Long-term results of microvascular submandibular gland transplantation in severe keratoconjunctivitis sicca

Abstract

Background: Dry eye syndrome is a common disease that results in possible damages of the ocular surface, or even in visual disturbance. Microvascular autologous submandibular gland (SMG) transfer provides a continuous and seromucinous tear substitution by salivary secretion. It is an effective treatment for severe keratoconjunctivitis sicca. This study was designed to investigate the long-term results of SMG transplantation and the ocular surface improvement. Methods: From February 2001 to December 2015, 55 patients (58 eyes) with severe dry eye syndrome were treated by SMG transfer. The transplantations were successful in 53 cases (56 eyes). Postoperative scintigraphy, Schirmer's test, breakup time, corneal staining and management of complications were performed to compare with 27 eyes without SMG transplantation. The mean follow-up time was 48 months. Results: Long-term follow-up reveals that SMG transplantation is an effective solution for patients with severe dry eye syndrome. The discomfort symptoms were relieved, and the frequency of use of pharmaceutical tear substitutes was reduced (90.91%). 34% of the patients (17/50) suffer from epiphora, which were modified by reduction surgery. Objective examination showed significant improvement in tear film and some features of ocular surface (P < 0.05). Visual acuity improved in 13/50 patients. Conclusion: Submandibular gland transfer in most patients achieved long-term relief from discomfort and stabilisation of the ocular surface. The function proven clinically and biochemically was stable for many years after surgery. Nearly 26% of the patients were improved in vision acuity with mile damage of the ocular surface.