Deng Yuqing, Ling Lirong, Luo Zhongzhou, Xu Ruiwen, Zhang Yimin, Yu Kang, Li Jijing, Zhang Tingting, Hu Xiaoqing, Xiao Peng, Yuan Jin
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China.
Quant Imaging Med Surg. 2024 Aug 1;14(8):5610-5620. doi: 10.21037/qims-24-379. Epub 2024 Jul 26.
Meibomian gland dysfunction (MGD), one of the most common ocular surface diseases, can induce dry eye and reduce patients' quality of life. Methodological limitations have resulted in contradictory interpretations of gland function. This study sought to investigate the correlation between meibography signal intensity (SI) and meibomian gland (MG) function and to validate an MGD classification strategy based on different levels of SI.
A multicenter, cross-sectional analysis was conducted on 817 eyes from 361 patients with MGD and 52 healthy controls. Additionally, 78 eyes from 39 patients with MGD who had undergone LipiFlow treatment were recruited for longitudinal analyses. The SI value was obtained via meibography using an automated analyzer, and all participants underwent ocular surface examinations. A cross-sectional analysis was performed to determine SI distribution and its relationship to clinical characteristics via a generalized estimating equation model. Longitudinal analyses were conducted on the treatment cohort using a mixed-effects model to explore the outcome in different SI levels.
Regression analysis revealed significant correlations between SI and lipid layer thickness (β=0.016), meibum expressibility (β=-0.676), meibum quality (β=-0.251), and fluorescein-stained tear-film break-up time (FBUT) (β=0.064) (all P values <0.001 for the above associations). Low-level SI MGD cases exhibited the most severe clinical signs, including the worst meibum expressibility (16% for level 3) and quality scores (19% for level 3), the shortest FBUT (3.82±0.13 s), and the thinnest lipid layer (65.68±2.58 nm), (all P values <0.05, respectively). Patients with medium SI showed the lowest ocular surface disease index (OSDI) value (26.64±1.06), the longest FBUT (4.56±0.08 s), and the thickest lipid layer (80.20±2.90 nm). After treatment, the high SI values reduced significantly at each follow-up point compared to baseline (all P values <0.05). The medium SI group demonstrated the greatest improvement in symptoms and signs, followed by the high SI group, and the low SI group.
Automated measurements of SI can effectively reflect MG secretory activity. The proposed low, medium, and high SI classifications represent different functional subtypes of MGD.
睑板腺功能障碍（MGD）是最常见的眼表疾病之一，可导致干眼并降低患者生活质量。方法学上的局限性导致对腺体功能的解释相互矛盾。本研究旨在探讨睑板腺造影信号强度（SI）与睑板腺（MG）功能之间的相关性，并验证基于不同SI水平的MGD分类策略。
对361例MGD患者的817只眼和52名健康对照者进行多中心横断面分析。此外，招募了39例接受LipiFlow治疗的MGD患者的78只眼进行纵向分析。使用自动分析仪通过睑板腺造影获得SI值，所有参与者均接受眼表检查。通过广义估计方程模型进行横断面分析，以确定SI分布及其与临床特征的关系。对治疗队列使用混合效应模型进行纵向分析，以探索不同SI水平的结果。
回归分析显示SI与脂质层厚度（β=0.016）、睑脂排出能力（β=-0.676）、睑脂质量（β=-0.251）和荧光素染色泪膜破裂时间（FBUT）（β=0.064）之间存在显著相关性（上述关联的所有P值均<0.001）。低水平SI的MGD病例表现出最严重的临床体征，包括最差的睑脂排出能力（3级为16%）和质量评分（3级为19%）、最短的FBUT（3.82±0.13秒）和最薄的脂质层（65.68±2.58纳米）（所有P值均<0.05）。中等SI的患者眼表疾病指数（OSDI）值最低（26.64±1.06）、FBUT最长（4.56±0.08秒）和脂质层最厚（80.20±2.90纳米）。治疗后，与基线相比，各随访点的高SI值均显著降低（所有P值均<0.05）。中等SI组症状和体征改善最大，其次是高SI组和低SI组。
SI的自动测量可有效反映MG的分泌活性。所提出的低、中、高SI分类代表了MGD的不同功能亚型。
