MGs aggravated and the MGs dropout score increased (r=0.596; P<0.001). LSCM showed that there were various cytological alterations in acinar cells of MGs with the progress of diabetes duration, such as expansion, atrophy or fibrosis of MG acinar units, decreased density of MG acinar units, deposition of lipid substances, infiltration of inflammatory cells, proliferation of fibrous tissues, etc. And the opening of the glandular duct changed from smooth at the beginning to narrow, blocked, fibrotic and so on. Compared with that in NDM group, the MGAUD in DM group was significantly lower (Z=-9.713; P<0.001), the MGALD and MGASD were significantly larger (Z=-9.751, -6.416; P<0.001). With the duration of diabetes, the MGAUD reduced, the MGASD increased (r=0.860, 0.364, P<0.001); but the MGALD had no correlation with diabetic duration (r=0.133, P=0.151). CONCLUSION With the progress of diabetes, the meibomian glandular acinar cells of diabetic patients show various manifestations. Those changes may result in the dysfuction of the MGs, tear film instability and dry eye symptoms in patients with type 2 DM.
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Affiliation(s)
- Tao Yu
- Shandong Provincial Qianfoshan Hospital, the First Hospital Affiliated with Shandong First Medical University, Jinan 250014, Shandong Province, China
| | - Xu-Guang Han
- Jinan Aier Ophthalmology Hospital, Aier Eye Hospital Group, Jinan 250014, Shandong Province, China
| | - Yang Gao
- Shandong Provincial Qianfoshan Hospital, the First Hospital Affiliated with Shandong First Medical University, Jinan 250014, Shandong Province, China
| | - Ai-Ping Song
- Shandong Provincial Qianfoshan Hospital, the First Hospital Affiliated with Shandong First Medical University, Jinan 250014, Shandong Province, China
| | - Guang-Fu Dang
- Shandong Provincial Qianfoshan Hospital, the First Hospital Affiliated with Shandong First Medical University, Jinan 250014, Shandong Province, China
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16
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López‐de la Rosa A, Alghamdi WM, Kunnen CME, Lazon de la Jara P, González‐García MJ, Markoulli M, Papas EB. Changes in the tarsal conjunctiva viewed by
in vivo
confocal microscopy are associated with ocular symptoms and contact lens wear. Ophthalmic Physiol Opt 2019; 39:328-336. [DOI: 10.1111/opo.12638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 08/05/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Alberto López‐de la Rosa
- Institute of Applied Ophthalmobiology (IOBA)University of Valladolid ValladolidSpain
- Department of Theoretical Physics, Atomic and Optics University of Valladolid Valladolid Spain
| | - Waleed M Alghamdi
- Department of Optometry College of Applied Medical Science Qassim University Qassim Saudi Arabia
- School of Optometry & Vision Science University of New South Wales SydneyAustralia
| | - Carolina ME Kunnen
- School of Optometry & Vision Science University of New South Wales SydneyAustralia
- Brien Holden Vision Institute SydneyAustralia
- Vision Cooperative Research Centre Sydney Australia
- Networking Research Center on Bioengineering Biomaterials and Nanomedicine (CIBER‐BBN) Valladolid Spain
- Alcon Laboratories Fort Worth USA
| | - Percy Lazon de la Jara
- School of Optometry & Vision Science University of New South Wales SydneyAustralia
- Brien Holden Vision Institute SydneyAustralia
- Vision Cooperative Research Centre Sydney Australia
| | - María J González‐García
- Institute of Applied Ophthalmobiology (IOBA)University of Valladolid ValladolidSpain
- Department of Theoretical Physics, Atomic and Optics University of Valladolid Valladolid Spain
| | - Maria Markoulli
- School of Optometry & Vision Science University of New South Wales SydneyAustralia
| | - Eric B Papas
- School of Optometry & Vision Science University of New South Wales SydneyAustralia
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17
