Submandibular gland transplantation may be option for severe dry eye treatment
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Submandibular gland transplantation showed efficacy for the treatment of end-stage refractory dry eye disease, while transplantation of minor salivary glands may be effective in treating less severe dry eye, according to a study.
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 (SMG) transplantation; group B, which included 20 eyes with end-stage DED treated with minor salivary glands (MSGs) transplantation; and group C, which included 18 eyes with non-end-stage DED treated with MSGs transplantation.
Eyes in group A, which had the most severe preoperative DED, experienced significant improvements in Schirmer test score (0.36 mm per 5 minutes to 20.23 mm per 5 minutes), tear breakup time (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 after SMG transplantation.
Eyes in group B experienced significant improvements after MSGs transplantation in Schirmer 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 eyes in group C improved significantly in Schirmer test score (0.89 mm per 5 minutes to 9.35 mm per 5 minutes) tear breakup time (3.49 seconds to 9.08 seconds) and corneal fluorescein staining (1.83 to 0.53) after MSGs transplantation.
Overall, the “abundant” lubrication provided by SMG transplantation improved tear film stability and the ocular surface, while MSGs transplantation resulted in less lubrication. The study authors said that MSGs transplantation offered a “significantly superior treatment effect compared with end-stage DED” for patients with DED secondary to non-cicatrizing conjunctivitis with less severe impairment.
“For the DED secondary to non-cicatrizing conjunctivitis and those with less severe impairment of the tear film stability and ocular surface (eg, group C), MSGs transplantation might be recommended as a first choice,” the authors wrote. “Most patients could benefit from adequate lubrication and substantial improvements with minor treatment risk and cost. However, for the end-stage DED secondary to cicatrizing conjunctivitis (as in group A or B of this study), the treatment effect of MSGs transplantation may be limited (less than 4 mm per 5 minutes of lubrication and 60% of symptoms relief rate); thus, SMG transplantation might be recommended.”
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