In vivo confocal microscopy assessment of meibomian glands microstructure in patients with Graves’ orbitopathy

Abstract Background: To evaluate microstructural changes in the meibomian glands (MGs) in patients with active and inactive Graves’ orbitopathy (GO), using in vivo confocal microscopy (IVCM), and to investigate the correlations between clinical and confocal findings.Methods: Forty patients (80 eyes) with GO (34 eyes with active GO, 46 eyes with inactive GO), and 31 age- and sex-matched control participants (62 eyes) were enrolled consecutively. Each participant completed an Ocular Surface Disease Index (OSDI) questionnaire and underwent a full eye examination, including assessments of clinical activity score (CAS), proptosis, palpebral fissure height (PFH), lagophthalmos, lipid layer thickness (LLT), partial blinking rate, noninvasive first breakup time (NIF-BUT), average breakup time (NIAvg-BUT), tear film breakup area (TBUA), corneal fluorescein staining (CFS), Schirmer I Test (SIT), meibum quality and MG expressibility. IVCM of the MGs was performed to determine the MG acinar density (MAD), MG longest and shortest diameters (MALD and MASD), MG orifice area (MOA), MG acinar irregularity (MAI), meibum secretion reflectivity (MSR), acinar wall inhomogeneity (AWI), acinar periglandular interstices inhomogeneity (API), and severity of MG fibrosis (MF).Results: All parameters demonstrated statistically significant differences among groups (all P＜0.05), except OSDI, LLT and NIAvg-BUT (P＞0.05). Compared to controls, GO groups showed lower MOA and MAD; greater MALD and MASD; and higher degrees of MAI, MSR, AWI, API, and MF (all P＜0.05). Eyes with active GO had higher degrees of MAI, AWI, and API, while eyes with inactive GO had higher degrees of MSR and MF (all P＜0.05). In GO groups, the two measured confocal signs of inflammation (AWI and API) were significantly correlated with CAS, proptosis, PFH, lagophthalmos, OSDI, NIF-BUT, CFS, SIT, meibum quality, and MG expressibility (all P＜0.05). MF was significantly correlated with CAS, OSDI, meibum quality, and MG expressibility (all P＜0.05). Conclusions: IVCM effectively revealed microstructural changes of MGs in eyes with GO and provided strong in vivo evidence for the roles of obstruction and inflammation in the ocular surface disease process. Furthermore, it revealed discernible patterns of MG abnormalities in eyes with active GO and inactive GO, which are not easily distinguishable by typical clinical examinations.

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In vivo confocal microscopy assessment of meibomian glands microstructure in patients with Graves’ orbitopathy

BMC Ophthalmology ◽

10.1186/s12886-021-02024-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shengnan Cheng ◽

Yueqi Yu ◽

Jin Chen ◽

Lin Ye ◽

Xinghua Wang ◽

...

Keyword(s):

