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2012 OMIG Abstract 11

In Vivo Confocal Microscopy in Meibomian Gland Dysfunction (MGD): A Clinical Tool for Profiling Conjunctival Immune Cellular Changes
Y. Qazi¹, B. Cavalcanti¹, A. Cruzat¹, C. Williams¹, M. Trinidad¹, C.A. Blackie², D.R. Korb³, P. Hamrah^1,4
1Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA; ²Tear Science, Morrisville, NC; ³Korb and Associates, Boston, MA; ⁴Immune Disease Institute, Harvard Medical School, Boston, MA

Purpose: To quantifiably profile the palpebral conjunctival immune cellular changes in MGD.

Methods: 22 eyes with MGD and 10 healthy eyes were analyzed retrospectively. Patients were diagnosed with MGD based on clinical slit-lamp examination (SLE) for assessment of the ocular surface and tear-film break-up time (TBUT). Following SLE, all subjects received in vivo confocal microscopy (IVCM) of the palpebral conjunctiva on both eyes of the patients, and on one eye of controls. IVCM images were analyzed for immune cells identified as hyper-reflective dendritiform and non-dendritiform cells in the palpebral conjunctival epithelium, substantia propria and meibomian glands. Image selection criteria included visualization of region of interest (depth of focus: 1-100 µm), good contrast of anatomical structures and cells and lack of motion artifacts. Three images per parameter per eye were analyzed using ImageJ. Student’s t-test and Pearson’s correlation coefficient were used for statistical analysis.

Results: In healthy individuals, immune cells were found in all layers of the palpebral conjunctiva (epithelium and substantia propria), and occasionally within some meibomian glands. However, as compared to healthy, asymptomatic controls, patients with MGD had 57% greater conjunctival epithelial immune cells (EIC; 576 ± 285 vs. 248 ± 260 cells/ mm², p=0.01) and significant increase in intraglandular immune cells (IGIC; 50 ± 21% vs. 21 ± 21%, p=0.007). In patients with MGD, there was no statistically significant difference between both eyes for EIC (p=0.3) and IGIC (p=0.5). Both parameters demonstrated inverse correlation with TBUT (EIC, r=-0.33, p<0.01; IGIC, r=-0.31, p<0.01).

Conclusions: IVCM allows detection of immune cellular changes in the palpebral conjunctiva, demonstrating significant increase in immune cells in MGD as compared to controls. Further, we demonstrate, for the first time, the presence of immune cells within meibomian glands in vivo. Imaging parameters for immune cells may thus serve as biomarkers for inflammation and disease severity in MGD.

Disclosure: NIH K08-EY020575 (PH), Research to Prevent Blindness Career Development Award (PH), Falk Medical Research Foundation (PH)

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