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Swiderska K, Blackie CA, Maldonado-Codina C, Fergie M, Read ML, Morgan PB. Evaluation of Meibomian gland structure and appearance after therapeutic Meibomian gland expression. Clin Exp Optom 2024; 107:504-514. [PMID: 37989323 DOI: 10.1080/08164622.2023.2251994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/21/2023] [Indexed: 11/23/2023] Open
Abstract
CLINICAL RELEVANCE Evaluating how Meibomian glands can change in appearance has the potential to advance the understanding of Meibomian gland health and may lead to enhanced diagnosis and therapy. BACKGROUND This work aimed to investigate Meibomian gland appearance after therapeutic Meibomian gland expression. METHODS Fifteen subjects attended three study visits over a two-week period. Meibography was performed before and after therapeutic Meibomian gland expression, the following day, and 2 weeks after expression. Six central glands were used to calculate Meibomian gland morphological parameters such as gland length ratio, gland width, gland area, gland tortuosity, and gland contrast. A custom semi-automated image analysis software was used to calculate Meibomian gland metrics. Furthermore, a high-resolution imaging system was developed to capture clear images of the Meibomian glands, free of any artefacts, which were used for precise calculations of Meibomian gland contrast. RESULTS The expression procedure had a significant impact on Meibomian gland contrast and length ratio immediately afterwards. The least square mean difference (95% CI) from baseline for Michelson contrast was -0.006 (-0.010, -0.001) and -1.048 (-2.063, -0.033) for simple contrast. The least square mean ratio of the gland length ratio immediately after the expression to baseline was 0.758 (0.618, 0.931). CONCLUSIONS Following therapeutic expression, Meibomian glands exhibit reduced brightness and length. However, within 24 h, they appear to recover and return to their baseline state, indicating a relatively short recovery time. This sheds light on whether meibography is solely focused on capturing gland structure or if it also captures acinar activity. The hyperreflective properties of lipids suggest that the decrease in contrast observed after expression could be attributed to a reduction in the visualisation of acini activity. A decrease in Meibomian gland length ratio implies that the loss of gland structure following treatment may be indicative of a temporary structural alteration.
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Affiliation(s)
- Kasandra Swiderska
- Eurolens Research, Division of Pharmacy and Optometry, The University of Manchester, Manchester, UK
| | - Caroline A Blackie
- Medical Affairs Department, Johnson & Johnson Surgical Vision, Inc, Irvine, CA, USA
| | - Carole Maldonado-Codina
- Eurolens Research, Division of Pharmacy and Optometry, The University of Manchester, Manchester, UK
| | - Martin Fergie
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - Michael L Read
- Eurolens Research, Division of Pharmacy and Optometry, The University of Manchester, Manchester, UK
| | - Philip B Morgan
- Eurolens Research, Division of Pharmacy and Optometry, The University of Manchester, Manchester, UK
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Zakrzewska A, Wiącek MP, Słuczanowska-Głąbowska S, Safranow K, Machalińska A. The Effect of Oral Isotretinoin Therapy on Meibomian Gland Characteristics in Patients with Acne Vulgaris. Ophthalmol Ther 2023; 12:2187-2197. [PMID: 37301783 PMCID: PMC10287853 DOI: 10.1007/s40123-023-00737-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/16/2023] [Indexed: 06/12/2023] Open
Abstract
INTRODUCTION The aim of the study was to determine the effect of oral isotretinoin therapy on the functional and morphological condition of the anterior segment of the eye, with particular emphasis on the meibomian glands. METHODS Twenty-four patients (48 eyes) with a diagnosis of acne vulgaris were involved in the survey. All patients underwent a thorough ophthalmological examination at three time points: before therapy, 3 months after the start of therapy, and 1 month after the completion of isotretinoin therapy. The physical examination included the following elements: blink rate, analysis of the lid margin abnormality score (LAS), tear film break-up time (TFBUT) and Schirmer's test, meibomian gland loss (MGL), and the evaluation of the meibum quality score (MQS) and meibum expressibility score (MES). Additionally, the total score of an ocular surface disease index (OSDI) questionnaire was analysed. RESULTS In comparison with pretreatment values, significant increases in OSDI during and after the treatment (p = 0.003 and p = 0.004, respectively) were observed. Substantial deterioration during the treatment was observed for MGL (p < 0.0001), MQS (p < 0.001) and LAS (p < 0.0001), while an improvement in those parameters after isotretinoin cessation was observed (p = 0.006, p = 0.02 and p = 0.0003, respectively). The frequency of using artificial eye drops was positively associated with MGL during (Spearman's rank correlation coefficient (Rs) = + 0.31; p = 0.03) and after the cessation of the therapy (Rs = + 0.28; p = 0.04). Meibomian gland atrophy correlated significantly with MQS during (Rs = + 0.29; p = 0.04) and after treatment (Rs = + 0.38; p = 0.008). The decrease in TFBUT values correlated with increased LAS (Rs = - 0.31; p = 0.03) during the course of isotretinoin usage. We found no changes in Schirmer's test or blink rates. CONCLUSION Isotretinoin therapy leads to increased ocular complaints related to lipid tear film component dysfunction. This is due to reversible changes in meibomian gland morphology and function observed during drug usage.
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Affiliation(s)
- Aleksandra Zakrzewska
- First Department of Ophthalmology, Pomeranian Medical University, Al. Powstańców Wlkp. 72, 70-111, Szczecin, Poland
| | - Marta P Wiącek
- First Department of Ophthalmology, Pomeranian Medical University, Al. Powstańców Wlkp. 72, 70-111, Szczecin, Poland
| | | | - Krzysztof Safranow
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Al. Powst. Wlkp. 72, 70-111, Szczecin, Poland
| | - Anna Machalińska
- First Department of Ophthalmology, Pomeranian Medical University, Al. Powstańców Wlkp. 72, 70-111, Szczecin, Poland.
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Tosun M, Bozali E, Yalınbaş Yeter D, Apa AS. Analysis of corneal topographic and densitometric properties in patients receiving systemic isotretinoin therapy. Cutan Ocul Toxicol 2023; 42:19-24. [PMID: 36433791 DOI: 10.1080/15569527.2022.2152042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate dry eye parameters, corneal topographic features, corneal densitometric changes, and anterior segment parameters in patients receiving systemic isotretinoin treatment. METHODS This prospective cross-sectional study included 66 eyes of 33 patients who were started on oral isotretinoin therapy for severe acne vulgaris. All patients were evaluated in terms of ocular surface tests such as tear break-up time (TBUT) and Schirmer-1 and were asked to fill in the ocular surface disease index (OSDI) questionnaire. Corneal densitometric and topographic measurements were obtained using the Scheimpflug imaging system. RESULTS The mean age of the patients was 19.9 ± 1.6 years, and 21 (63.6%) of the participants were female. The mean OSDI score was significantly higher in the third month than before treatment (20.05 ± 19.38, vs. 26.96 ± 22.94, p = 0.00, respectively). The mean values of the TBUT test were significantly lower in the third month than before treatment (9.06 ± 4.40 sec, vs. 10.71 ± 4.61 sec, p = 0.02, respectively). Mean scores of the Schirmer 1 test showed no statistically significant difference between before treatment and the third month (16.08 ± 8.40 mm, vs. 16.08 ± 8.50 mm, p = 1, respectively). There was no statistically significant difference between before treatment and the third month in the majority of the densitometry measurements in concentric zones. However, the difference tended to be significant between the groups concerning posterior zone 0-2 mm (11.01 ± 0.85 GSU vs. 10.62 ± 0.89 GSU, p = 0.006). The RMS LOAs (front), RMS Total (Total), RMS LOAs Total (Total), RMS HOAs Total (Total), Kmax, CCT, and CoV values were significantly higher in the third month than before treatment (p < 0.05 for all). CONCLUSIONS The dermatology specialists should be aware of the ocular complications of systemic isotretinoin therapy. Therefore, a complete ophthalmologic examination for the prompt apprehension and management of ocular involvement is essential in patients under isotretinoin therapy to increase ocular comfort and adherence to the therapy.
