title: Minor salivary glands and labial mucous membrane graft in the treatment of severe symblepharon and dry eye in patients with Stevens-Johnson syndrome.
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 (χ(2) 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 (χ(2) 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Alameda dos Quinimuras, 34, Planalto Paulista, São Paulo 04068-000, Brazil. anestela@uol.com.br
authors.forename: Ana Estela B P P
authors.initials: AE
authors.lastname: Sant' Anna
authors.forename: Rossen M
authors.initials: RM
authors.lastname: Hazarbassanov
authors.forename: Denise
authors.initials: D
authors.lastname: de Freitas
authors.forename: José Álvaro P
authors.initials: JÁ
authors.lastname: Gomes
mesh_terms: D000328:Adult; D003229:Conjunctival Diseases / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D003315:Cornea / Q000503:physiopathology; D015352:Dry Eye Syndromes / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005141:Eyelid Diseases / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007742:Labial Frenum; D008297:Male; D009061:Mouth Mucosa / Q000637:transplantation*; D011446:Prospective Studies; D012470:Salivary Glands, Minor / Q000637:transplantation*; D013262:Stevens-Johnson Syndrome / Q000150:complications*; D011795:Surveys and Questionnaires; D013536:Suture Techniques; D013666:Tears / Q000502:physiology; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology