RESUMO

OBJETIVOS: Estudar os efeitos clínicos da secreção das glândulas salivares labiais na lubrificação das cavidades anoftálmicas secas, avaliar a durabilidade dos resultados e apresentar a técnica do transplante. A aplicação desse procedimento em cavidades anoftálmicas secas é inédita na literatura. MÉTODOS: Estudo prospectivo das cirurgias de enxertos glândulo-mucosos, compostos pela mucosa labial e glândulas salivares subjacentes, colocados no fórnice conjuntival de 5 pacientes com cavidades anoftálmicas que apresentavam grave xeroftalmia e retração dos fórnices conjuntivais. As cirurgias foram realizadas durante o período de julho/00 a janeiro/09. Dois pacientes já haviam sido tratados previamente com enxertos de mucosa ou de pele. A técnica do procedimento é descrita em detalhes. Os parâmetros que serviram para a análise comparativa dos resultados foram o quadro clínico, o aspecto do revestimento da cavidade, o ressecamento da superfície da prótese e a frequência do uso de colírios lubrificantes. RESULTADOS: Em todos os casos foi constatada a integração do enxerto e a melhora dos parâmetros avaliados. A evolução mostrou persistência e estabilidade dos resultados. CONCLUSÕES: A lubrificação da superfície da cavidade produzida pela secreção salivar mostrou ser eficiente, bem tolerada e constante, resultando maior conforto do uso da prótese. Infere-se que essa melhor lubrificação obtida ajuda a prevenir a evolução do processo de retração da cavidade. O transplante das glândulas salivares labiais para o fórnice conjuntival demonstrou ser um procedimento de fácil execução, acessível a qualquer cirurgião oftalmologista.

PURPOSE: To study the clinical effects of labial salivary glands' secretion used as ocular lubricant in anophthalmic cavities with severe xerophthalmia; to evaluate the evolution of the results; and to present the surgical technique. This procedure application in dry anophthalmic cavities is new in the literature. METHODS: Prospective study of patients presenting anophthalmic cavities with severe xerophthalmia and conjunctival fornix retraction treated with labial salivary glands transplantation to the conjunctival fornices. The surgeries were performed in five patients during the period of July 2000 to January 2009. In two cases the fornix retraction was previously treated with mucosa or skin graft. The surgical procedure technique is described in details. The postoperative comparative analysis was based on the clinical picture, the cavity surface aspect, the dryness of the cavity and prosthesis and the frequency of lubricant eye drops use. RESULTS: In all cases both graft integration and improvement of the evaluated parameters were observed. The evolution proved the persistence and stability of the results. CONCLUSION: The salivary secretion produced by the transplanted labial glands proved to be efficient as conjunctival lubricant, well tolerated and permanent, making the use of the prosthesis more comfortable. This improvement helps to prevent the progression of the cavity retraction process. Labial salivary glands graft into the anophtalmic cavity is a simple procedure and accessible to any ophthalmic surgeon.

Assuntos

RESUMO

PURPOSE: To study the clinical effects of labial salivary glands' secretion used as ocular lubricant in anophthalmic cavities with severe xerophthalmia; to evaluate the evolution of the results; and to present the surgical technique. This procedure application in dry anophthalmic cavities is new in the literature. METHODS: Prospective study of patients presenting anophthalmic cavities with severe xerophthalmia and conjunctival fornix retraction treated with labial salivary glands transplantation to the conjunctival fornices. The surgeries were performed in five patients during the period of July 2000 to January 2009. In two cases the fornix retraction was previously treated with mucosa or skin graft. The surgical procedure technique is described in details. The postoperative comparative analysis was based on the clinical picture, the cavity surface aspect, the dryness of the cavity and prosthesis and the frequency of lubricant eye drops use. RESULTS: In all cases both graft integration and improvement of the evaluated parameters were observed. The evolution proved the persistence and stability of the results. CONCLUSION: The salivary secretion produced by the transplanted labial glands proved to be efficient as conjunctival lubricant, well tolerated and permanent, making the use of the prosthesis more comfortable. This improvement helps to prevent the progression of the cavity retraction process. Labial salivary glands graft into the anophtalmic cavity is a simple procedure and accessible to any ophthalmic surgeon.

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RESUMO

PURPOSE: To study the clinical effects of the secretion of transplanted labial glands used as ocular lubricant to treat severe dry-eye cases, to evaluate the duration of the results and to simplify the surgical technique. METHODS: Thirty-seven surgeries were performed in twenty-one patients during the period of July 2000 to January 2004. The graft, consisting of labial mucosa and underlying salivary glands, was transplanted to the previously prepared area in the conjunctival fornix. All procedures were recommended in severe dry-eye cases, that is, eyes with total or nearly total xerophthalmia. The preoperative and postoperative protocols are presented emphasizing the items which were used in the comparative analysis of the results as well as the technical description of the surgical procedure. RESULTS: The graft survival and integration into the host tissues were observed in 97.2% of the cases. The clinical improvement, demonstrated by the disappearance of the symptoms, better biomicroscopic aspect of the ocular surface, better vision and disuse of lubricant drops, was observed in 91.9% of the cases. The follow-up showed not only persistence but also stability of the results. Infection represented one case and ptosis represented three cases of the only four observed complications. CONCLUSION: The improvement of severe dry-eye cases detected after the transplantation of labial salivary glands is significant. It demonstrates that the lubricant ocular surface produced by the salivary secretion is efficient and well-tolerated. The follow-up shows that the result persists in the long term from which it is concluded that the production of the secretion is permanent. The surgical technique of transplanting the labial salivary gland to the conjunctival fornix is very simple and easily accessible to any ophthalmic surgeon.

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RESUMO

OBJETIVO: Estudar os efeitos clínicos da secreção das glândulas labiais como alternativa de lubrificação ocular para alívio do olho seco, avaliar a durabilidade dos resultados e simplificar a técnica. MÉTODOS: Estudo prospectivo de 37 cirurgias de enxerto glândulo-mucoso, composto pela mucosa labial e glândulas salivares subjacentes, colocado no fórnice conjuntival de 21 pacientes. Todas as cirurgias foram realizadas em olhos com grave xeroftalmia, sendo a técnica do procedimento descrita em todos os detalhes. Os parâmetros que serviram para a análise comparativa dos resultados foram o quadro clínico, o brilho ocular, o quadro biomicroscópico, a visão e o uso de colírios lubrificantes. RESULTADOS: A integração do enxerto ocorreu em 97,2 por cento das cirurgias que foram realizadas durante o período de julho/2000 a janeiro/2004. Foi observado que em 91,9 por cento dos casos houve melhora dos parâmetros avaliados e a evolução (acompanhamento médio de 19,7 meses) mostrou persistência e estabilidade dos resultados. As complicações observadas foram: um olho com infecção hospitalar e três pálpebras com ptose. CONCLUSAO: A melhora clínica do olho seco grave observada após o enxerto das glândulas salivares labiais foi estatisticamente significativa. A lubrificação da superfície ocular produzida pela secreção salivar mostrou ser eficiente, bem tolerada e constante. O transplante das glândulas salivares labiais para o fórnice conjuntival demonstrou ser procedimento de fácil execução, acessível a qualquer cirurgião oftalmologista.

Assuntos