Federal University of Sao Paulo Vision Institute Sao Paulo. SP. Brazil

EFFICACY OF SALIVARY GLAND AND LABIAL MUCOUS MEMBRANE

TRANSPLANTATION IN THE TREATMENT OF SEVERE SYMBLEPHARON AND DRY EYE

SECONDARY TO STEVENS-JOHNSON SYNDROME

Ana Estela BPP Sant´Anna, Rossen Harzarbassanov, Aline L Araújo, Tammy H Osaki, Midori H Osaki, Vera

LL Costa, Hellen PR Santos, Denise de Freitas, José AP Gomes

Federal University of Sao PauloVision Institute

Sao Paulo. SP. Brazil.

We do not have any financial interests or relationships to disclose

Stevens-Jonhson SyndromeStevens-Jonhson syndrome is an immunological disease that causes dry eye and severe cicatricial changes in the cornea, conjunctiva and eyelids.

Purpose

Evaluate salivary gland and labial mucous membrane transplantation in the treatment of patients with severe symblepharon and dry eye secondary to SSJ

Patients and Methods Design

Prospective interventional non-comparative case series Federal University of Sao Paulo. Sao Paulo. SP. Brazil.2006 -2009

Inclusion criteriaStevens-Johnson syndrome

○ Severe dry eyePrevious Schirmer I test = 0

○ Severe Symblepharon ○ Poor visual acuity

Steps of surgery: A. pre operative, B. obtaining mucous

membrane graft from inferior and superior lip with Ficas mucotome,

C. labial mucous membrane attached to the sclera,

D. obtaining the salivary glands,

E. fixing the salivary glands,

F. postoperative.

Results: Salivary Gland TransplantationCase Age/Sex Schirmer

Pre (mm)SchirmerPO (mm)

Visual acuity improvement

SymptomsImprovements

FU(months)

1. ANS 43♂ /0 /0 → ↑ 212. AAP 13♀ 0 1 ↑ ↑ 233. ALAJ 58♂ 0 2 → ↑ 54. CTO 18♀ 0 1 ↑ ↑ 275. CFS 52♂ 0 0 → ↑ 86. DMAA 41♀ 0 3 ↑ ↑ 207. FL 36♂ /0 /0 → ↑ 38. IG 45♀ 0 1 → ↑ 159. JLBS 10♂ 0 3 → ↑ 3510. LBS 13♂ 0 1 → ↑ 2611. LMC 31♂ 0 3 → ↑ 1512. LCPG 35♂ 0 4 ↑ ↑ 1313. MSA 37♀ 0 0 ↑ ↑ 1714. MPSN 16♂ 0 11 ↑ ↑ 2815. MLO 40♀ /0 /3 ↑ ↑ 2016. MRMS 24♀ /0 /3 → ↑ 1717. NRAO 17♀ /0 /0 ↑ → 2018. PAP 35♂ /0 /5 ↑ ↑ 3219. TMLL 35♀ 0 4 → ↑ 26

Results19 eyes (19 patients with SJS)

Age: 10-58 yo (mean 31 yo)FU time: 3-35 months (mean 19)

47% improvement of VA

Salivary Gland TransplantationFederal University of Sao Paulo

Sant´Anna & Gomes, 2009

Schirmer I test 14/19 patients (73%) 10 (52%) ≥ 2mm.

10 glands (p=0.0129)=increase tears

Group1

(Schirmer

=0mm)

Group2

(Schirmer

≤2mm)

Group3

(Schirmer

<2mm)

ϰ2  test P=

glands

(0-5)

66.67(2/3) 33.33(1/3) 0(0/3) 0.6065

glands

(5-10)

28.57(2/7) 28.57(2/7) 42.86(3/7) 0.1826

glands

(>10)

10(1/10) 20(2/10) 70(7/10) 0.0129

Schirmer I test versus transplanted salivary glands

52.6% improvement corneal transparency73.6% improvement corneal neovascularization

Grade 3 (%) Grade 4 (%) chi-squared or ϰ2  test

Pre Post Pre Post Pre Post

Transparency 0 (0/19)

10.53

(2/19)

15.79 (3/19)

63.16

(12/19)

84.21 (16/19)

26.32 (5/19)

0.0014

Neovascularization 0 (0/19)

10.52

(2/19)

5.26 (1/19)

26.33

(5/19)

94.74 (18/19)

63.15 (12/19)

0.0532

Pre Post

PostPre

Pre and postoperative.Notice the labial mucosa harvesting the entire sclera, at right.It looks like a new conjunctiva

PrePost

Conclusions Salivary gland and oral mucosa tp seems

to be efficient in treating severe dry eye 2ry to SJS and maybe improve the results of limbal SC tp

The procedure is reproducible and needs to be performed under general anesthesia

More cases and longer FU time are needed to further confirm our findings

anestela@uol.com.br