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Autologous Submandibular Gland Transplantation for Absolute Dry-eyes due to Cicatrizing Conjunctivitis
1Schröder C., 2Hakim S. G., 3Collin J. R. O., 3Dart J. K. G., 1Geerling G.,
1Medizinische Universität zu Lübeck, Klinik für Augenheilkunde (Lübeck)
2Medizinische Universität zu Lübeck, Klinik für Kiefer- und Gesichtschirurgie (Lübeck)
3Moorfields Eye Hospital (London)
Background: Absolute tear deficiency can be a result of cicatrizing conjunctivitis. Despite frequent application of unpreserved tear substitutes this may lead to a progressive ocular surface disease and severe dry eye symptoms. We examined the effect of microvascular autotransplantation of a submandibular gland on lubrication, symptoms and signs of ocular surface disease in a prospective controlled clinical clinical study of dry eyes due to cicatrising conjunctivitis for up to 4 years.
Methods: In 14 eyes with a viable submandibular gland transplant and 14 control eyes with absolute tear deficiency secondary to cicatrising conjunctivitis visual acuity, Schirmer-Test, tear break up time and slitlamp microscopy were performed prior to and up to 4 years postoperatively. Rose Bengal staining as well as a an impressionscytology and conjunctival smears were carried out.
Results: Submandibular gland autotransplantation significantly improved symptoms, Schirmer test after anaesthesia and tear break up time when compared with controlls. Slitlamp microscopical findings and impression cytology remained unchanged in the group with a viable salivary gland transplant while control eyes showed a trend to deteriorate. In 6 eyes excessive salivary lubrication resulted in a microcystic epithelial oedema, which regressed after surgical reduction of the transplant. 3 cases of eyes with corneal subsequently to submandibular gland grafting will be described.
Conclusions: Autologous submandibular gland transplantation can improve lubrication and symptoms of previously absolute dry eyes due cicatrizing conjunctivitis for up to 4 years. The ocular surface is stabilised despite the salivary character of the lubrication.
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