Objective: To evaluate the feasibility of microvascular autologous transplantation of partial submandibular gland (SMG) to prevent or reduce epiphora in severe keratoconjunctivitis sicca (KCS).
Methods: Thirty-nine patients with KCS, for 42 eyes, were randomized to undergo transplantation of partial or total SMG from January 2006 to December 2009. Survival rate of transplanted SMG; ophthalmologic features of best-corrected visual acuity, Schirmer’s test results, break-up time (BUT) of tear film, and fluorescence staining; incidence of postoperative epiphora and frequency of subsequent surgery.
Results: Total SMG transplantation was performed in 22 cases, and partial SMG transplantation was performed in other 20 cases. All transplanted SMGs survived. Microvascular crisis occurred in 1 case of partial SMG transplantation, but the gland survived after exploration to remove the venous thrombus. Obstruction of ductal orifice in 1 case of partial SMG transplantation was resolved by reconstruction of the ductal orifice. Symptoms of dry eyes disappeared, and patients were able to discontinue use of artificial tears. Severe epiphroa occurred in 6 eyes undergoing partial SMG transplantation and in 19 undergoing total SMG transplantation ( P < 0.01). Surgical reduction was performed in 6 eyes undergoing partial SMG transplantation and 18 undergoing total SMG transplantation ( P < 0.01).
Conclusion: Microvascular transplantation of partial SMG is feasible and effective for severe KCS and does not decrease the survival rate of transplanted SMG. For ample SMGs with normal function, transplantation of partial SMG alleviates the symptoms of dry eye and significantly reduces the incidence of severe postoperative epiphora.