Fu Jiayu, Chou Yilin, Hao Ran, Jiang Xiaodan, Liu Yushi, Li Xuemin
Department of Ophthalmology, Peking University Third Hospital, Beijing, P.R. China.
Medicine (Baltimore). 2019 Aug;98(31):e16547. doi: 10.1097/MD.0000000000016547.
This study aimed to propose a comprehensive grading scale to evaluate different clinical manifestations in patients with varying severity of meibomian gland dysfunction (MGD) and analyze the correlations between the parameters of ocular surface impairment in MGD.A total of 63 patients with MGD were enrolled. Ten specific symptoms were evaluated each with a subjective score and total score was applied to grade the severity of MGD. Thirty-seven patients were diagnosed with mild, 19 with moderate, and 7 with severe MGD. Slit-lamp and keratography were used to assess the signs of ocular surface and meibomian gland (MG). In vivo confocal microscopy (IVCM) was performed to evaluate the corneal nerves and dendritic cells. The differences and correlations between symptoms, signs, and IVCM parameters were analyzed.Dryness, foreign body sensation, asthenopia, and photophobia were the most common and severe symptoms in our patients. The severe MGD group showed worse MG expressibility, Meibum score, Meiboscore, MG score, and higher nerve reflectivity (P < .05). The mild MGD group showed higher nerve density (P < .05). Total symptom score was negatively correlated with nerve density (r = -0.374, P < .05), while positively correlated with nerve reflectivity and dendritic cell density (r = 0.332 and 0.288, respectively, P < .05). MG score was correlated with nerve reflectivity (r = 0.265, P < .05).The comprehensive grading scale was suitable for evaluating clinical manifestations in MGD of varying severity. The relationship between the specific symptoms, signs, and IVCM results concerning whole ocular surface impairment could help elucidate MGD pathophysiology and benefit evaluation or treatment in the future.
本研究旨在提出一种综合分级量表，以评估睑板腺功能障碍（MGD）不同严重程度患者的不同临床表现，并分析MGD患者眼表损伤参数之间的相关性。共纳入63例MGD患者。评估了10种特定症状，每种症状采用主观评分，总评分用于对MGD的严重程度进行分级。37例患者被诊断为轻度MGD，19例为中度，7例为重度。使用裂隙灯和角膜地形图评估眼表和睑板腺（MG）的体征。进行活体共聚焦显微镜检查（IVCM）以评估角膜神经和树突状细胞。分析症状、体征和IVCM参数之间的差异及相关性。干眼、异物感、视疲劳和畏光是我们患者中最常见和严重的症状。重度MGD组的MG排出能力、睑脂评分、睑板腺评分、MG评分更差，神经反射率更高（P<0.05）。轻度MGD组的神经密度更高（P<0.05）。总症状评分与神经密度呈负相关（r=-0.374，P<0.05），而与神经反射率和树突状细胞密度呈正相关（分别为r=0.332和0.288，P<0.05）。MG评分与神经反射率相关（r=0.265，P<0.05）。该综合分级量表适用于评估不同严重程度MGD的临床表现。关于整个眼表损伤的特定症状、体征和IVCM结果之间的关系有助于阐明MGD的病理生理学，并为未来的评估或治疗提供帮助。