Confocal Microscopy ◽

Ocular Surface ◽

Disease Process ◽

Clinical Activity ◽

In Vivo Confocal Microscopy ◽

Orifice Area ◽

Microstructural Changes ◽

Graves Orbitopathy ◽

Meibomian Glands

Abstract Background To evaluate microstructural changes in the meibomian glands (MGs) in patients with active and inactive Graves’ orbitopathy (GO), using in vivo confocal microscopy (IVCM), and to investigate the correlations between clinical and confocal findings. Methods Forty patients (80 eyes) with GO (34 eyes with active GO, 46 eyes with inactive GO), and 31 age- and sex-matched control participants (62 eyes) were enrolled consecutively. A researcher recorded the clinical activity score (CAS) for each patient. A complete ophthalmic examination was then performed, including external eye, ocular surface and MGs. IVCM of the MGs was performed to determine the MG acinar density (MAD), MG longest and shortest diameters (MALD and MASD), MG orifice area (MOA), MG acinar irregularity (MAI), meibum secretion reflectivity (MSR), acinar wall inhomogeneity (AWI), acinar periglandular interstices inhomogeneity (API), and severity of MG fibrosis (MF). Results All confocal microscopy assessments of MGs significantly differed among groups (all P = 0.000). Compared to controls, GO groups showed lower MOA (1985.82 ± 1325.30 μm2 in active GO and 2021.59 ± 1367.45 μm2 in inactive GO vs. 3896.63 ± 891.90 μm2 in controls, all P = 0.000) and MAD (87.21 ± 32.69 /mm2 in active GO and 80.72 ± 35.54 /mm2 in inactive GO vs. 114.69 ± 34.90 /mm2 in controls, P = 0.001 and 0.000, respectively); greater MALD (118.11 ± 30.23 μm in active GO and 120.58 ± 27.64 μm in inactive GO vs. 58.68 ± 20.28 μm in controls, all P = 0.000) and MASD (44.77 ± 19.16 μm in active GO and 46.02 ± 20.70 μm in inactive GO vs. 27.80 ± 9.90 μm in controls, all P = 0.000); and higher degrees of MAI, MSR, and MF (all P<0.05). Eyes with active GO had higher degrees of MAI (P = 0.015), AWI (P = 0.000), and API (P = 0.000), while eyes with inactive GO had higher degrees of MSR (P = 0.000) and MF (P = 0.017). In GO groups, AWI and API were positively correlated with CAS (r = 0.640, P = 0.000; r = 0.683, P = 0.000, respectively), and MF was negatively correlated with CAS (r = − 0.228, P = 0.042). Conclusions IVCM effectively revealed microstructural changes of MGs in eyes with GO and provided strong in vivo evidence for the roles of obstruction and inflammation in the ocular surface disease process. Furthermore, it revealed discernible patterns of MG abnormalities in eyes with active GO and inactive GO, which are not easily distinguishable by typical clinical examinations.

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IN VIVO CONFOCAL MICROSCOPY FOR STUDYING CORNEAL DISEASES/CONDITIONS ASSOCIATED WITH CORNEAL NERVE DAMAGE AND OCULAR SURFACE DISEASE.

Cornea ◽

10.1097/00003226-200011002-00196 ◽

2000 ◽

Vol 19 (Supplement 2) ◽

pp. S131

Author(s):

T Tervo ◽

T U Valle ◽

J AO Moilanen ◽

M E Rosenberg ◽

I SJ Tuominen ◽

...

Keyword(s):

Confocal Microscopy ◽

Ocular Surface ◽

Nerve Damage ◽

Ocular Surface Disease ◽

In Vivo Confocal Microscopy ◽

Corneal Nerve

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An in vivo confocal microscopy study of corneal changes in patients with systemic sclerosis

Scientific Reports ◽

10.1038/s41598-021-90594-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Eszter Szalai ◽

Gabriella Szucs ◽

Szilvia Szamosi ◽

Zsuzsa Aszalos ◽

Ildiko Afra ◽

...

Keyword(s):

Systemic Sclerosis ◽

Confocal Microscopy ◽

Ocular Surface ◽

Healthy Subjects ◽

Ocular Surface Disease ◽

Nerve Plexus ◽

In Vivo Confocal Microscopy ◽

Software Analysis ◽

Subbasal Nerve Plexus

AbstractTo investigate corneal microstructure of systemic sclerosis (SSc) patients using in vivo confocal microscopy (IVCM). 33 patients with SSc and 30 age-matched healthy subjects were recruited. All participants underwent comprehensive ophthalmic examination including IVCM (Heidelberg Retina Tomograph III, Heidelberg Engineering GmbH, Heidelberg, Germany) and ocular surface evaluation. Subbasal nerve plexus morphology was investigated using automated software analysis (ACCMetrics V3; University of Manchester, Manchester, UK). Keratocyte cell densities in the anterior stroma were significantly lower in patients with SSc compared to controls (P < 0.0001). In 7 SSc patients no keratocyte nuclei were identified in the anterior stroma and in most patients scattered hyperreflective punctate material were observed in the anterior stroma. Significantly lower subbasal nerve fiber parameters were found in patients with SSc compared to healthy subjects (P < 0.05). There were no significant correlations between the duration of SSc and any of the corneal cell density values. Tear break-up time values (4.82 ± 3.15 s) and Ocular Surface Disease Index scores (33.27 ± 30.11) were abnormal, Schirmer values (6.78 ± 5.82 mm) were borderline in SSc patients. In SSc, corneal morphological changes and accumulation of punctate material in the stroma was detected with confocal microscopy. Severe ocular surface disease was observed in SSc patients with significant impairment in subbasal nerve plexus morphology resembling peripheral neuropathy.

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