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Salivary gland transplantation for dry eye disease: Indications, techniques, and outcomes
The Ocular Surface ( IF 6.4 ) Pub Date : 2022-08-07 , DOI: 10.1016/j.jtos.2022.07.013
Swati Singh 1 , Sayan Basu 2 , Gerd Geerling 3
Affiliation  

The transplantation of salivary glands to the eye serves as a substitute for restoring tear volume in patients with severe dry eye disease. The lacrimal gland and salivary glands share similar acinar-ductal organization with some differences in the nature of secretions. This review summarizes the comparative anatomy of salivary and lacrimal glands, various salivary gland transplantation techniques, their indications, outcomes and complications along with future perspectives. Autologous microvascular submandibular gland transplantation (SMGT) into the temporal fossa with duct placement into the conjunctival fornix improves tear volume considerably but provides a hyposmolar tear film, which can induce corneal edema (in 3.5-40% of eyes). The transplanted submandibular graft improves tear volume and stability but visual acuity and conjunctival inflammation remain unchanged. The transplanted submandibular gland maintains stable function in the long-term and can have hypersecretion in 24–60% secondary to persistent autonomic innervation. Partial SMGT, gland reduction surgery, topical atropine gel or Botulinum Toxin A injection are options for treatment of postoperative epiphora. Minor salivary gland transplantation (MSGT) into the upper and/or lower conjunctival fornix results in an average improvement of 2–4 mm in Schirmer values compared to 16 to > 30 mm observed in eyes after SMGT. Reflex epiphora is rarely a problem in MSGT. Both MSGT or SMGT can improve the ocular surface and quality of life of patients with severe, debilitating dry eye disease. However, postoperative visual acuity and outcomes of corneal transplantation are still inconsistent. More studies and additional technical improvements are needed to further improve the results of these procedures.



中文翻译:

唾液腺移植治疗干眼症:适应症、技术和结果

将唾液腺移植到眼睛可作为恢复严重干眼症患者泪液量的替代方法。泪腺和唾液腺具有相似的腺泡导管组织,但分泌物的性质存在一些差异这篇综述总结了唾液腺和泪腺的比较解剖学、各种唾液腺移植技术、它们的适应症、结果和并发症以及未来的展望。自体微血管下颌下腺移植 (SMGT) 进入颞窝,导管置入结膜穹窿,可显着改善泪液量,但会产生低渗性泪膜,这会诱发角膜水肿(在 3.5-40% 的眼睛中)。移植的下颌下移植物改善了泪液量和稳定性,但视力和结膜炎症保持不变。移植的下颌下腺长期保持稳定的功能,24-60% 可继发于持续的自主神经支配。部分 SMGT、腺体缩小手术、局部阿托品凝胶或肉毒杆菌毒素注射是治疗术后溢泪。小唾液腺移植 (MSGT) 到上部和/或下部结膜穹窿导致 Schirmer 值平均改善 2-4 毫米,而 SMGT 后眼睛观察到 16 至 > 30 毫米。反射性溢泪在 MSGT 中很少成为问题。MSGT或SMGT均可改善眼表严重、使人衰弱的干眼病患者的生活质量。然而,术后视力和角膜移植的结果仍然不一致。需要更多的研究和额外的技术改进来进一步改进这些程序的结果。

更新日期:2022-08-10
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