Abstract:AIM: To investigate the changes in ocular surface-related indicators and tear matrix metalloproteinase-9(MMP-9)levels in diabetic patients complicated with meibomian gland dysfunction(MGD), analyze the effects of diabetes mellitus on ocular surface status and tear MMP-9 levels in patients with MGD, and provide evidence for clinical diagnosis and treatment.
METHODS: Prospective observational study.Patients with type 2 diabetes mellitus complicated with MGD who visited the Department of Ophthalmology of the hospital from June 2024 to December 2024 were enrolled(diabetes mellitus+MGD group), and patients diagnosed solely with MGD without a history of diabetes mellitus during the same period were recruited as the non-diabetic MGD group. Patients in the diabetes mellitus+MGD group were further subdivided into aglycosylated hemoglobin(HbA1c)<7.5% subgroup and an HbA1c≥7.5% subgroup based on HbA1c levels, and into a diabetes duration<10 y subgroup and a diabetes duration ≥10 y subgroup according to the duration of diabetes mellitus. Multiple ocular surface parameters, including the Ocular Surface Disease Index(OSDI)score and eyelid margin alteration score, as well as tear MMP-9 concentration, were measured in all participants, followed by between-group comparative analyses.
RESULTS:Total of 101 patients(202 eyes)with type 2 diabetes mellitus combined with MGD were enrolled, including 56 males and 45 females with a mean age of 60.2±8.5 y. The non-diabetic MGD group consisted of 151 patients(302 eyes), with 82 males and 69 females and a mean age of 57.5±7.8 y.The HbA1c <7.5% group comprised 55 patients(110 eyes)aged 59.6±8.2 y; 31 males and 24 females. The HbA1c ≥7.5% group included 46 patients(92 eyes)aged 60.9±8.7 y; 25 males and 21 females.The subgroup with diabetes duration <10 y had 50 patients(100 eyes)aged 58.7±8.1 y; 28 males and 22 females, and the subgroup with duration ≥10 y consisted of 51 patients(102 eyes)aged 61.6±8.4 y; 27 males and 24 females. Patients in diabetes mellitus+MGD group exhibited higher OSDI scores, meibomian gland orifice scores, meibum expressibility scores, meibum quality scores, corneal fluorescein staining scores, and tear MMP-9 levels compared with non-diabetic MGD patients(all P<0.01), while tear film breakup time(BUT)and Schirmer test values were lower(all P<0.01).Among diabetic patients with MGD, the HbA1c≥7.5% subgroup had significantly higher OSDI score, meibomian gland orifice score, meibum expressibility scores, meibum quality scores, corneal fluorescein staining scores, and tear MMP-9 concentration than the HbA1c<7.5% subgroup(all P<0.05), accompanied by significantly shorter BUT and lower Schirmer I test results(all P<0.05). Similarly, the diabetes duration≥10 y subgroup showed significantly higher OSDI score, meibomian gland orifice score, meibum expressibility scores, meibum quality scores, corneal fluorescein staining scores, and tear MMP-9 concentration compared with the diabetes duration<10 y subgroup(all P<0.05), whereas BUT and Schirmer I values were significantly lower(all P<0.05).
CONCLUSION: Diabetes mellitus may be associated with aggravated ocular surface damage in patients with MGD, accompanied by elevated tear MMP-9 levels. Poor glycemic control and longer disease duration are related to more severe ocular surface injury and higher tear MMP-9 levels. Tear MMP-9 may serve as a potential indicator for evaluating ocular surface inflammation and damage in diabetic patients with MGD, providing certain evidence for clinical treatment decision-making.