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Maskin SL, Alluri S. Expressible Meibomian Glands Have Occult Fixed Obstructions: Findings From Meibomian Gland Probing to Restore Intraductal Integrity. Cornea 2019; 38:880-887. [PMID: 30998615 PMCID: PMC6571175 DOI: 10.1097/ico.0000000000001954] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/21/2019] [Accepted: 03/01/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe and quantify findings of intraductal obstruction during probing expressible and nonexpressible meibomian glands (MGs) in patients with obstructive meibomian gland dysfunction using a 1-mm intraductal MG probe. METHODS A retrospective study of probe findings from 108 consecutive patients. Nonparametric tests using SPSS software 25.0 to explore relationships between expressibility and probe findings. RESULTS Of 11,776 probed glands of 404 lids, 84% showed mechanical resistance (MR) and 16% showed no resistance (NR). Fixed, firm, focal unyielding resistance (FFFUR) occurred in 79.5% of obstructed glands, and nonfixed, nonfocal easily yielding soft resistance (SFT) in 20.4%. FFFUR was characterized by an audible and tactile "firm pop" (FP) or "firm gritty" (FG) sensation. No significant difference in MR and FFFUR for lids between 0% and >90% gland expressibility was observed. FP correlated with increased expressibility (P = 0.011), lid tenderness (P = 0.045), and complete proximal obstruction (P = 0.037), whereas SFT correlated with reduced expressibility (P = 0.016). Upper lids showed greater incidence of MR (P < 0.001), FFFUR (P < 0.001), and FG (P < 0.001), whereas lower lids showed greater expressibility (P < 0.001) and NR (P < 0.001). CONCLUSIONS FFFUR was the most common probe finding in a large series of consecutively probed MGs, with an incidence of 67% of glands and 80% of obstructed glands. FFFUR was independent of gland expressibility, demonstrating expressible glands harbor FFFUR deep to at least one acinus. FP was associated with expressible gland occult obstruction and lid tenderness. SFT correlated with reduced expressibility, perhaps related to altered duct/duct contents. Upper lids correlated with increased MR, FFFUR, and FG and lower lids with increased expressibility and NR, possibly reflecting contrasting anatomy and blink-related microtrauma.
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18
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Qazi Y, Kheirkhah A, Blackie C, Trinidad M, Williams C, Cruzat A, Korb DR, Hamrah P. Clinically Relevant Immune-Cellular Metrics of Inflammation in Meibomian Gland Dysfunction. Invest Ophthalmol Vis Sci 2019; 59:6111-6123. [PMID: 30592499 PMCID: PMC6314224 DOI: 10.1167/iovs.18-25571] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose To determine the reliability and clinical relevance of in vivo confocal microscopy (IVCM)-based immune-cellular metrics of palpebral conjunctival inflammation in meibomian gland dysfunction (MGD). Methods Sixteen MGD patients and 13 reference controls included in this cross-sectional, retrospective study, had an ocular surface exam, symptom assessment (Ocular Surface Disease Index questionnaire [OSDI]), and palpebral conjunctival IVCM imaging. Bland-Altman analyses, intraclass correlation coefficient (ICCa), Lin's concordance correlation coefficient (ρc), receiver operating characteristic (ROC) analyses, and correlations were performed. Clinical outcome measures were symptom severity (OSDI scores), tear break-up time (TBUT), and corneal fluorescein staining (CFS grade). Results Compared to controls, patients with MGD had variable symptom severity (average OSDI score: 48.3 ± 7.6, P = 0.0008, range: 8.3–85.42), shorter TBUT (6.8 ± 0.9 seconds, P = 0.002), comparable corneal staining (0.31 ± 0.19, P = 0.20), and greater conjunctival inflammation (epithelial immune cells [EIC]: 477.8 ± 54.2 vs. 123.3 ± 17.2 cells/mm2, P < 0.0001; intraglandular immune cells [IGIC]: 41.9 ± 3.3% vs. 20.33 ± 7.3%, P < 0.01). Immune-cellular metrics had high inter- and intraobserver agreement (ρc: 0.86–0.94; ICCa and Cronbach's α: 0.85–0.97, P < 0.0001). EIC correlated positively with OSDI (rs: 0.49, P = 0.03), while both EIC and IGIC correlated inversely with TBUT (rs: −0.47, −0.45, P < 0.05), and had high accuracy in detecting inflammation (ROC area under the curve [AUC]: 0.97 and 0.89, P ≤ 0.001). Conclusions EIC and IGIC are increased in highly symptomatic patients with MGD that have minimal corneal staining, and correlate with symptoms and clinical signs. EIC and IGIC may provide reliable and clinically relevant metrics of inflammation.
