Centre for Ocular Regeneration, L V Prasad Eye Institute, Hyderabad, India; Ophthalmic Plastic Surgery Services, L V Prasad Eye Institue, Hyderabad, India.
Centre for Ocular Regeneration, L V Prasad Eye Institute, Hyderabad, India; The Cornea Institute, L V Prasad Eye Institute, Hyderabad 500034, Telangana, India.
Ocul Surf. 2022 Oct;26:53-62. doi: 10.1016/j.jtos.2022.07.013. Epub 2022 Aug 7.
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.
唾液腺移植到眼睛可作为恢复严重干眼症患者泪液体积的替代方法。泪腺和唾液腺具有相似的腺管组织，但分泌物的性质存在一些差异。本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、它们的适应证、结果和并发症以及未来的展望。自体微血管颌下腺移植（SMGT）到颞窝，并将导管放置到结膜穹窿，可以显著改善泪液体积，但提供的泪膜低渗，可导致角膜水肿（在 3.5-40%的眼中）。移植的颌下腺可改善泪液体积和稳定性，但视力和结膜炎症保持不变。移植的颌下腺在长期内保持稳定的功能，并可因持续的自主神经支配而出现 24-60%的高分泌。SMGT 的部分切除、腺体缩小手术、局部阿托品凝胶或肉毒杆菌毒素 A 注射是治疗术后溢泪的选择。将小唾液腺移植（MSGT）到上、/或下结膜穹窿，可使 Schirmer 值平均提高 2-4mm，而 SMGT 后观察到的眼平均提高 16-30mm。MSGT 很少出现反射性溢泪。MSGT 或 SMGT 都可以改善严重、使人衰弱的干眼症患者的眼表面和生活质量。然而，角膜移植术后的视力和结果仍然不一致。需要更多的研究和额外的技术改进来进一步提高这些手术的效果。
