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Morphology of the Meibomian gland evaluated using meibography in patients with hypohidrotic ectodermal dysplasia
Morfología de las glándulas de Meibomio valorada por meibografía en pacientes con displasia ectodérmica hipohidrótica
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Genéticamente presentan DEH con herencia recesiva ligada al sexo. a) Varón de 52 años, DEH. OD. b) Mujer de 47 años, DEH portadora. OD. c) Varón de 17 años, DHE. OD.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.D. Romero-Caballero, I. Lozano-García, A. Caravaca-Alegría, S. Gómez-Rivera" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M.D." "apellidos" => "Romero-Caballero" ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Lozano-García" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Caravaca-Alegría" ] 3 => array:2 [ "nombre" => "S." 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Left: central oval-shaped epithelial defect, upper paracentral leukomas with neovascular plumes. Right: positive fluorescein corneal staining in stromal bed of epithelial defect in the same patient.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F. Pérez-Bartolomé, D. Mingo Botín, E. de Dompablo, P. de Arriba, F. Arnalich Montiel, F.J. Muñoz Negrete" "autores" => array:6 [ 0 => array:2 [ "nombre" => "F." "apellidos" => "Pérez-Bartolomé" ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Mingo Botín" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "de Dompablo" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "de Arriba" ] 4 => array:2 [ "nombre" => "F." "apellidos" => "Arnalich Montiel" ] 5 => array:2 [ "nombre" => "F.J." 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Lozano-García, A. Caravaca-Alegría, S. Gómez-Rivera" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M.D." "apellidos" => "Romero-Caballero" "email" => array:1 [ 0 => "mdromero@um.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "I." "apellidos" => "Lozano-García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Caravaca-Alegría" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "S." 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Ectodermic dysplasia with sex-linked recessive inheritance. (a) mother carrying ectodermic dysplasia. RE. (b) daughter carrying HED. LE.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Ectodermal dysplasias constitute rare diseases arising from the abnormal formation of tissue derived from embryo ectoderm, i.e., skin, teeth, hair, nails, sweat and sebaceous glands. Hypohidrotic ectodermal dysplasia (HED) or Christ-Siemens-Touraine syndrome is the most frequent. In most cases, HED is due to X-linked recessive inheritance. This genetic alteration induces mutations in a gene that codes ectodisplasin, a transmembrane protein involved in ectodermal morphogenesis.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">1</span></a> The diagnostic triad comprises hypohydrosis, hypotrichosis and hypodontics. In the skin, sweat gland dysfunction limits the ability to regulate body temperature through sweat. At the ocular level, Meibomian gland agenesia or dysgenesia causes these patients to develop evaporative dry eye from early childhood.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Meibomian glands are sebaceous glands that provide lipidic components to the lacrimal film. They are located inside the tarsal plate and under normal conditions the number of glandular acini is greater in the upper tarsus (30–40) than in the lower tarsus (20–30). Said glands are derived from the embryonary ectoderm through growth of basal epithelium cells located in the palpebral margin towards the interior of the tarsal plate. Patients with HED exhibit aplasia or hypoplasia of Meibomian glands due to the absence of specific signals required for their development and differentiation.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Even though the functionality of Meibomium glands has not yet been related to the total number of acini, it is known that the progressive atrophy thereof produces qualitative and quantitative changes in gland secretion that could compromise the stability of the lacrimal tear and induce ocular surface alterations.</p><p id="par0020" class="elsevierStylePara elsevierViewall">At present, some topographers have included infrared light in their equipment to enable the visualization of Meibomium glands in the tarsus in order to capture and subsequently analyze the Images.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">3</span></a> Infrared meibography allows ophthalmologists to assess the architecture of the Meibomium glands and evaluate atrophy of glandular acini.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The objective of the present study was to study the morphology of Meibomium glands by means of infrared meibography in a group of patients genetically diagnosed with HED and compare said morphology with a control group without pathology.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">A transversal and comparative study between groups. The first group was formed by 14 eyes of 7 patients, 4 females and 3 males, all diagnosed as carriers of the HED gene. Participants were members of 3 families, 2 of which exhibited sex-related recessive inheritance and the third had dominant autosomal inheritance with the gene in heterozygosis.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The second (control) group included 32 eyes of 16 patients, 9 females and 7 males. Inclusion criteria for this group were normal OSDI, tear breakup time–BUT– >10<span class="elsevierStyleHsp" style=""></span>s, Schirmer test >10<span class="elsevierStyleHsp" style=""></span>mm at 5<span class="elsevierStyleHsp" style=""></span>min and fluorescein and green lysine within normal ranges. The study excluded patients with palpebral pathologies, allergic conjunctivitis, usual contact lens users, under habitual or systemic topical treatment that could alter the lacrimal film and those who underwent ophthalmological surgery in the last 6 months.