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Affiliation(s)
- Yureeda Qazi
- Ocular Surface Imaging Center, Cornea Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Ahmad Kheirkhah
- Ocular Surface Imaging Center, Cornea Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | | | - Monique Trinidad
- Ocular Surface Imaging Center, Cornea Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Candice Williams
- Ocular Surface Imaging Center, Cornea Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Andrea Cruzat
- Ocular Surface Imaging Center, Cornea Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Donald R Korb
- Korb and Associates, Boston, Massachusetts, United States
| | - Pedram Hamrah
- Ocular Surface Imaging Center, Cornea Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States.,Center for Translational Ocular Immunology and Cornea Service, New England Eye Center/Tufts Medical Center, Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts, United States
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19
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Cheng S, Zhang M, Chen H, Fan W, Huang Y. The correlation between the microstructure of meibomian glands and ocular Demodex infestation: A retrospective case-control study in a Chinese population. Medicine (Baltimore) 2019; 98:e15595. [PMID: 31083247 PMCID: PMC6531270 DOI: 10.1097/md.0000000000015595] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Meibomian gland dysfunction (MGD) is a common disease in ophthalmic clinic. This study aimed to explore ocular Demodex infestation on the microstructure changes of the meibomian glands (MGs) in patients with MGD by in vivo confocal microscopy (IVCM).We retrospectively reviewed 103 eyes of 52 patients with MGD and 62 eyes of 31 non-MGD patients. All enrolled patients underwent IVCM examination. The following IVCM parameters were recorded: the MG acinar density (MAD), MG acinar longest diameter (MALD), MG acinar shortest diameter (MASD), MG orifice area (MOA), severity of MG fibrosis (MF), MG acinar irregularity (MAI), meibum secretion reflectivity (MSR), inhomogeneous appearance of walls of acinar units (AWI) and periglandular interstices of acinar units (API), and the number of Demodex.The positive rate of Demodex infestation in MGDs was 89.32%, and statistically higher than control group (controls; P < .001). All parameters showed statistically significant differences between MGDs and controls (P < .001), and Demodex-negative group and Demodex-positive group (P < .05) in both MGDs and controls, except MAD (P = .826) in controls. The number of Demodex was positively correlated with MALD, MASD, MF, MAI, MSR, AWI, and API in MGDs and controls (P < .05), and negatively correlated with MAD and MOA in MGDs (P < .05). MOA showed a strong significant correlation with the number of Demodex in controls (P < .001), whereas there was no significant difference between the number of Demodex and the MAD in controls (P = .448).Demodex can cause microstructural changes of MGs, which can cause or aggravate MGD, and the more the number of Demodex infestation, the more serious the structural damage.
