Autotransplantation der unterkieferspeicheldrüse bei absoluter keratoconjunktivitis sicca - Einfluss auf die okulare oberfläche

Background: In absolute dry eyes the use of pharmaceutical lubricants can be insufficient to prevent progressive conjunctival and corneal epitheliopathy and the severe symptoms associated. In this situation a microvascular autologous submandibular gland transplant can be used to continuously provide a natural tear substitute. We studied the effect of this salivary tear film on the ocular surface in a prospective controlled clinical study. Patients and methods: We examined 20 eyes with a viable submandibular gland transplant and 20 severely dry eyes without or with a nonviable transplant as a control for the first postoperative year. Visual acuity, baseline-tear secretion, fluorescein break-up time and slit-lamp microscopical grading of ocular surface features, Rose Bengal staining and conjunctival impression cytology were evaluated. Results: Postoperatively baseline-tear secretion and break-up time were significantly better in the group with a viable submandibular gland transplant than in the controls. The biomicroscopical staging of eyes with a salivary tear film was stable or showed a trend to improvement, while controls showed a trend to deteriorate. A successful submandibular gland transplant reduced the conjunctival and corneal neovascular hyperaemia. However, in 6 eyes with an excessive salivary epiphora, a microcystic epithelial oedema was observed. The epiphora and the associated oedema could be successfully controlled by means of a surgical reduction of the transplant. Conclusions: Following successful autologous submandibular gland transplantation lubrication and comfort are significantly improved and the ocular surface is stabilised during the first post-operative year. Severe preoperative morphological alterations and the salivary character of the new tear film prevent a more obvious improvement of the ocular surface.