Radiotherapy and Radiosurgery in the Management of Optic Nerve Sheath Meningiomas: An International Systematic Review and Meta-Analysis of Twenty Studies.

BACKGROUND: Optic nerve sheath meningiomas (ONMs) are often managed with radiotherapy (RT) with the goal of achieving radiographic local control (LC) and preventing deterioration of visual acuity (VA). We aimed to perform a systematic review and meta-analysis of outcomes for patients with ONM treated with RT. METHODS: The PICOS/PRISMA/MOOSE selection criteria were used to identify studies. Primary outcomes were stable or improved VA and radiographic LC at last follow-up. The secondary outcomes were incidences of radiation-induced retinopathy and xerophthalmia and stable or improved visual fields (VFs). Weighted random-effects meta-analyses using the DerSimonian and Laird methods were conducted to characterize effect sizes. Mixed-effects regression models were used to examine potential correlations between gross tumor volume (GTV) and outcomes. RESULTS: In total, 444 patients with ONM across 20 published studies were included. The estimated LC rate was 99.8% (95% confidence interval [CI], 98.3%-100%), and the estimated proportion of patients with stable or improved VA or VF was 89.7% (95% CI, 86.2%-92.4%) and 93.3% (95% CI, 89.5%-95.8%), respectively. Estimated incidences of radiation-induced retinopathy and xerophthalmia were 7.2% and 10.1%, respectively. GTV was significantly associated with VA (P = 0.014) with estimated VA rates of 96.4%, 91.4%, and 80.5% for GTVs of 2.0, 3.0, and 4.0 cm3, respectively. CONCLUSIONS: RT was well tolerated, with excellent LC achieved. Nearly 90% of patients noted either stability or improvement in VA and VF. Larger ONMs were associated with poorer VA.

Citología de impresión conjuntival en pacientes con valores OSDI normales y alterados / Conjunctival impression cytology in patients with normal and impaired OSDI scores

OBJETIVO: Describir la graduación de Nelson y la densidad de células caliciformes en distintas áreas de la superficie ocular usando citología de impresión conjuntival (CIC), en pacientes con valores Ocular Surface Disease Index (OSDI©) normales y alterados. MATERIALES Y MÉTODOS: Los pacientes (n = 166) en evaluación por ojo seco, reclutados entre 2011 y 2012, fueron clasificados según el cuestionario OSDI en 4 categorías (normal y alteradas). Se evaluó citología (CIC con tinción Papanicolaou) aplicando el sistema de graduación de Nelson, con modificaciones en la determinación de la estadificación, y recuento de células caliciformes en zonas nasal, temporal, superior e inferior de la superficie conjuntival. RESULTADOS: El grado de Nelson fue significativamente mayor en pacientes con valores OSDI severos, variando desde 0,86 ± 0,09 en pacientes normales a 1,41 ± 0,14 en OSDI severo (p < 0,01). La densidad de células caliciformes disminuyó desde 497,31 ± 50,07 células por muestra en pacientes normales a 310,24 ± 56,24 células por muestra en pacientes con OSDI severo (p < 0,001). La conjuntiva bulbar no fotoexpuesta presentó un número de células caliciformes significativamente mayor (p < 0,0001) que la zona fotoexpuesta en pacientes con OSDI leve (p < 0,01) y moderado (p < 0,001). CONCLUSIÓN: La densidad de células caliciformes es menor y la clasificación de Nelson es mayor en pacientes con OSDI severo. La densidad de células caliciformes es mayor en la conjuntiva bulbar no fotoexpuesta

PURPOSE: To describe goblet cell density and Nelson grading in different areas of the ocular surface using conjunctival impression cytology (CIC) among patients with normal and impaired Ocular Surface Disease Index (OSDI) scores. MATERIAL AND METHODS: Patients (n = 166) under assessment for dry eye were recruited between 2011 and 2012 and classified according to the OSDI score in 4 categories (normal and impaired). Cytological study (CIC plus Papanicolaou staining) using the Nelson grading system, with modifications in staging, and goblet cell counting were performed on the nasal, temporal, inferior, and superior bulbar conjunctival surfaces. RESULTS: Nelson grading was significantly higher in patients with a severely impaired OSDI score (1.41 ± 0.14) compared to normal patients (0.86 ± 0.09) (P<0.01). Goblet cell density was significantly reduced in patients with a severely impaired OSDI score (310.24 ± 56.24 cells per sample) compared with normal subjects (497.31 ± 50.07 cells per sample) (P<0.001). Compared with the photoexposed bulbar conjunctiva, goblet cell density on the non-photoexposed conjunctiva was significantly higher both in patients with mild (P<0.01) and moderate (P<0.001) OSDI scores. CONCLUSION: Patients with severely impaired OSDI scores have less goblet cells and a higher Nelson grade. Goblet cells are more abundant on the non-photoexposed conjunctiva