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20
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Zhou S, Robertson DM. Wide-Field In Vivo Confocal Microscopy of Meibomian Gland Acini and Rete Ridges in the Eyelid Margin. Invest Ophthalmol Vis Sci 2019; 59:4249-4257. [PMID: 30128496 PMCID: PMC6103323 DOI: 10.1167/iovs.18-24497] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose In vivo confocal microscopy (IVCM) has been widely used to evaluate changes in the meibomian glands (MGs) in response to age and disease. This study examined the structures described as MGs using wide-field IVCM and laser scanning confocal microscopy (LSCM) in situ and characterized their spatial distribution and localization relevant to the eyelid margin. Methods IVCM was performed on 30 subjects aged 18 to 38 to visualize structures in the eyelid margin. Size, shape, and distribution characteristics were measured, and individual frames were montaged into wide-field images. Structures observed on IVCM were then visualized using LSCM of whole-mount and cryosectioned cadaver eyelids stained with Nile red, mucin-1 (MUC1), laminin-5, and 4′,6-diamidine-2′-phenylindole dihydrochloride. Results The size, distribution, and staining patterns of the reflective structures seen on IVCM did not correspond to the MGs in cadaver eyelids. Instead, staining profiles indicated that these structures corresponded to the rete ridges present at the dermal–epidermal junction. Wide-field imaging showed a densely populated field of rete ridges with distinct size and shape characteristics depending on their location relative to the meibomian orifices. A distal shift of the mucocutaneous junction (MCJ) was evident in some eyelids. Conclusions IVCM is unable to visualize MGs in the human eyelid margin due to light attenuation at that tissue depth. LSCM confirms that these structures are rete ridges located at the dermal–epidermal junction. Alterations in the structure of the dermal–epidermal junction within the eyelid margin indicate a shifting of the MCJ and may impact tear film dynamics.
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Affiliation(s)
- Scott Zhou
- The Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Danielle M Robertson
- The Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, United States
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21
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Safonova TN, At'kova EL, Kintyukhina NP, Reznikova LV. [Modern methods of evaluating the morphological and functional state of the eyelids in chronic blepharitis]. Vestn Oftalmol 2018; 134:276-281. [PMID: 30499529 DOI: 10.17116/oftalma2018134051276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The article reviews the literature on methods of evaluating the morphological and functional state of the eyelids in chronic blepharitis. Development of methods continues together with further research on the etiology and pathogenesis of the disease.
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Affiliation(s)
- T N Safonova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - E L At'kova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - N P Kintyukhina
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - L V Reznikova
- I.M. Sechenov First Moscow State Medical University, Chair of Ophthalmology, 8-2 Malaya Trubetskaya St., Moscow, Russian Federation, 119991
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22
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In Reply: Meibomian Gland Features and Conjunctival Goblet Cell Density in Glaucomatous Patients Controlled With Prostaglandin/Timolol Fixed Combinations: A Case Control, Cross-sectional Study. J Glaucoma 2018; 27:e197. [PMID: 30161077 DOI: 10.1097/ijg.0000000000001072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Ocular surface inflammation impairs structure and function of meibomian gland. Exp Eye Res 2017; 163:78-84. [PMID: 28950941 DOI: 10.1016/j.exer.2017.06.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/03/2017] [Accepted: 06/13/2017] [Indexed: 11/23/2022]
Abstract
Dysfunction of the meibomian glands alters secreted meibum quantitatively and qualitatively that can lead to damage to the ocular surface epithelium. In response to an unstable tear film cause by meibomian gland dysfunction, ocular surface epithelium is damaged and expresses inflammatory cytokines leading to secondary ocular inflammation. In turn, inflammatory disorders of the palpebral conjunctiva and lid margin may affect the structure and function of meibomian gland. The disorders include allergic conjunctivitis, long-term usage of contact lenses, dermatological diseases that affect conjunctival homeostasis, Stevens-Johnson's syndrome or chemical burning of the ocular surface and lid margin.
