Long Term Follow Up After Submandibular Gland Transplantation In Severe Dry Eyes Secondary To Cicatrising Conjunctivitis

Abstract

Purpose: : To present the longterm follow–up results after autologous submandibular gland (SMG) transplant in eyes with cicatrising conjunctivitis.

Methods: : Forty–four eyes (35 patients) received an autologous SMG transplant. We retrospectively identified a cohort of 14 patients with a severe aqueous tear deficiency due to cicatrising conjunctivitis of various origin. Best corrected visual acuity, frequency of tear substitute instillation and severity of dry eye discomfort were recorded and lid margin erythema, conjunctival injection, corneal epithelial oedema, Fluorescein–Break–up time, Schirmer tests as well as corneal Fluoresceine and conjunctival Rose Bengal staining were evaluated. Central corneal thickness and sensitivity, barrier function of the corneal epithelium, type and extent of conjunctival and lid margin flora and conjunctival impression cytology were determined in a subgroup of 7 patients. Paired samples of salivary tears and normal SMG saliva were analyzed for viscosity, surface tension and presence of mucins.

Results: : SMG transplantation in patients with absolute dry eyes resulted in a significant improvement of subjective parameters (i.e. pharmaceutical tear substitute instillations preOP 59±47, five years postOP 2.4±3.6), tear film parameters (i.e. Schirmer–Test preOP 2.2±4.6 mm/5min, five years postOP 27.8±22.8mm/5min) and some ocular surface parameters (i.e. Fluoresceine staining score preOP 2.4±1.0, five years postOP 1.7±1.1).

Conclusions: : The indication for autologous SMG transfer remains limited to very severe cases of keratoconjunctivitis sicca. Whilst it does not offer a chance for direct or indirect visual rehabilitation, it is able to provide symptomatic relief to individuals suffering from severe pain due to absolute tear deficiency in blinding conditions such as Stevens–Johnson–Syndrome.

Keywords: cornea: tears/tear film/dry eye