In vivo confocal microscopy evaluation of meibomian gland dysfunction in atopic-keratoconjunctivitis patients.

PURPOSE: To clarify meibomian gland (MG) alterations in atopic keratoconjunctivitis (AKC) patients and compare the findings with obstructive MG dysfunction (MGD) patients and control subjects using in vivo confocal microscopy (CM). DESIGN: Prospective, controlled, single-center study. PARTICIPANTS: Twelve AKC patients (10 males, 2 females; mean age, 31.0±16.5 years), 12 obstructive MGD patients (7 males, 5 females; mean age, 37.6±5.6 years), and 26 control subjects (13 males, 13 females; mean age, 32.9±5.7 years) were recruited. No significant age or gender differences were observed between the 3 groups. METHODS: All subjects underwent assessment of tear evaporation rate from the ocular surface (TEROS), slit-lamp examinations, tear break-up time (BUT) measurements, vital staining, Schirmer test I, meibography, MG expressibility, and CM examination of the MG (HRTII-RCM). Statistical analysis was performed using the Mann-Whitney test. MAIN OUTCOME MEASURES: The MG acinar unit density, inflammatory cell density, MG acinar unit longest diameter, MG acinar unit shortest diameter, and MG acinar unit area as observed by in vivo CM, MG drop-out, MG expressibility grading, tear stability, tear evaporation, and vital staining scores. RESULTS: The TEROS values, mean BUT, vital staining scores, MG expressibility, and MG dropout grades were significantly worse in AKC patients compared with those in obstructive MGD patients and controls (P<0.05). The mean values of the CM parameters in AKC patients were significantly worse than those observed in the obstructive MGD patients and controls (P<0.001). CONCLUSIONS: Changes in MG in AKC patients seem to be more severe than in patients with obstructive MGD and controls. In vivo CM is a noninvasive, efficient tool in the assessment of MG status and ocular surface disease in AKC.

The efficacy, sensitivity, and specificity of in vivo laser confocal microscopy in the diagnosis of meibomian gland dysfunction.

PURPOSE: To evaluate the efficacy, sensitivity and specificity of confocal microscopy (CM) parameters: meibomian gland (MG) acinar longest diameter (MGALD), MG acinar shortest diameter (MGASD), inflammatory cell density (ICD), and MG acinar unit density (MGAUD) in the diagnosis of MG dysfunction (MGD). DESIGN: Prospective, controlled, single-center study. PARTICIPANTS: Twenty MGD patients (9 males, 11 females; mean age, 63.5+/-16.5 years) and 26 age- and gender-matched control subjects (13 males, 13 females; mean age, 53.2+/-15.7 years) were recruited. METHODS: All subjects underwent slit-lamp examinations, tear film break-up time (BUT) measurements, assessment of tear evaporation rate from the ocular surface (TEROS), vital stainings, Schirmer test, meibography, MG expressibility, and CM of the MG. Data were compared between the 2 groups using the Mann-Whitney and chi-square tests. MAIN OUTCOME MEASURES: The correlation between the clinical findings of tear functions, vital staining scores, and the 4 CM parameters were tested by Spearman's correlation coefficient by rank test. Receiver operating characteristic curve technique was used to evaluate the sensitivity, specificity, and cutoff values of CM parameters. RESULTS: The mean tear film BUT, vital staining scores, TEROS values, MG expressibility, and MG dropout grades by meibography were significantly worse in MGD patients compared with controls (P<0.001). The mean values of the MGALD, MGASD, ICD, and MGAUD in MGD patients were significantly worse than those observed in the controls with CM. All CM parameters showed a strong, significant correlation with tear functions, ocular surface vital stainings, MG expressibility, and MG dropout grades. The cutoff values for MGALD, MGASD, ICD, and MGAUD in the diagnosis of MGD were 65 microm, 25 microm, 300 cells/mm2, and 70 glands/mm2, respectively. The sensitivity and specificity values of these parameters under these cutoff values were 90% and 81% for MGALD, 86% and 96% for MGASD, 100% and 100% for ICD, 81% and 81% for MGAUD. CONCLUSIONS: Confocal microscopy has the potential to diagnose the simple MGD with high sensitivity and specificity. The CM-based diagnostic parameters correlated significantly and strongly with the status of the ocular surface disease. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Evaluation of conjunctival inflammatory status by confocal scanning laser microscopy and conjunctival brush cytology in patients with atopic keratoconjunctivitis (AKC).

