The Dry Eye Zone

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Abstract: Salivary gland transplantation

I'd like to know how many of the "10 eyes with cicatrizing conjunctivitis and a failed submandibular gland transplantation or no submandibular gland transplantation" were the former. And what "some ocular surface parameters" are. And how many of the patients would do it all over again.

This kind of surgery gives me the willies. I can't imagine why you would do something so invasive (and, apparently, risky) without first trying BOSP.

Long-Term Follow-up after Submandibular Gland Transplantation in Severe Dry Eyes Secondary to Cicatrizing Conjunctivitis.
Am J Ophthalmol. 2010 Oct 2. [Epub ahead of print]
Borrelli M, Schröder C, Dart JK, Collin JR, Sieg P, Cree IA, Matheson MA, Tiffany JM, Proctor G, van Best J, Hyde N, Geerling G.
Centro Grandi Apparecchiature, Seconda Universita degli Studi di Napoli, Napoli, Italy; Department of Ophthalmology, University of Würzburg, Würzburg, Germany.

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.
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