Allogenic submandibular gland transplantation following hematopoietic stem cell transplantation.

BACKGROUND: Autologous submandibular gland transfer for treatment of progressive dry eye symptoms requires a functionally intact submandibular gland. In cases of total function loss of both lacrimal and submandibular glands this procedure has to be modified. Here we report on the first two cases of the allogenic transplantation of a submandibular gland to treat patients suffering from complete functional loss of both glands due to graft-versus-host disease (GvHD) following stem cell transplantation. METHODS: We carried out allogenic transplantation of the submandibular gland of the matched former stem cell donor to the temporal fossa of the stem cell recipient suffering from GvHD-induced dry eye. The treatment was carried out in two male patients who showed complete donor chimerism to the stem cell donors, so that no immunosuppressive therapy was applied. RESULTS: Postoperative clinical assessment of the patients revealed primary success of the procedure. The ocular surface showed improvement of lubrication and reduction of inflammatory signs. In the long-term follow-up sialoscintigraphy revealed lower tracer activity than expected and secretion of saliva-tears decreased. CONCLUSION: Even though the so-called total donor chimerism was assessed allogenic transplantation of the submandibular gland following GvHD-induced dry eye showed signs of organ rejection and therefore initial immunosuppressive therapy after allogenic transplantation has to be considered.

Tratamento das cavidades anoftálmicas secas com transplante de glândulas salivares labiais / Treatment of dry anophthalmic cavities with labial salivary glands transplantation

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.

[Treatment of dry anophthalmic cavities with labial salivary glands transplantation]. / Tratamento das cavidades anoftálmicas secas com transplante de glândulas salivares labiais.

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.

[Vision jeopardizing xerophthalmia in Denmark]. / Synstruende xeroftalmi i Danmark.

A 54-year-old alcoholic was admitted with keratomalacia in 2001. The right cornea had an ulceration and the left cornea had stromal necrosis and a perforation. Serum retinol and serum betacaroten were extremely low. Treatment consisted of high-dose retinol and left sided cornea transplantation. The right eye healed with little scarring, vision: 0.5. The left eye was stabilized after a second cornea transplantation and covering with conjunctiva, vision: hand movement at a distance of 1 m. This proves the existence of symptomatic vitamin A deficiency among socially exposed subjects in Denmark.

[Reliability of venae comitant of facial artery as the donor vein in microvascular autologous submandibular gland transfer].

OBJECTIVE: To analyse the reliability of concomitant venae of facial artery as the donor vein in microvascular autologous submandibular gland transfer. METHODS: One hundred and seventeen cases with severe keratoconjunctivitis sicca treated by microvascular transfer of autogenous submandibular gland transfer from August of 1999 to November of 2007 were reviewed. The cases were divided into three groups according to their different donor veins, with group A using facial veins, group B using concomitant venae of facial artery, and group C using a vein near the duct. Group A and B were compared in terms of venous thrombosis rate and failure rate related to venous thrombosis. RESULTS: Among 117 cases, there were 122 sides of submandibular gland transfers, with 93 in group A, 27 in group B, and 2 in group C. Postoperative venous thromboses rate was 15% in group A and 7% in group B, with significant difference (P < 0.01). The failure rate of transferred gland related to venous thrombosis was 8% in group A, and 7% in group B, with no significant difference (P > 0.05). CONCLUSIONS: Concomitant venae of facial artery can be used as reliable donor vein in microvascular autologous submandibular gland transfer.

Use of amniotic membrane graft and corneal transplantation in a patient with bilateral keratomalacia induced by uncontrolled phenylketonuria.

