Meibomian gland atrophy in Keratoconus: A case-control study

Abstract

Purpose

To assess the Meibomian Gland Atrophy (MGA) in keratoconus patients by comparison to healthy controls.

Setting

French Keratoconus national reference center, Bordeaux, France.

Design

Observational, monocentric, comparative case control study.

Methods

Eighty-eight keratoconic eyes free of any surgical treatment (KC group) and 88 healthy eyes (NKC group) matched for age and gender, included from December 2018 to May 2019, underwent infrared meibography providing a meiboscore of MGA (primary outcome measure), scaled from 0 to 6. Secondary outcomes including Lipid Layer Thickness (LLT) assessment using interferometry, Tear Break-Up Time (T-BUT) evaluated by a slit lamp examination, corneal OCT-based topography, and two dry eye questionnaires (OSDI and SPEED) filled by the patients during the consultation.

Results

A significant difference in distribution of meiboscore scores between groups (p < 0.0001 for total, superior and inferior meiboscore) was found, with lower scores in controls compared to eyes with keratoconus. Using a cut-off value of ≥2 as abnormal meiboscore, 64.8% of eyes of cases had abnormal meiboscore by comparison to only 27.3% of controls (OR, 4.91; 95%CI, 2.56 to 9.38). Patients with keratoconus had higher OSDI (mean difference 15.3, 95%CI 1.8 to 1.7) and SPEED (mean difference 2.5, 95%CI 2.5 to 4.5) results. No significant difference was found in T-BUT whereas keratitis was more common in cases.

Conclusion

Keratoconus was associated with higher meibomian gland atrophy in this study.