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Clinical science
Use of saliva flow rate measurement in minor salivary glands autotransplantation for treatment of severe dry eye disease
  1. Jia-Zeng Su1,
  2. Zhen Wang1,2,
  3. Xiao-Jing Liu1,
  4. Lan Lv3,
  5. Guang-Yan Yu4
  1. 1 Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
  2. 2 Department of Stomatology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
  3. 3 Department of Ophthalmology, Affiliated Beijing Tong Ren Hospital, Capital University of Medical Science, Beijing, China
  4. 4 Department of Oral and Maxillofacial Surgery, Peking University School of Stomatology, Beijing, China
  1. Correspondence to Professor Guang-Yan Yu, Department of Oral and Maxillofacial Surgery, Peking University School of Stomatology, Beijing, China; gyyu{at}263.net; Dr Lan Lv; tryklvlan{at}126.com

Abstract

Aims To use minor salivary glands’ flow rate (MSGFR) measurement in minor salivary glands (MSGs) autotransplantation for the treatment of severe dry eye disease (DED).

Methods 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.

Results 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/cm2. 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/cm2. Patients with preoperative MSGFR >1.785 µL/min/cm2 showed greater improvement of Schirmer test values after surgery than those with MSGFR ≤1.785 µL/min/cm2 (p<0.05).

Conclusion 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.

  • lacrimal gland
  • tears
  • treatment surgery
  • ocular surface

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article and they are also available from the corresponding author upon reasonable request.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bjophthalmol-2020-317552

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    Data availability statement

    Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article and they are also available from the corresponding author upon reasonable request.

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    Footnotes

    • J-ZS and ZW contributed equally.

    • Contributors JZS and ZW contributed equally to this work. JZS and GYY obtained funding. JZS, ZW, LL and GYY designed the study. JZS, ZW and XJL collected all the data. JZS, ZW, XJL and LL were involved in data cleaning, mortality follow-up and verification. JZS and ZW analysed the data. JZS drafted the manuscript. JZS, ZW, XJL, LL and GYY contributed to interpreting the results and critical revision of the manuscript for important intellectual content and approved the final version of the manuscript. All authors have read and approved the final manuscript. LL and GYY are the study guarantors and the corresponding authors.

    • Funding This work was supported by the National Natural Science Foundation of China (81500873, 81974151, 81671005).

    • Competing interests None declared.

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

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