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

https://doi.org/10.1016/j.ajo.2010.05.010Get rights and content

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.

Section snippets

Patient Groups

Between 1994 and the beginning of 2005, 44 eyes (35 patients) underwent an autologous submandibular gland transplantation. All patients had severe to absolute aqueous tear deficiency. Three months after surgery and during the subsequent follow-up, 35 of the 44 transplants were classified as viable. Viability was judged either on the basis of an increase of Schirmer test results or by means of technetium-99m–pertechnetate scintillography.17 Loss of graft viability was thought to be predominantly

Primary Surgical Success and Postoperative Complications

Early and late postoperative complications are listed in Table 2. One patient (2 eyes) died in the second postoperative year of cardiovascular disease.

Subjective Criteria

Before surgery, no difference between the transplantation group and the control group in visual acuity (P = .9), the frequency of tear substitute instillation (P = .4), and the severity of symptoms (P = .13) was found.

The best-corrected visual acuity in 7 of the 15 eyes in the transplantation group and in 4 of the 10 eyes in the control group was

Discussion

Herein we present the results of a prospective, controlled clinical cohort study on the long-term follow-up of submandibular gland autotransplantation in patients with cicatrizing conjunctivitis. Over a 5-year follow-up, submandibular gland transplantation provided lasting improvement of discomfort, of tear film parameters, and of some ocular surface parameters (fluorescein and Rose Bengal staining). However, other markers of ocular surface health, such as conjunctival hyperemia, metaplasia,

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