Probably the most frequent issues within the every day practise of the ophthalmologist is that of the dry eyes. Particularly older sufferers complain of dry eyes. Certainly: the operate of the lacyrmal gland dramatically decreases after the age of 60 however increasingly youthful sufferers are seen with dry eyes. It is because additionally a number of medication, surgery (e.g. Refractive Surgical procedure like LASIK, Beauty Eyelid surgery,…), illnesses (e.g. rheuma,..), trauma and neoplasms can affect the traditional operate of the lacrymal glands
In a majority of instances remedy is proscribed to a substitution for the dearth of regular tears. A prevention of the outflow of tears to the nose by placing a silicone plug within the tear duct is one other doable remedy. Everyone knows the synthetic tears, gels and ointments that sufferers should purchase within the pharmacy. Beside, the ophthalmologist can put silicone plugs within the tear ducts to cease evauation of the tears to the nose. These plugs, though useful in lots of instances even have disadvantages as a result of they not solely cease the evacuation of tears to the nose but in addition restrict the elimination of micro organisms and mud from the eyes.
For sufferers who reply insufficiently to therapies with synthetic teras or punctal plugs we developed a very new surgical remedy. It’s using labial mucosa and salivary glands from the decrease lip that may be transplanted to the internal facet of the eyelids. It was Prof. Juan Murube Del Castillo from the well-known Alcalá College of Madrid in Spain who found that the saliva that’s secreted by these particular glands is similar to pure tears and that the glands proceed to operate when rigorously dissected and transplanted to the eyelids.
It is vitally straightforward to dissect the mucosa and underlying glands from the decrease lip. With Radiosurgery, utilizing excessive frequency radio waves, the small glands and overlying mucosa will be rigorously dissected and transplanted to the internal facet of each higher and decrease eyelid with out damaging the fragile glandular constructions. For the fixation of the graft I put a working Prolene suture that’s taken out after already 2 weeks. The small wound within the mouth doesn’t must be sutured in any respect On the time of the elimination of the sutures, sufferers can usually already really feel the useful results of the secretion of the salivary glands in order that the can diminish the frequency of instillations of synthetic tears. The operation is completed underneath normal anesthesia and since the handled eye is patched through the first week after surgery, I want to deal with each eyes individually with an interval of at the very least one month. To have the ability to verify the affected person the day after we ask them to remain in a single day however all additional verify ups are performed on an ambulatory base.
With this system 17 eyes have been handled efficiently. All sufferers improved considerably after surgery though a few of them nonetheless should put synthetic tears, be it at a a lot decrease frequency. And we even have a scientific proof the transplantation is efficient. In 2 sufferers a biopt was taken of the transplanted tissue: one at 18 and one at 36 months. Microscopic examination of the specimen revealed regular functioning glandular constructions! This confirmsthe assertion that labial salivary glands can maintait their basal secretion after cautious dissection.
Though extra must be performed, transplantation of labial salivary glands to the conjunctiva already guarantees to be a dependable new remedy in instances of extreme dry eyes which are proof against different therapies.