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Mastropasqua R, Agnifili L, Fasanella V, Nubile M, Gnama AA, Falconio G, Perri P, Di Staso S, Mariotti C. The Conjunctiva-Associated Lymphoid Tissue in Chronic Ocular Surface Diseases. MICROSCOPY AND MICROANALYSIS : THE OFFICIAL JOURNAL OF MICROSCOPY SOCIETY OF AMERICA, MICROBEAM ANALYSIS SOCIETY, MICROSCOPICAL SOCIETY OF CANADA 2017; 23:697-707. [PMID: 28480834 DOI: 10.1017/s1431927617000538] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Ocular surface diseases (OSDs) represent a widely investigated field of research given their growing incidence and the negative impact on quality of life. During OSDs, cytokines generated by damaged epithelia trigger and deregulate the lymphoid cells composing the eye-associated lymphoid tissues, inducing an immune-mediated chronic inflammation that amplifies and propagates the disease during time. The conjunctiva-associated lymphoid tissue (CALT), given its particular position that permits immune cells covering the cornea, might play a crucial role in the development of OSDs. Despite the recognized inflammatory role of mucosa-associated lymphoid tissues in other stations taking contact with the external environment (gut or bronchus), CALT did not gain the deserved consideration. In the last years, the diffusion of the in vivo confocal microscopy (IVCM) stimulated the interest to CALT, especially in dry eye, ocular allergy, and glaucoma. Though the initial stimuli were different, IVCM documented similar changes, represented by increased lymphoid cells within the diffuse layer, follicles and interfollicular spaces. These findings, which need to be validated by immunohistology, support the CALT stimulation during OSDs. However, while an involvement of the CALT in OSDs is hypothesizable, the exact role of this structure in their pathogenesis remains unclear and warrants further investigations.
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Affiliation(s)
| | - Luca Agnifili
- 2Ophthalmology Clinic,Department of Medicine and Aging Science,University G. d'Annunzio of Chieti-Pescara,Chieti 66100,Italy
| | - Vincenzo Fasanella
- 2Ophthalmology Clinic,Department of Medicine and Aging Science,University G. d'Annunzio of Chieti-Pescara,Chieti 66100,Italy
| | - Mario Nubile
- 2Ophthalmology Clinic,Department of Medicine and Aging Science,University G. d'Annunzio of Chieti-Pescara,Chieti 66100,Italy
| | - Agbeanda A Gnama
- 2Ophthalmology Clinic,Department of Medicine and Aging Science,University G. d'Annunzio of Chieti-Pescara,Chieti 66100,Italy
| | - Gennaro Falconio
- 2Ophthalmology Clinic,Department of Medicine and Aging Science,University G. d'Annunzio of Chieti-Pescara,Chieti 66100,Italy
| | - Paolo Perri
- 3Department of Biomedical and Surgical Sciences,Division of Ophthalmology,University of Ferrara,Ferrara 44100,Italy
| | - Silvio Di Staso
- 4Department of Surgical Science,Ophthalmic Clinic,University of L'Aquila,L'Aquila 67100,Italy
| | - Cesare Mariotti
- 5Eye Clinic,Polytechnic University of Marche,Ancona 60020,Italy
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25
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Argüeso P. Proteolytic activity in the meibomian gland: Implications to health and disease. Exp Eye Res 2017; 163:53-57. [PMID: 28284957 DOI: 10.1016/j.exer.2017.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/23/2017] [Accepted: 03/06/2017] [Indexed: 12/23/2022]
Abstract
The function of the meibomian gland in the upper and lower eyelids is critical to maintaining homeostasis at the ocular surface. Highly specialized meibocytes within the gland must differentiate and accumulate intracellular lipid droplets that are released into the tear film following rupture of the cell membrane. Proteases and their inhibitors have been recognized as key players in remodeling extracellular matrices and promoting the normal integrity of glandular tissue. They modulate a wide range of biological processes, such as cell proliferation and differentiation, and can contribute to disease when aberrantly expressed. Deciphering the role of proteolytic activity in the meibomian gland offers an opportunity to gain a more comprehensive and fundamental understanding of the developmental, physiological, and pathological processes associated with this gland.
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Affiliation(s)
- Pablo Argüeso
- Schepens Eye Research Institute and Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, United States
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26
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Niyadurupola N, Broadway DC. Special considerations for glaucoma management in the elderly. EXPERT REVIEW OF OPHTHALMOLOGY 2016. [DOI: 10.1080/17469899.2016.1190643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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