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Minor salivary gland transplantation for severe dry eye disease due to cicatrising conjunctivitis: multicentre long-term outcomes of a modified technique
  1. Jayesh Vazirani1,
  2. Swapnil Bhalekar2,
  3. Guillermo Amescua3,
  4. Swati Singh4,
  5. Sayan Basu5
  1. 1 Centre for Excellence in Ocular Surface, Excel Eye Care, Ahmedabad, Gujarat, India
  2. 2 Department of Cornea, Super Specialty Eye Hospital, Shirur, Maharashtra, India
  3. 3 Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
  4. 4 Centre for Ocular Regeneration (CORE), LV Prasad Eye Institute, Hyderabad, Telangana, India
  5. 5 The Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
  1. Correspondence to Sayan Basu, Director and D Balasubramanian Chair of Eye Research, Brien Holden Eye Research Centre, LV Prasad Eye Institute, Road No. 2, Banjara Hills Hyderabad 500034, India; sayanbasu{at}


Aim To report the clinical outcomes of autologous minor salivary gland transplantation (MSGT) for the treatment of severe dry eye disease caused by cicatrising conjunctivitis.

Methods This was a retrospective case series of patients undergoing MSGT at four different centres from 2016 to 2018. The technical modifications included en bloc harvesting of a 20 mm×15 mm mucosa–gland–muscle complex and fixation of the glands to the superior bulbar surface anchored to the superior rectus muscle. The primary outcome measure was improvement in best-corrected visual acuity (BCVA). Secondary outcome measures were change in Schirmer test scores and grades of conjunctival and corneal fluorescein staining, grades of corneal neovascularisation, opacification and keratinisation.

Results 21 eyes of 19 patients underwent MSGT, with a median follow-up duration of 3 years. The median BCVA improved from a baseline value of 20/500 to 20/125 at 1 year (p=0.0004) and 20/80 at 3 years (p=0.0002) after surgery. The proportion of cases with BCVA ≥20/200 improved from 38% at baseline to 67% at 1 year (p=0.0294), 78% at 2 years (p=0.0227) and 93% at 3 years (p=0.0015) after surgery. There was a significant improvement (p<0.0036) in Schirmer scores, conjunctival and corneal staining scores as well as grades of corneal neovascularisation and opacification after surgery. There were no serious sight-threatening complications in the transplanted eyes or at the donor site.

Conclusions Long-term improvement in the visual acuity, ocular surface environment, and keratopathy was noted after MSGT performed in severely dry eyes using a modified technique.

  • Ocular surface
  • Cornea
  • Tears

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  • Contributors Concept and design of study or acquisition of data or analysis and interpretation of data: JV, SB, GA, SB. Drafting the article or revising it critically for important intellectual content: JV, SS, GA, SB. Final approval of the version to be published: all authors. The manuscript has been read and approved by all the authors, the requirements for authorship as stated above have been met and each author believes that the manuscript represents honest work.

  • Funding This work was supported by Hyderabad Eye Research Foundation (HERF), Hyderabad, India (No award number).

  • Competing interests None declared.

  • Ethics approval This study was approved by the Ethics Committee of the L V Prasad Eye Institute (LEC_18_147, 148 & 153), Hyderabad, India. Written informed consent was obtained from all participants.

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

  • Data availability statement The authors have provided all relevant data in the manuscript and online supplemental appendix.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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