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Abstract
Purpose
To demonstrate that the meibomian gland ductal basement membrane and basal epithelial cell layer are in continuity with and may derive from lid margin orifice-associated rete ridge epithelial/basement membrane structures (OARREBS) and to characterize changes in the distal duct microanatomy after meibomian gland probing (MGP) using in vivo confocal microscopy (IVCM).
Patients and Methods
Pre/post-MGP IVCM examinations were performed on upper lids. Thirty-six identical glands from 20 lids of 16 patients (49.24 ±17.11 y/o with 13:3 F:M) were identified, analyzed, and compared to control cases. Statistical analyses were performed using ImageJ software and IBM SPSS version 27. All MGPs were performed within 12 weeks of the initial examination. Post-MGP follow-up exams occurred at 5.03 ±4.48 months.
Results
Post-MGP images showed more superficially organized OARREBS with accelerated and more superficial basement membrane formation, and an average increase of 32.2%, 25.4%, 32.04%, 77.7%, and 81.3% in duct wall epithelial cell layers (DWECL) (p < 0.001, compared to control (CTC) p < 0.001), distal duct wall thickness (DWT) (p < 0.001, CTC p < 0.001), proximal DWT (p < 0.001, CTC p < 0.001), distal lumen area (p < 0.001, CTC p = 0.037), and proximal lumen area (p < 0.001, CTC p = 0.007), respectively. The increase in the distal DWT and lumen area correlated with the months of follow-up (p = 0.004 and p = 0.010, respectively). Immediate post-MGP imaging revealed the probe track confined to the ductal epithelial compartment.
Conclusion
MGP appears to stimulate a proliferative epithelial response characterized by an accelerated more superficial formation of ductal basement membrane with increased DWECL as well as DWT and lumen area at two separate duct foci. These findings suggest activation of lid margin meibomian gland precursor cells and confirm that MGP stimulates an epithelial regenerative phenomenon, not a fibrotic one.
Abbreviations
MG, meibomian gland; MGP, meibomian gland probing; o-MGD, obstructive meibomian gland dysfunction; OARREBS, orifice-associated rete ridge epithelial/basement membrane structures; RR, rete ridge; DWECL, duct wall epithelial cell layers; DWT, duct wall thickness; IVCM, in vivo confocal microscopy; PDF, periductal fibrosis.
Data Sharing Statement
All data relevant to the study are included in the article.
Ethics Approval and Informed Consent
This research, involving the collection and study of existing data and documents, was recorded by the investigator in such a manner that subjects could not be identified directly or through identifiers linked to them. This study received an institutional review board exempt review determination by WCG IRB, an independent institutional review board.
Author Contributions
SLM and CT planned and conducted the study, analyzed the data, as well as drafted and revised manuscript. CT performed statistical analysis. SLM is guarantor. All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
SLM is the owner (>5% stock holder) of MGD Innovations, Inc., which holds patents on instrumentation and methods for intraductal diagnosis and treatment of meibomian gland disease (MGD), and related patents on the use of jojoba-based treatment options for MGD. The authors report no other conflicts of interest in this work.