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Steven L Maskin, Sreevardhan Alluri; An Alternative Hypothesis of Atrophic Meibomian Gland Dysfunction Using Stem Cell Concept. Invest. Ophthalmol. Vis. Sci. 2020;61(7):343.
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© ARVO (1962-2015); The Authors (2016-present)
To propose an alternative new hypothesis, using the stem cell deficiency concept, for development of atrophic Meibomian gland dysfunction (MGD) based on new understandings of the frequency of periductal fibroses and possible deleterious effect on putative stem cells within the external duct wall with resultant atrophy of acinar-ductule units.
260 gland ducts from central third of 79 upper lids of 40 arbitrarily selected patients with obstructive MGD were examined using confocal microscopy volume imaging to evaluate presence and frequency of periductal fibroses. From this group, meibography videos of 32 upper lids from 16 patients were reviewed to evaluate 378 cumulative glands from central 8mm of the lid to assess and document acinar-ductule atrophy within the distal 1mm with possible correlation to periductal fibroses. IBM SPSS version 25 software was used to run descriptive and statistical analysis for significance (p≤ 0.05).
252 (96.9%) glands showed signs of periductal fibroses, often invading the external duct wall. Additional signs of inflammation on confocal microscopy include changes in rete ridges showing 138 (56%) with advanced, and 111 (42.7%) variable atrophy at the dermal epidermal junction while 3 (1.2%) glands showed none. Other findings included decreased thickness and neovascularization of the duct wall. From this group of 79 upper lids, there were 32 lids (16 patients (average age: 58 years (±14.7), M:F 5:11)) with additional infrared meibography. 1 lid was not considered for meibography analysis due to lack of clear visibility of distal part of the lid. Inspection of distal 1mm of 378 centrally located glands on meibography revealed 281 (74.5%) with atrophic changes and 17 of 32 lids showed signs of cystic acinar deformity. A positive correlation was observed between % atrophy and % periductal fibrosis as per non-parametric Spearman’s rho correlation test (p=0.036).
Periductal fibroses of the meibomian glands is often characterized by disruption and invasion of external duct wall, decreased wall thickness, and occasional neovascularization of duct wall. Such changes are correlated with meibomian gland atrophy and may represent localized stem cell deficiency.
This is a 2020 ARVO Annual Meeting abstract.
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