Microvascular submandibular gland (SMG) transplantation can effectively treat end-stage refractory dry eye disease (DED), while minor salivary gland (MSGs) transplantation may provide satisfying results for refractory DED with less severity when other treatments are inadequate, according to a study published in the American Journal of Ophthalmology.
Researchers conducted a retroscopic cohort analysis of 73 eyes with refractory DED and stratified participants into 3 groups: eyes with end-stage DED that underwent SMG transplantation (group A, n=28, 23 women), eyes with end-stage DED that underwent MSGs transplantation (group B, n=19, 12 women), and eyes with non-end-stage DED that underwent MSGs transplantation (group C, n=14, 4 women). The team noted no significant differences in age or gender between group A and B. Group C was younger (mean age 28.2±4.2 years) with more participants who were men (n=14).
Investigators performed Schirmer test (ST), tear break-up time (TBUT), corneal fluorescein staining (FL), and best-corrected visual acuity (BCVA) measurements on all participants before and after surgery and administered a questionnaire to determine patients’ satisfaction with the procedure. They administered these objective and subjective analyses at baseline, 3-month follow-up, and at a final follow-up assessment conducted 2 or more years after baseline.
Researchers reported that the length of hospital stays, length of operation, and hospital fees were significantly higher in group A compared with groups B and C. Eyes in group A demonstrated the most severe DED disease symptomatology with preoperative ST, TBUT, FL, and BCVA of 0.36 mm/5min, 0.03 s, 10.97, and 0.11 logMAR, respectively, which improved significantly (except BCVA) to 20.23mm/5min, 1.74 s, 7.58, and 0.2 logMAR at follow-up visits conducted 2 years or more after baseline visit.
Group B had similar baseline data, and significant but limited improvement in the ST (0.55 to 3.79 mm/5min; P <.01) and FL (11.10 to 9.58; P <.05) during long-term follow-up conducted 2 or more years following surgery.
Group C had baseline ST, TBUT, FL, and BCVA of 0.89 mm/5min, 3.49 s, 1.83, and 0.81 logMAR, respectively, which improved significantly (except for BCVA) to 9.35 mm/5min, 9.08 s, 0.53, and 0.89 logMAR after MSGs transplantation.
“Considering both risks and benefits, for refractory DED patients who do not have other treatments as an option, the surgical modalities should be chosen according to the severity of the disease,” according to the investigators. “For the DED secondary to non-cicatrizing conjunctivitis and those with less severe impairment of the tear film stability and ocular surface (e.g., group C), MSGs transplantation might be recommended as a first choice. Most patients could benefit from adequate lubrication and substantial improvements with minor treatment risk and cost.”
Study limitations include a single center design, retrospective nature, and lack of treatment randomization.
Su J-Z, Zheng B, Wang Z, et al. Submandibular gland transplantation vs. minor salivary glands transplantation for treatment of dry eye: a retrospective cohort study. Am J Ophthalmol. Published online May 28, 2022. doi:10.1016/j.ajo.2022.05.019