PURPOSE: To elucidate the status of the conjunctival inflammation in atopic keratoconjunctivitis (AKC) using laser scanning confocal microscopy and compare the relevant findings with conjunctival brush cytology in a prospective controlled study. METHODS: Twenty eyes from 20 AKC patients as well as 16 eyes from 16 age and sex matched normal subjects were studied. The subjects underwent tear film break-up time (BUT), fluorescein and Rose Bengal staining of the ocular surface, conjunctival confocal microscopy, Schirmer test, and brush cytology. Brush cytology specimens and in vivo confocal microscopy scans underwent evaluation for inflammatory cell densities. RESULTS: Brush cytology specimens and in vivo confocal microscopy scans from AKC patients revealed significantly higher numbers of inflammatory cells (p<0.05). Conjunctival inflammatory cell density showed a negative correlation with tear stability and a positive correlation with vital staining scores and conjunctival injection grades. The extent of conjunctival inflammation assessed by in vivo confocal microscopy showed a strong positive linear correlation with the inflammation status evaluated by brush cytology. The corneal inflammatory cell density assessed by in vivo confocal microscopy showed a significant negative correlation with tear stability and a positive linear correlation with corneal fluorescein staining. CONCLUSIONS: Confocal scanning laser microscopy is an efficient, noninvasive, and a promising tool for the quantitative assessment of conjunctival inflammation, a parameter of this new technology which correlated well with subjective and objective ocular surface clinical findings.

Corneal in vivo confocal scanning laser microscopy in patients with atopic keratoconjunctivitis.

OBJECTIVE: To elucidate the morphologic alterations of the cornea in atopic keratoconjunctivitis (AKC) using confocal microscopy (Heidelberg Retina Tomograph II-Rostock Cornea Module: HRT-II RCM). DESIGN: Prospective comparative study. PARTICIPANTS: We studied 21 right eyes of 21 AKC patients (11 males, 10 females; mean age, 26.3 years) as well as 19 right eyes of 19 normal subjects (12 males, 7 females; mean age, 28.4 years). METHODS: All subjects underwent corneal sensitivity measurements, Schirmer test, tear film break-up time, fluorescein and Rose Bengal stainings, and HRT-II confocal laser scanning microscopy of the central cornea. MAIN OUTCOME MEASURES: The epithelial and endothelial cell densities of the central cornea, the density of subbasal long nerve fibers (LNFs) and total nerve branches (NBs) of the subbasal nerve plexus were calculated. The morphologic characteristics of the corneal nerves were studied. Correlation between nerve density, tear functions, and ocular surface examination parameters were investigated. RESULTS: The corneal sensitivity, tear stability and vital staining scores were significantly worse in eyes with AKC (P<0.01). Eyes with AKC showed a significantly lower density of basal epithelial cells, LNFs, and NBs compared with normal eyes. Nerve fiber abnormalities such as increased tortuosity, bifurcation abnormality, sharp deflections, and thickening of stromal nerves, as well as several inflammatory cells in close proximity of the subbasal and stromal nerve fibers were observed. CONCLUSIONS: The corneal disease in AKC was associated with significant alterations of the basal epithelium, and subbasal and stromal corneal nerves, which related to the changes in tear functions and corneal sensitivity. Confocal scanning laser microscopy was useful to study the pathological in vivo corneal changes in AKC.

Conjunctival in vivo confocal scanning laser microscopy in patients with atopic keratoconjunctivitis.

PURPOSE: To elucidate the morphological alterations of the conjunctiva in atopic keratoconjunctivitis (AKC) using the new generation Heidelberg Retina Tomograph II (HRT II)/Rostock Cornea Module confocal microscope in a prospective controlled study. METHODS: Sixteen eyes from AKC patients (eight males, mean age: 20.3+/-5.9 years) were treated with 0.05% topical cyclosporine A (CsA) in addition to topical steroid and anti-allergic eye drops and 12 eyes from patients with AKC were treated using topical steroids and anti-allergic drops (six males, mean age: 22.2+/-10.0 year). These two groups, as well as 14 eyes from normal subjects (six males, one female, average age 30.4+/-6.8 years) were studied. All subjects underwent corneal sensitivity measurements, the Schirmer test, tear film break-up time (BUT), fluorescein, Rose Bengal staining of the ocular surface, and confocal laser scanning microscopy of the tarsal palpebral conjunctiva. The density of conjunctival inflammatory infiltrates was calculated. Morphological characteristics of the papillary lesions were also studied. RESULTS: Corneal sensitivity, tear stability, and vital staining scores were significantly worse in patients with AKC compared to control subjects (p<0.01). Eyes of AKC patients using CsA showed a significantly lower density of inflammatory infiltrates compared to eyes on topical steroid and anti-allergic drops. Conjunctival inflammatory cell density showed a negative correlation with tear stability and corneal sensitivity and a positive correlation with the vital staining scores. Papillary lesions revealed remarkable fibrosis in patients using CsA. CONCLUSIONS: Confocal scanning laser microscopy was an efficient and a noninvasive tool for the quantitative assessment of the conjunctival inflammation and evaluation of pathological alterations in the papillary lesions and their relation to the ocular surface disease in patients with AKC.