</p><p id="par0040" class="elsevierStylePara elsevierViewall">All the patients had a meibographic study with the CA-800 corneal analyzer by Topcon<span class="elsevierStyleSup">®</span>. This topographer with placido disc technology includes an ocular surface module with meibography due to its 4 infrared LEDs. After palpebral eversion, infrared meibographs of the upper and lower tarsal glands of both eyes were taken for subsequent analysis. In 4 young participants, only the lower image was captured due to poor cooperation.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The meibograph enables the assessment of glandular atrophy degree by means of the 5- grade meibographic scale published by Pult et al.,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">4</span></a> i.e., grade 0 signifies no alterations in the Meibomian glands, grade 1 is gland acini compromise of <25%, grade 2 is atrophy between 25 and 50% of the glandular parenchyma, grade 3 between 51–75% and grade 4 represents an alteration >75% (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Gland atrophy grade in each eye was calculated after assessing the atrophy grade of the upper and lower eyelids and taking the mean value excepting 4 patients in which the gland atrophy grade was measured in the lower eyelid for that eye. All meibographs were classified by a single examiner in order to minimize measurement bias in the variable being studied.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The Helsinki protocol was fulfilled, obtaining informed consents of all patients and that of their parents in the case of under age subjects.</p><p id="par0060" class="elsevierStylePara elsevierViewall">A descriptive statistic of both groups was utilized for statistical analysis and the Mann–Whitney nonparametric U test was applied for inter-group comparison, considering a significance level of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">In the group of HED patients, comprising 14 eyes of 7 patients (57% females and 43% males), the mean age was 23<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>19 years. All the patients in this group exhibited some degree of glandular parenchyma atrophy. Overall, 57% (8 of 14) had severe atrophy of gland acini >75%, in meibography scale grade 4. In addition, 35.8% (5 of 14) had grades 3 and 7.2% (1 of 14) had grade 2 (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). None of the patients in this group exhibited meibography grade 0 or 1. The central measure of glandular atrophy grade in patients with HED according to Pult's meibography scale was 3 – median – with a range between 1 and 4.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">In the control group, comprising 32 eyes of 16 subjects without pathology (56.25% females and 43.75% males) with a mean age of 21.36<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9 years, the distribution in glandular atrophy grades was as follows: 62.5% did not exhibit any compromise, with grade 0 of the meibography scale, 28.1% had grade 1 and 9.4% grade 2. None of the control group subjects exhibited grade 3 or 4 of the meibography scale. The central glandular atrophy grade measure in patients without pathology according to the meibography scale was 0 – median – with a range between 0 and 2.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Statistically significant differences were found between the control group and the group of patients with HED (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.000) in the comparison for the glandular atrophy grade. No significant differences were found between both groups in what concerns age and sex.</p><p id="par0080" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRefs" href="#fig0015">Figs. 3–5</a> show meibographs of one eye -upper and lower eyelid- of patients belonging to 3 different families, all with HED.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">At present, Meibomian gland dysfunction (MGD) is defined as the chronic and diffuse alteration of Meibomium glands, characterized by terminal obstruction of ducts and/or qualitative or quantitative changes in gland secretion.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">5</span></a> Said chronic alteration of Meibomian glands induces progressive atrophy of gland acini that can be evaluated by means of meibography.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Kaercher<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a> published the most extensive ophthalmological review of patients with HED, and MGD was present in 95.5%, being in addition the most frequent ophthalmological expression followed by periorbital pigmentation and eyebrow anomalies (94.4%). The study by Keklikci<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">7</span></a> found periorbital pigmentation and eyebrow anomalies as the first ocular expression (88.9%), whereas intraoperative dry eye symptoms accounted for 47% of cases. In the present study, 100% of patients with HED exhibited some grade of gland atrophy in the meibography scale against 37.5% of control group subjects who also exhibited gland atrophy.</p><p id="par0095" class="elsevierStylePara elsevierViewall">It must be borne in mind that the methodological criteria for classifying MGD were different: in the present study, that utilized infrared meibography for diagnosing the grade of gland atrophy whereas the previous studies were based on signs obtained from slit lamp examinations. Accordingly, as previous studies did not use meibography, it is likely that said pathology was undervalued.