| Objective: To investigate the changes of meibomian gland structure and function in patients with type 2 diabetes mellitus(DM)and its effect on ocular surface.To analyze the relationship between the structural function of the meibomian glands and the abnormality of ocular surface and the severity of diabetic retinopathy in type 2 diabetic patients.Materials and methods: This study collected 128 patients with type 2 diabetes who had been diagnosed from September 2016 to September 2017 as a trial group.130 cases of cataract patients(excluding diabetes)at the same time period as a control group.The age of the patients in the experimental group ranged from 49 to 68 years old,with an average age of(57.68 ± 8.27)years,including 65 males and 63 females.The duration of diabetes is between 15 and 20 years,with an average of 17.64 years.The age of the control group ranged from 51 to 70 years old,with an average age of(58.27 ± 6.95)years,including 62 males and 68 females.The basic data of the above two groups were not statistically significant(P>0.05).Ask all the selected subjects for basic information,conduct an Ocular Surface Disease Index(OSDI)survey,and perform the following ocular surface related examinations for both groups: including the observation of the meibomian gland opening under the slit lamp,scored;Select 5 glands in the central region of the meibomian gland for analysis of occlusion status,evaluation criteria for meibomian gland: All five glands in the center have a non-occlusion rate of 0 points,and the number of glands that are secreted is 1 point between 3 and 4,and the number of glands that are secreted is 2 points between 1 and 2.The glandular gland is secreted by 3 points.using the Keratograph 5M ocular surface analyzer to examine tear height(Tear meniscus height,TMH),non-invasive tear breakup time(NI-BUT),non-contact infrared sacral gland photography The model(meibography)was used to observe the loss of the meibomian gland area and score and grade;The degree of meibomian gland loss was expressed by the meibomian gland loss area score,and the calculated index was: 0: no glandular loss;1 point: glandular loss ≤ 1/3 total area of meibomian glands;2 points : 1/3 < gland missing area ≤ 2 / 3 total area of meibomian glands;3 points: area of gland missing > 2 / 3 total area of meibomian glands.Each eye is scored separately.Meibomian gland grading: According to the total score of the upper and lower meibomian glands in each eye,the grading is performed,with a maximum of 6 points.Level 0: 0 points;Level 1: 1～2 points;Level 2: 3～4 points;Level 3: 5～6 points.The total score grade ≥ 1 is the meibomian gland loss.The traits of the secretion of the meibomian gland after extrusion were observed under the slit lamp and scored.Meibomian gland opening secretion traits scoring standard: 0 points: transparent clear and non-viscosity liquid decyl ester;1 point: turbid yellow liquid decyl ester;2 points: turbid granular semi-solid oxime ester;3 points: thick ester such as toothpaste or even fat plug.All patients are examined by the same experienced observer.The results of the right eye of all subjects were selected for statistical analysis.The ocular surface symptom score,tear height,non-invasive tear film rupture time,meibomian gland loss area score classification,and secretion traits were compared between the experimental group and the control group.Abnormal score,glandular gland occlusion degree score.According to the International Clinical Staging Standard for Diabetic Retinopathy(2002),the patients in the experimental group were divided into three groups: NDR group,41 eyes;NPDR group,45 eyes.PDR group,42 eyes,and explore the relationship between the above indicators and the degree of diabetic retinopathy.Results: 1.The OSDI score of the patients in the experimental group was(25.12±12.24),which was significantly higher than that of the control group(11.12±8.48)based on the test level of P<0.05,the difference was statistically significant(Z=-6.018 and P<0.001).2.Keratograph 5M ocular surface comprehensive analyzer showed that the tear river height test group(0.15±0.05)was significantly lower than the control group(0.28±0.02),the difference was statistically significant(Z=3.251 and P<0.001);the test group patients The NI-BUT was(3.86 ± 2.60 s),which was significantly shorter than that of the control group(8.96 ± 4.74 s).The difference was statistically significant(Z =-7.632,P < 0.001);59.37% of patients in the experimental group had sputum Plate gland loss was significantly higher than that of the control group (38.46%);the test group patients with meibomian gland loss area score was significantly higher than the control group,the meibomian gland loss increased,the difference was statistically significant(Z=-3.865 and P<0.01).3.The slit lamp examination results showed that the meibomian gland opening obstruction score test group(1.89±0.87)was significantly higher than the control group(0.84±0.72),the difference was statistically significant(Z=-8.413 and P<0.001);the experimental group The sputum gland secretion trait score was(1.46 ± 0.68)was also significantly higher than the control group(0.82 ± 0.63),the difference was statistically significant(Z =-8.761 and P < 0.001).4.The effect of the degree of diabetic retinopathy on the above indicators: OSDI score did not show a significant increase or decrease with the progression of diabetic retinopathy,the difference between the three groups was not statistically significant(Z = 3.018,P>0.01),and the height of the tear river gradually decreased with the progression of diabetic retinopathy,the difference was statistically significant(Z=-8.151 and P<0.01),and the NI-BUT became obvious as the disease progressed.Shorted,the difference was statistically significant(Z=-8.176 and P<0.01).The proportion of meibomian gland loss increased,including 42.86% in the NDR group,66% in the NPDR group,and 75.61% in the PDR group;the meibomian gland loss area score gradually increased.Conclusion: 1.The proportion of abnormal morphology and function of meibomian glands in patients with type 2 diabetes is significantly higher than that of non-diabetic patients.The incidence of ocular surface symptoms and ocular surface damage is also much higher than that of non-diabetic patients.Compared with non-diabetic patients,the symptoms of dry eye in diabetic patients are more severe.2.As the degree of diabetic retinopathy worsens,the objective examination indicators of the ocular surface are gradually aggravated,but the patient’s self-conscious symptoms are not aggravated. |
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