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E. Villani, M. De Capitani, S. Beretta, D. Galimberti, F. Viola, V. Canton, R. Sala, R. Ratiglia; In vivo Confocal Microscopy of Meibomian Glands in Sjogren’s Syndrome. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3386.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the morphological changes of the meibomian glands and the status of periglandular inflammation in patients with primary (SSI) and secondary (SSII) Sjogren’s syndrome by in vivo confocal microscopy and to investigate the correlations between clinical and confocal findings.
Twenty patients with SSI, 25 with SSII, 20 with meibomian gland disease (MGD) and 20 age- and gender-matched control subjects were consecutively enrolled. Each partecipant completed an Ocular Surface Disease Index questionnaire and underwent a full eye exam (including BUT, fluorescein and lissamine green staining, and Schirmer test) and a laser confocal microscopy examination of the meibomian glands (to study acinar unit density and diameter, meibum secretion reflectivity, atrophic and fibrotic changes and inflammatory cells density in basal epithelium, interstitium and glandular epithelium).
All the clinical and confocal parameters showed statistical significant differences among the groups (P<0.001, Kruskal Wallis test). Confocal microscopy showed no differences between SSI and SSII (Mann-Whitney U test).Compared to control subjects, SS meibomian glands showed higher periglandular inflammation and secretion reflectivity and more evident atrophic and fibrotic changes (P<0.001, Mann-Whitney U test).Compared to MGD, SS meibomian glands had higher acinar density, smaller diameter, higher density of periglandular inflammatory cells and lower secretion reflectivity (P<0.001, Mann-Whitney U test).In SS patients, the 3 considered confocal signs of inflammation were significantly interrelated and correlated with corneal fluorescein staining (P≤0.01, Spearman). Acinar density and diameter were strongly correlated between them (P<0.001) and with BUT (P<0.05).
In vivo laser confocal microscopy can effectively demonstrate morphological and inflammatory changes of meibomian glands. In SS patients, the most evident alterations are inflammatory and fibrotic findings, with characteristics easily differentiable from MGD.
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