</p><p id="par0100" class="elsevierStylePara elsevierViewall">In a recent paper, Kaercher referred that infrared meibography is a diagnostic technique featuring 100% sensitivity and specificity for diagnosing patients with suspected HED and is superior to other technologies like thermography, NIBUT, osmolarity, Schirmer and OSDI among others).<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a> And even though a genetic study is necessary for diagnostic confirmation when HED is clinically suspected, the ease with which meibography can be carried out makes this technology useful in places where genetic studies are not available or results are being processed for patients with characteristic signs of the disease as yet unconfirmed by genetic testing.</p><p id="par0105" class="elsevierStylePara elsevierViewall">According to Viso<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">9</span></a> the prevalence of asymptomatic MGD in the population of Spain over 40 years of age is of 22%. However, they did not apply meibography in their diagnosis. The present study found 37.5% of young asymptomatic patients exhibiting some grade of gland atrophy (grade >0). The methodological and epidemiological differences of the present study as well as the small number of patients could explain said results. However, they do express the large variability exhibited by said glands in the young healthy population.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">10,11</span></a> Other studies that utilized the meibography grade scale for evaluating asymptomatic MGD found higher prevalence in healthy adults as well as in paediatric populations.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">12,13</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">In general, the disease presents in patients with HED with recessive inheritance linked to sex. Accordingly, women are carriers of the disease, with highly variable expressions of the healthy chromosome (<a class="elsevierStyleCrossRefs" href="#fig0015">Figs. 3b, 4a and b</a>). In contrast, the only chromosome that expresses in males is affected by the disease and for this reason it becomes fully manifest (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>a and c). When inheritance is dominant autosomal, if the affected gene is heterozygotic the phenotypic expression is also highly variable between subjects (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>).</p><p id="par0115" class="elsevierStylePara elsevierViewall">Even though in 92.8% of patients with HED the present study found marked gland parenchyma atrophy evaluated with meibography (meibographic scale grades 3 and 4), it is worthy pointing out that males with X-linked inheritance exhibit more gland atrophy severity and accordingly have higher risk of evaporative dry eye requiring close follow-up and early treatment.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Additional studies also reported Meibomium glands agenesia/dysgenesia observed through meibography in genetic diseases associating alterations of tissue derived from embryonary ectoderm such as the ectrodactyly syndrome, ectodermic dysplasia and cleft palate –EED–<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">14,15</span></a> or lamellar ichthyosis.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">16</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Therapeutic management of evaporative dry eye secondary to HED should include the use of lipidic artificial tears and creams on demand. It must be taken into account that mainly children do not spontaneously report dry eye symptoms such as feeling of roughness, itching, tearing, blurred vision or photophobia, a fact that increases the importance of regular checkups. It is also essential to educate families about the chronic nature of symptoms and the importance of controlling environmental factors such as limiting the use of computer screens, humidification of dry environments, inclusion of omega-3 fatty acids in diets, among others. The possibility of genetic counselling in reproductive age is essential and future developments for treatment give rise to the possibility of using the epidermic growth factor for the activation and development of sweat glands and other ectodermic derivates.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">17</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">By way of conclusions, the authors wish to emphasize the importance of infrared meibography as an adequate diagnostic method to evaluate the grade of gland atrophy both in healthy populations and ectodermic dysplasia patients, even though in the latter group of patients genetic confirmation is always necessary to provide genetic counselling in reproductive age. The ease with which infrared meibography can be carried out, its considerable dissemination and inclusion in latest generation topographers (Keratograph<span class="elsevierStyleSup">®</span>, Sirius<span class="elsevierStyleSup">®</span>, Antares<span class="elsevierStyleSup">®</span> and others) can help patients with HED and their families to understand the importance of Meibomian glands dysfunction and accordingly to establish adequate treatment since the early asymptomatic stages of the disease in order to improve the visual prognosis of these children.