Long-Term Follow-up after Submandibular Gland Transplantation in Severe Dry Eyes Secondary to Cicatrizing Conjunctivitis

• Published in: American journal of ophthalmology 2010-12, Vol.150 (6), p.894-904
• Main Authors: Borrelli, Maria, Schröder, Christina, Dart, John K.G, Collin, John Richard O, Sieg, Peter, Cree, Ian A, Matheson, Melville A, Tiffany, John M, Proctor, Gordon, van Best, Jaap, Hyde, Nick, Geerling, Gerd
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cell culture; Cicatrix - pathology; Cicatrix - surgery; Conjunctivitis - complications; Conjunctivitis - physiopathology; Conjunctivitis - surgery; Disease; Dry Eye Syndromes - etiology; Dry Eye Syndromes - physiopathology; Dry Eye Syndromes - surgery; Eyes & eyesight; Family medical history; Female; Follow-Up Studies; Graft Survival - physiology; Hospitals; Humans; Male; Medical sciences; Middle Aged; Miscellaneous; Mucins - metabolism; Ophthalmology; Pharmaceuticals; Postoperative Complications; Prospective Studies; Submandibular Gland - transplantation; Surface Tension; Surgery; Tears - chemistry; Tears - metabolism; Transplantation, Autologous; Transplants & implants; Viscosity; Visual Acuity - physiology; Young Adult
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2010.05.010

Purpose To evaluate the long-term results of autologous submandibular gland transplantation in eyes with cicatrizing conjunctivitis and to determine biomechanical and biochemical features of the resulting salivary tear film. Design Prospective, observational case series. Methods Fifteen eyes with cicatrizing conjunctivitis with a viable autologous submandibular gland transplantation were compared with 10 eyes with cicatrizing conjunctivitis and a failed submandibular gland transplantation or no submandibular gland transplantation. Best-corrected visual acuity, frequency of tear substitute instillation, severity of dry eye discomfort, lid margin erythema, conjunctival hyperemia, corneal epithelial edema, tear film break-up time, Schirmer test results, and corneal fluorescein and conjunctival Rose Bengal staining were evaluated. In a subgroup central corneal thickness and sensitivity, corneal epithelial barrier function, conjunctival and lid margin flora, and conjunctival impression cytologic analysis results were evaluated. In 3 patients, preoperative and postoperative tear samples were analyzed for viscosity, surface tension, and presence of mucins. Results Submandibular gland autotransplantation resulted in long-term improvement of subjective, objective, and some ocular surface parameters. Salivary mucins were detectable in salivary tears after submandibular gland transplantation. The viscosity of salivary tears was more similar to normal saliva and the surface tension was intermediate between the 2 original secretions. Conclusions Submandibular gland autotransplantation provides long-term relief from pain and reduces the need for frequent installation of lubricants.