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Affiliation(s)
- Mustafa Tosun
- Department of Dermatology, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | - Erman Bozali
- Department of Ophthalmology, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | - Duygu Yalınbaş Yeter
- Department of Ophthalmology, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | - Anıl Selim Apa
- Department of Ophthalmology, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Turkey
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Eom Y, Song JS, Kim HM. Effectiveness of Topical Cyclosporin A 0.1%, Diquafosol Tetrasodium 3%, and Their Combination, in Dry Eye Disease. J Ocul Pharmacol Ther 2022; 38:682-694. [PMID: 36473191 DOI: 10.1089/jop.2022.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose: To compare the effectiveness of the topical use of cyclosporin A (CsA) 0.1%, diquafosol (DQS) tetrasodium 3% ophthalmic solution, and their combination in treating dry eye disease in a general health care setting. Methods: This prospective, nonrandomized, observational study analyzed 279 patients. Patients instilled topical CsA 0.1% (Ikervis®; Santen Pharmaceutical Co., Ltd., Japan) once daily and/or DQS tetrasodium 3% (Diquas-S®; Santen) six times a day for 12 weeks. Objective signs [tear break-up time (TBUT), National Eye Institute (NEI) corneal and conjunctival staining scores] and symptoms [Symptom Assessment in Dry Eye (SANDE) and Dry Eye-related Quality-of-Life Score (DEQS) questionnaires] were evaluated at baseline, week 4, and week 12. Results: Patients (n = 279) were mainly female (85.0%) with a mean (SD) age of 50.1 (14.8) years, and received CsA (n = 93), DQS (n = 99), or CsA/DQS (n = 87). Both monotherapies and CsA/DQS combination therapy significantly improved TBUT, NEI corneal and conjunctival staining scores, and SANDE and DEQS scores from baseline to week 12 (all P < 0.0001). The mean change in TBUT between baseline and week 12 was significantly higher in CsA/DQS combination therapy (2.13 ± 2.41 s) than in CsA monotherapy (1.07 ± 1.71 s; P = 0.0011). Conclusions: Monotherapy with CsA or DQS and CsA/DQS combination therapy all significantly improved the objective signs and symptoms of dry eyes during 12 weeks of treatment. CsA/DQS combination therapy provides an additional benefit in terms of TBUT compared with CsA alone; however, a randomized controlled trial still needs to be performed to confirm this result.
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Affiliation(s)
- Youngsub Eom
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea.,Department of Ophthalmology, Korea University Ansan Hospital, Gyeonggi-do, South Korea
| | - Jong Suk Song
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea.,Department of Ophthalmology, Korea University Guro Hospital, Seoul, South Korea
| | - Hyo Myung Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea.,Department of Ophthalmology, Korea University Anam Hospital, Seoul, South Korea
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Zhang P, Tian L, Bao J, Li S, Li A, Wen Y, Wang J, Jie Y. Isotretinoin Impairs the Secretory Function of Meibomian Gland Via the PPARγ Signaling Pathway. Invest Ophthalmol Vis Sci 2022; 63:29. [PMID: 35353124 PMCID: PMC8976919 DOI: 10.1167/iovs.63.3.29] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Purpose To investigate the effects of isotretinoin on the ocular surface and to explore the possible mechanisms. Methods Rats were treated with isotretinoin 20 mg/kg/d for five months and tested monthly for tear secretion, fluorescein staining, and infrared photography. After five months of treatment, tissues were harvested for routine staining to evaluate the morphological changes; and real-time polymerase chain reaction, Western blot, and immunohistochemistry to study the expression of associated genes and their products such as forkhead box protein O1 (FoxO1), forkhead box protein O3, peroxisome proliferator–activated receptor γ (PPARγ), adipose differentiation–related protein, elongation of very long chain fatty acids protein 4, fatty acid binding protein 4, matrix metalloproteinase-9, and interleukin-6. Results Systemically, isotretinoin-treated rats have a significantly lower body weight that controls and apparent skin damage. Locally, although there was no alteration in tear secretion, a significant corneal involvement indicated by increased fluorescein staining scores, and also the contrast of meibomian gland was significantly reduced but no significant atrophy of the acinus was found. In addition, isotretinoin causes a decrease in conjunctival goblet cells. Furthermore, isotretinoin treatment did not cause the upregulation of FoxO1 and inflammation related genes but significantly suppressed the expression of PPARγ pathway. Conclusions Isotretinoin does not cause a significant atrophy of the acinus and a significant change of FoxO1 expression in the meibomian gland. Isotretinoin causes meibomian gland dysfunction, affecting meibocyte differentiation and qualitative and quantitative changes in the meibum, through PPARγ pathway.
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Affiliation(s)
- Peng Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing, China
| | - Lei Tian
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing, China
| | - Jiayu Bao
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing, China
| | - Shang Li
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing, China
| | - Ao Li
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing, China
| | - Ya Wen
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing, China
| | - Jingyi Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing, China
| | - Ying Jie
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing, China
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