Arita Reiko, Itoh Kouzo, Maeda Syuji, Maeda Koshi, Furuta Ayumu, Fukuoka Shima, Tomidokoro Atsuo, Amano Shiro
Itoh Clinic, Saitama, Japan.
Ophthalmology. 2009 Nov;116(11):2058-63.e1. doi: 10.1016/j.ophtha.2009.04.037. Epub 2009 Sep 10.
To compare clinical findings between patients with obstructive meibomian gland dysfunction (MGD) and normal controls and to propose diagnostic criteria for obstructive MGD.
Cross-sectional, observational case series.
Fifty-three eyes of 53 patients (18 men, 35 women; age [mean +/- standard deviation] 71.4 +/- 10.0 years) who were diagnosed with obstructive MGD and 60 eyes of 60 healthy volunteers (22 men, 38 women; 71.0 +/- 9.3 years) as a control group.
Ocular symptoms were scored from 0 to 14 according to the number of existing symptoms. Lid margin abnormality was scored from 0 to 4 depending on the number of existing abnormalities. Meibomian gland changes were scored from 0 to 6 based on noncontact meibography (meibo-score). Superficial punctuate keratopathy (SPK) was scored from 0 to 3. Meibum was graded from 0 to 3 depending on the volume and quality. Tear film production was evaluated by Schirmer's test. Receiver operating characteristic curves with calculations of area under the curve (AUC) were used to describe the accuracy of each parameter to differentiate obstructive MGD from normal eyes.
Ocular symptom score, lid margin abnormality score, meibo-score, meibum score, SPK score, tear film breakup time (BUT), and the Schirmer value.
Ocular symptom score, lid margin abnormality score, meibo-score, meibum score, and SPK score were significantly higher in the obstructive MGD group than in the control group (P<0.0001 for all scores). The BUT was significantly shorter in the obstructive MGD group than in the control group (P<0.0001). The AUC values indicated that the ocular symptom score had the highest diagnostic power as a single parameter, followed by the lid margin abnormality score, meibo-score, and BUT.
Based on these findings, we recommend that physicians use the ocular symptom score, lid margin abnormality score, and meibo-score to diagnose MGD. Obstructive MGD should be suspected when any 2 of the 3 scores are abnormal. Obstructive MGD is very likely when all 3 scores are abnormal.
比较阻塞性睑板腺功能障碍（MGD）患者与正常对照者的临床特征，并提出阻塞性MGD的诊断标准。
横断面观察性病例系列研究。
53例被诊断为阻塞性MGD患者的53只眼（男性18例，女性35例；年龄[均值±标准差]71.4±10.0岁），以及60例健康志愿者的60只眼（男性22例，女性38例；71.0±9.3岁）作为对照组。
根据现有症状数量，眼部症状评分为0至14分。根据睑缘异常数量，睑缘异常评分为0至4分。基于非接触式睑板腺造影（睑板腺评分），睑板腺变化评分为0至6分。浅层点状角膜炎（SPK）评分为0至3分。根据睑脂的量和质，睑脂分级为0至3级。通过泪液分泌试验评估泪膜分泌情况。采用计算曲线下面积（AUC）的受试者工作特征曲线来描述各参数区分阻塞性MGD与正常眼的准确性。
眼部症状评分、睑缘异常评分、睑板腺评分、睑脂评分、SPK评分、泪膜破裂时间（BUT）和泪液分泌试验值。
阻塞性MGD组的眼部症状评分、睑缘异常评分、睑板腺评分、睑脂评分和SPK评分显著高于对照组（所有评分P<0.0001）。阻塞性MGD组的BUT显著短于对照组（P<0.0001）。AUC值表明，眼部症状评分作为单一参数时诊断能力最高，其次是睑缘异常评分、睑板腺评分和BUT。
基于这些发现，我们建议医生使用眼部症状评分、睑缘异常评分和睑板腺评分来诊断MGD。当这三个评分中的任意两个异常时，应怀疑为阻塞性MGD。当三个评分均异常时，阻塞性MGD的可能性很大。
