Slide 1

Ana Estela BPP SantAnna, Rossen Harzarbassanov, Aline L Arajo, Tammy H Osaki, Midori H Osaki, Vera LL Costa, Hellen PR Santos, Denise de Freitas, Jos AP Gomes Federal University of Sao Paulo Vision Institute Sao Paulo. SP. Brazil. We do not have any financial interests or relationships to disclose Slide 2 Stevens-Jonhson Syndrome Stevens-Jonhson syndrome is an immunological disease that causes dry eye and severe cicatricial changes in the cornea, conjunctiva and eyelids. Slide 3 Purpose Evaluate salivary gland and labial mucous membrane transplantation in the treatment of patients with severe symblepharon and dry eye secondary to SSJ Slide 4 Patients and Methods Design Prospective interventional non-comparative case series Federal University of Sao Paulo. Sao Paulo. SP. Brazil. 2006 -2009 Inclusion criteria Stevens-Johnson syndrome Severe dry eye Previous Schirmer I test = 0 Severe Symblepharon Poor visual acuity Slide 5 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. Slide 6 Results: Salivary Gland Transplantation Case Age/Sex Schirmer Pre (mm) Schirmer PO (mm) Visual acuity improvement Symptoms Improvements FU (months) 1. ANS 43 /0 21 2. AAP 13 0123 3. ALAJ 58 025 4. CTO 18 0127 5. CFS 52 008 6. DMAA 41 0320 7. FL 36 /0 3 8. IG 45 0115 9. JLBS 10 0335 10. LBS 13 0126 11. LMC 31 0315 12. LCPG 35 0413 13. MSA 37 0017 14. MPSN 16 01128 15. MLO 40 /0/320 16. MRMS 24 /0/317 17. NRAO 17 /0 20 18. PAP 35 /0/532 19. TMLL35 0426 Slide 7 Results Results 19 eyes (19 patients with SJS) 19 eyes (19 patients with SJS) Age: 10-58 yo (mean 31 yo) FU time: 3-35 months (mean 19) 47% improvement of VA 47% improvement of VA Salivary Gland Transplantation Federal University of Sao Paulo SantAnna & Gomes, 2009 Slide 8 Schirmer I test 14/19 patients (73%) 10 (52%) 2mm. 10 glands (p=0.0129) = increase tears Group1 (Schirmer =0mm) Group2 (Schirmer 2mm) Group3 (Schirmer10) 10(1/10)20(2/10)70(7/10) 0.0129 Schirmer I test versus transplanted salivary glands Slide 9 52.6% improvement corneal transparency 73.6% improvement corneal neovascularization Grade 3 (%)Grade 4 (%) chi- squared or 2 test PrePostPrePostPrePost 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 Slide 10 Pre Post Pre Slide 11 Pre and postoperative. Notice the labial mucosa harvesting the entire sclera, at right. It looks like a new conjunctiva Pre Post Slide 12 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