TRANSPLANTATION OF THE AUTOLOGOUS SUBMANDIBULAR-GLAND FOR MOST SEVERECASES OF KERATOCONJUNCTIVITIS SICCA

Objective: This study aimed to examine the long-term qualitative and q uantitative function of the secretion of transplanted autologous subma ndibular glands in patients with most severe keratoconjunctivitis sicc a, Design: The study design was clinical. Participants: The authors pe rformed 26 operations in 22 patients. A complete ophthalmologic examin ation was performed in 16 eyes of 13 patients 1 week and 3 months and in 8 eyes of 8 patients 1 year after surgery. Intervention: The subman dibular gland was moved from its natural site into the temporal fossa. The glands supplying vessels were connected to the temporal artery an d vein, and its secretory duct was implanted into the conjunctival for nix, Main Outcome Measures: Scintigraphy with Tc 99m Pertechnetate was used to document the graft vitality, Subjective symptoms and applicat ion frequency of artificial tears were recorded. Baseline as well as s timulated secretion and breakup time were measured and rose bengal sta ining and ocular ferning test were performed. In selected cases, the s ecretory product could be sampled for the detection of electrolytes, a mylase, and secretory immunoglobulin A (SlgA). Results: Scintigraphy s howed vital gland tissue in 14 of 16 grafts at 3 months and 6 of 8 gra fts at 1 year after surgery. Two of the 16 transplants were lost compl etely during the first 3 postoperative months, 1 because of an underly ing autoimmunopolyendokrinopathy and the other because of an insuffici ent vascular anastomoses. In eyes with a vital transplant, baseline se cretion and breakup time were increased significantly at 3 months and 1 year after surgery, Patients with a vital transplant reported a stro ng relief of symptoms and were able to stop taking artificial tear sub stitution at 1 year. Electrolytes showed a fluctuating concentration. A year after transplantation, the SlgA and amylase concentrations were more than ten times increased compared to normal tear values. Conclus ion: Microvascular transferral of an autologous, paralytic submandibul ar gland results in a significant relief of subjective symptoms, a red uction of artificial tear applications, and an increase of baseline se cretion over the first postoperative year. The composition and volume of the secretory product fluctuate, but high values of SlgA and amylas e show an actively secreting graft. Although the authors' long-term ex perience still is limited, they believe that the procedure is a promis ing alternative approach for desperate dry eye conditions.