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interests</span><p id="par0135" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1173010" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1097143" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1173009" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1097144" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interests" ] 9 => array:2 [ "identificador" => "xack400929" "titulo" => "Acknowledgments" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-09-10" "fechaAceptado" => "2018-12-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1097143" "palabras" => array:3 [ 0 => "Hypohidrotic ectodermal dysplasia" 1 => "Meibography" 2 => "Meibomian gland dysfunction" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1097144" "palabras" => array:3 [ 0 => "Displasia ectodérmica hipohidrótica" 1 => "Meibografía" 2 => "Disfunción de glándulas de Meibomio" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hypohidrotic ectodermal dysplasia (HED) is a rare disease that results from the abnormal development of the ectodermal germ layer in early embryogenesis. In these patients, hypoplasia of Meibomian glands is one of the most frequent ophthalmological manifestations.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The main aim of this study is to evaluate the usefulness of meibography for the morphology of Meibomian glands in a group of patients with HED, and to compare it with a control group.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 14 eyes of 7 patients diagnosed with HED were included, and 32 eyes of 16 patients were included as a control group. The meibographic study was carried out using CA-800 Corneal Analyser (Topcon<span class="elsevierStyleSup">®</span>). Grading of images was assessed by a meibomian gland atrophy score: grade 0, no alterations; grade 1, ≤25% gland atrophy; grade 2, 25% to 50% gland atrophy; grade 3, 51% to 75% gland atrophy; and grade 4 >75% gland atrophy.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Both groups were compared using the Mann–Whitney U non-parametric test.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">All patients with HED showed some degree of gland atrophy, with 57% showing severe atrophy (>75% of gland atrophy), 35.8% with a grade 3, and 7.2% grade 2. The mean grade of glandular atrophy in HED was 3 (1–4).</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">In the control group, 62.5% had no involvement (grade 0), with 28.1% showing grade 1 and 9.4% grade 2 gland atrophy. The mean glandular atrophy grade within the control group was 0 (0–2). There were statistically significant differences between both groups.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Meibography is a simple diagnostic tool that allows to differentiate between patients without disease and those with HED.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La displasia ectodérmica hipohidrótica (DEH) es una enfermedad rara caracterizada por la anormal formación de los tejidos derivados del ectodermo. La hipoplasia de las glándulas de Meibomio es una de las manifestaciones oftalmológicas más frecuentes en estos pacientes.</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se planteó estudiar la morfología de las glándulas de Meibomio mediante meibografía en un grupo de pacientes con DEH y compararlo con un control.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 14 ojos de 7 pacientes diagnosticados de DEH. Y un grupo control con 32 ojos de 16 pacientes. Se les realizó un estudio meibográfico mediante el analizador corneal CA-800 de Topcon®. Se usó una escala meibográfica para valorar el grado de atrofia glandular. Grado 0, sin alteraciones, grado 1 afectación < 25% de ácinos glandulares, grado 2 atrofia entre el 25 y 50%, grado 3, entre el 51-75% y grado 4, alteración > 75%. En la comparación estadística se utilizaron los test no paramétricos de Mann-Whitney.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Todos los pacientes con DEH mostraron algún grado de afectación. El 57% presentó atrofia severa > 75%. El 35,8% presentó un grado 3 y el 7,2% grado 2. El grado medio de atrofia glandular en DEH fue de 3 (rango 1-4).</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">En el grupo control el 62,5% no presentaron afectación alguna, grado 0. El 28,1% grado 1 y el 9,4% un grado 2. El grado medio de atrofia glandular fue de 0 (0,2). Se encontraron diferencias estadísticamente significativas entre los grupos.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">La meibografía es una prueba diagnóstica sencilla que permite diferenciar entre pacientes sanos y con DEH.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Romero-Caballero MD, Lozano-García I, Caravaca-Alegría A, Gómez-Rivera S. Morfología de las glándulas de Meibomio valorada por meibografía en pacientes con displasia ectodérmica hipohidrótica. Arch Soc Esp Oftalmol. 2019;94:165–170.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2725 "Ancho" => 1451 "Tamanyo" => 244884 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Gland atrophy measured with the meibographic scale.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 704 "Ancho" => 1295 "Tamanyo" => 50169 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Percentage distribution of gland atrophy grade according to meibographic scale in patients with ectodermic dysplasia –HED– and the control group.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2194 "Ancho" => 2174 "Tamanyo" => 263726 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">First family comprising 2 brothers and the son of the woman. Genetically they exhibit HED with sex-linked recessive inheritance. (a) male, 52, HED. RE. (b) female, 47, HED carrier. RE. (c) male, 17, DHE. RE.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1086 "Ancho" => 1500 "Tamanyo" => 130495 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Second family comprising mother and daughter. Ectodermic dysplasia with sex-linked recessive inheritance. (a) mother carrying ectodermic dysplasia. RE. (b) daughter carrying HED. LE.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1544 "Ancho" => 1250 "Tamanyo" => 117325 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Third family comprising 2 siblings (male and female). Ectodermic dysplasia with dominant autosomic inheritance and heterozygosis gene. (a) female, 16, HED. RE. (b) male, 13, HED. 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