Topical diquafosol for patients with obstructive meibomian gland dysfunction

Abstract

Aims: To evaluate the effect of topical diquafosol in patients with meibomian gland dysfunction (MGD) using tear film parameters and quantitatively analyse the meibomian gland morphology.

Subjects and methods: The subjects were 19 eyes of 10 patients diagnosed with obstructive MGD. All subjects were given 3% diquafosol ophthalmic solution with instructions to use one drop four times a day. Ocular symptoms were scored from 0 to 14. Lid margin abnormalities were scored from 0 to 4. Changes in the meibomian glands were scored using non-contact meibography (meiboscore). Superficial punctate keratopathy (SPK) was scored from 0 to 3. Meibum was graded from 0 to 3. Tear film production was evaluated by Schirmer's test. Quantitative image analysis of the meibomian glands was performed using the original software.

Results: 10 patients completed more than 4 months of therapy. Ocular symptoms, lid margin abnormalities, SPK score and meibum grade were decreased. Break-up time and tear film meniscus were increased. Mean ratio of the meibomian gland area was significantly increased after treatment (p<0.0001).

Conclusions: Quantitative image analysis was useful for evaluating the morphological changes of the meibomian glands. Topical diquafosol therapy was effective for patients with obstructive MGD.

Figure 1

Meibomian gland area measurement process. (A) Original meibography image. (B) Border for the analysis was manually determined. (C) Separate meibomian glands within the total analysis area were manually detected. (D) After the binarised meibomian glands were separated as independent closed curves, our original software labelled each meibomian gland and calculated the area of the closed meibomian glands. The ratio of the meibomian gland area relative to the total analysis area was then calculated.

Figure 2

Representative case of a 66-year-old woman with obstructive meibomian gland dysfunction (case #5). (A) Lid margin vascularity and pluggings of the orifices were observed before therapy. (B) Tear meniscus height was very low (0.1 mm). (C) Lid margin vascularity and pluggings of the orifices decreased after 8 months of therapy. (D) Tear meniscus height was increased (0.3 mm).

Figure 3

Changes in meibomian gland area before and after Diquas treatment. Changes in meibomian gland area were significantly increased after the Diquas treatment in the upper and lower eyelids.

Figure 4

Quantitative image analysis of the meibomian glands before and after therapy with topical diquafosol in case #2. (A and B) Meibomian gland area was 22.0% before therapy. (C and D) Meibomian gland area had increased to 31.6% after 4 months of therapy with topical diquafosol.