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Minor salivary glands and labial mucous membrane graft in the treatment of severe symblepharon and dry eye in patients with Stevens–Johnson syndrome
  1. Ana Estela B P P Sant' Anna1,
  2. Rossen M Hazarbassanov2,
  3. Denise de Freitas2,
  4. José Álvaro P Gomes2
  1. 1Oculoplastic Unit, Department of Ophthalmology, Federal University of São Paulo, SP, Brazil
  2. 2Cornea and External Disease Unit, Department of Ophthalmology, Federal University of São Paulo, SP, Brazil
  1. Correspondence to Ana Estela B P P Sant' Anna, Alameda dos Quinimuras, 34, Planalto Paulista, São Paulo 04068-000, Brazil; anestela{at}uol.com.br

Abstract

Objective To evaluate minor salivary glands and labial mucous membrane graft in patients with severe symblepharon and dry eye secondary to Stevens–Johnson syndrome (SJS).

Methods A prospective, non-comparative, interventional case series of 19 patients with severe symblepharon and dry eye secondary to SJS who underwent labial mucous membrane and minor salivary glands transplantation. A complete ophthalmic examination including the Schirmer I test was performed prior to and following surgery. All patients had a preoperative Schirmer I test value of zero.

Results Nineteen patients with severe symblepharon and dry eye secondary to SJS were included in the study. There was a statistically significant improvement in the best spectacle-corrected visual acuity in eight patients (t test; p=0.0070). Values obtained in the Schirmer I test improved significantly in 14 eyes (73.7%) 6 months following surgery (χ2 test; p=0.0094). A statistically significant increase in tear production (Schirmer I test) was found in eyes that received more than 10 glands per graft compared with eyes that received fewer glands (χ2 test; p=0.0096). Corneal transparency improved significantly in 11 (72.2%) eyes and corneal neovascularisation improved significantly in five eyes (29.4%) (McNemar test; p=0.001 and p=0.0005). The symptoms questionnaire revealed improvement in foreign body sensation in 53.6% of the patients, in photophobia in 50.2% and in pain in 54.8% (Kruskal–Wallis test; p=0.0167).

Conclusion Labial mucous membrane and minor salivary glands transplantation were found to constitute a good option for the treatment of severe symblepharon and dry eye secondary to SJS. This may be considered as a step prior to limbal stem cell and corneal transplantation in these patients.

  • Mouth mucosa
  • salivary glands
  • entropion
  • transplantation
  • tears
  • ocular surface

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Footnotes

  • Competing interests None to declare.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Research Ethics Committee of the Paulista School of Medicine (CEP0427/08).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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