Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
Department of Stomatology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China.
Br J Ophthalmol. 2022 Jul;106(7):902-907. doi: 10.1136/bjophthalmol-2020-317552. Epub 2021 Mar 5.
To use minor salivary glands' flow rate (MSGFR) measurement in minor salivary glands (MSGs) autotransplantation for the treatment of severe dry eye disease (DED).
MSGs autotransplantations were performed in 18 eyes (17 patients) with severe DED. MSGFR were measured before operation. The upper or lower lip with higher MSGFR was selected as the donor site. Buccal mucosa was the back-up in cases labial MSGs showing markedly decreased MSGFRs. Two pieces of salivary lobules with the covering mucosa were harvested and transplanted to the recipient beds prepared in both upper and lower lids.
The donor sites included lower lip in 12 eyes, upper lip in 5 eyes and buccal mucosa in 1 eye. Postoperative follow-up confirmed viable grafts in all cases. The overall subjective relief rate of DED symptoms was 58.8%, with Schirmer test values increasing from 0 mm to 4 mm (p<0.05). The mean preoperative MSGFR was 1.7 (range: 0.9-3.3) µL/min/cm. ROC analysis indicated an outstanding discrimination power for preoperative MSGFR to predicate postoperative relief of DED symptoms (area under the curve (AUC)=0.948, p<0.01). The maximum sensitivity (100%) and specificity (72.7%) were reached at a cut-off of 1.785 µL/min/cm. Patients with preoperative MSGFR >1.785 µL/min/cm showed greater improvement of Schirmer test values after surgery than those with MSGFR ≤1.785 µL/min/cm (p<0.05).
MSGs transplantation proved to be useful for treating severe DED. The amount of postoperative lubrication and the treatment effect were positively correlated with preoperative MSGFR. MSGFR measurement and donor-site selection should be critical steps before the operation.
利用小唾液腺（MSG）自移植术中小唾液腺流量（MSGFR）的测量来治疗严重干燥性眼病（DED）。
对 17 例（18 只眼）严重 DED 患者进行了 MSG 自移植术。术前测量 MSGFR。选择 MSGFR 较高的上唇或下唇作为供体部位。如果唇 MSGs 的 MSGFR 明显降低，则颊黏膜作为备用供体。采集两块带有覆盖黏膜的唾液小叶，并将其移植到上下眼睑准备好的受体床中。
12 只眼的供体部位为下唇，5 只眼的供体部位为上唇，1 只眼的供体部位为颊黏膜。所有病例术后均证实移植物存活。DED 症状的整体主观缓解率为 58.8%，Schirmer 测试值从 0mm 增加到 4mm（p<0.05）。术前 MSGFR 的平均值为 1.7（范围：0.9-3.3）µL/min/cm。ROC 分析表明，术前 MSGFR 对预测 DED 症状术后缓解具有出色的区分能力（曲线下面积（AUC）=0.948，p<0.01）。在截断值为 1.785µL/min/cm 时，达到了 100%的最大灵敏度和 72.7%的特异性。术前 MSGFR>1.785µL/min/cm 的患者术后 Schirmer 测试值的改善大于 MSGFR≤1.785µL/min/cm 的患者（p<0.05）。
MSG 移植术治疗严重 DED 是有效的。术后润滑量和治疗效果与术前 MSGFR 呈正相关。MSGFR 测量和供体部位选择应是手术前的关键步骤。
