Submandibular gland transplantation may be an option for the treatment of severe dry eye disease


Disclosures: The authors report no relevant financial information.

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According to one study, submandibular gland transplantation has been shown to be effective in treating refractory end-stage dry eye disease, while minor salivary gland transplantation may be effective in treating less severe dry eye disease.

The retrospective clinical cohort study included 73 eyes with refractory dry eye disease (DED) divided into three groups: Group A, which included 35 eyes with end-stage DED treated with submandibular gland transplantation (SMG); Group B, which included 20 eyes with end-stage DED treated with minor salivary gland transplantation (MSG); and Group C, which included 18 non-end-stage DED eyes treated with MSG grafting.

Group A eyes, which had the most severe preoperative DED, experienced significant improvements in Schirmer test score (0.36 mm every 5 minutes to 20.23 mm every 5 minutes), break-up time tears (0.03 seconds to 1.74 seconds), corneal fluorescein staining (10.97 to 7.58) and best corrected visual acuity (0.11 to 0.2) more than 2 years later SMG transplant.

Group B eyes showed significant improvements after MSG transplantation in Schirmer’s test score (0.55 mm per 5 minutes to 3.79 mm per 5 minutes) and corneal fluorescein staining (11.10 to 9.58), while Group C eyes improved significantly in Schirmer test score (0.89 mm per 5 minutes to 9.35 mm per 5 minutes) tear break-up time (3 .49 seconds to 9.08 seconds) and corneal fluorescein staining (1.83 to 0.53) after MSG transplantation.

Overall, the “abundant” lubrication provided by SMG grafting improved tear film stability and ocular surface area, while MSG grafting resulted in less lubrication. The study authors stated that MSG transplantation provided a “significantly superior treatment effect compared to end-stage DED” for patients with DED secondary to non-healing conjunctivitis with less severe impairment.

“For DED secondary to nonhealing conjunctivitis and those with less severe impairment of tear film and ocular surface stability (eg, group C), MSG transplantation might be recommended as a first choice,” wrote the authors. “Most patients could benefit from adequate lubrication and substantial improvements with minor treatment risk and cost. However, for end-stage DED secondary to healing conjunctivitis (as in group A or B of this study), the therapeutic effect of GMS grafting may be limited (less than 4 mm per 5 minutes of lubrication and 60 % symptom relief rate); thus, SMG transplantation might be recommended.

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