PURPOSE: To report a patient with a rare complication of bilateral keratomalacia induced by uncontrolled phenylketonuria (PKU) that was successfully treated with amniotic membrane transplantation in 1 eye and penetrating keratoplasty in the second eye. METHODS: Case report and literature review. RESULTS: A 9-month-old girl with uncontrolled PKU was referred to our clinic because of bilateral keratomalacia. Slit-lamp examination of the right eye revealed 2 large corneal erosions with stromal thinning on the nasal and inferior regions of the right cornea. Left eye examination revealed a large area of melting involving two thirds of the cornea with corneal perforation and iris bulging on the temporal side and no anterior chamber. She underwent amniotic membrane transplantation on her right cornea and penetrating keratoplasty on her left cornea. Treatment after surgery included antibiotic and steroid eye drops and a special diet regimen with partial phenylalanine intake. Examination under anesthesia 4 months after surgery revealed intact cornea in her right eye and a clear corneal graft with a deep anterior chamber on her left eye. Intraocular pressure was normal in both eyes. CONCLUSIONS: Bilateral keratomalacia, although a rare ophthalmic manifestation of PKU, can cause a severe corneal injury that may threaten the eyeball integrity. Surgical treatments with amniotic membrane graft and corneal transplantation, along with the appropriate diet treatment, were found to be effective procedures, yielding rapid healing of the corneal surface.

Submandibular gland transfer for severe xerophthalmia.

OBJECTIVE: To report early clinical experience with a new microvascular reconstructive procedure for patients with severe xerophthalmia. STUDY DESIGN: Retrospective clinical series. METHODS: Patients with severe xerophthalmia were referred for treatment after having exhausted all conventional means of treatment. The ipsilateral submandibular gland was transferred to the temporal fossa, as described by Macleod et al., and revascularized using the superficial temporal artery and appropriate vein(s). The submandibular duct was directed to the superolateral fornix so that the saliva produced moistened the eye. Results and complications were reviewed. RESULTS: Seven microvascular submandibular gland transfer procedures were performed in five patients, ages 6 to 54. The etiology of severe xerophthalmia was Stevens-Johnson syndrome in four and chemical burn in one. Follow-up time was 4 to 20 months. Successful transfer with revascularization was achieved in six of seven (86%) cases. Schirmer's test scores improved from 1.3 pretransfer to 8.1 posttransfer (P = .005). Patients experienced symptomatic relief within 1 month, and the microenvironment of the eye surface improved enough to make them candidates for visual restorative eye surgery. There were no major complications. CONCLUSIONS: Microvascular submandibular gland transfer is an effective approach for correcting severe xerophthalmia. The procedure should be within the skills of any reconstructive microsurgeon. This procedure offers a unique opportunity for otolaryngologist-head and neck reconstructive surgeons to help restore vision to this unfortunate group of patients.

[Transplantation of labial salivary glands for severe dry eye treatment]. / Transplante de glândulas salivares labiais no tratamento do olho seco grave.

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.

Transplante de glândulas salivares labiais no tratamento do olho seco grave / Transplantation of labial salivary glands for severe dry eye treatment

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.

[Long-term follow-up after autologous submandibular gland transplantation in scarring keratoconjunctivitis with absolute dry eyes]. / Mehrjahresverlauf nach Autotransplantation der Unterkieferspeicheldrüse bei vernarbender Keratokonjunktivitis mit absolutem Tränenmangel.

INTRODUCTION: An autologous submandibular gland can be transplanted to the temporal fossa and following microvascular anastomosis to the temporal artery and vein and implantation of the secretory duct into the superotemporal conjunctival fornix to provide continuous substitute lubrication. Here we report our experiences with this procedure. PATIENTS AND METHODS: In a prospective, controlled clinical cohort study, we investigated the development of the Schirmer- test, fluorescein-break up time (F-BUT), degree of discomfort, use of pharmaceutical tear substitutes, visual acuity, Rose Bengal staining and conjunctival hyperemia in 14 eyes with a successful submandibular gland transplant and 11 dry eyes without salivary lubrication. RESULTS: Over a mean postoperative period of 3.3 years the transplantation group showed significant improvements of the Schirmer-Test, FBUT, use of pharmaceutical tear substitutes, discomfort and Rose Bengal staining up to the last follow-up when compared to the preoperative and control groups. CONCLUSION: Transplantation of an autologous submandibular gland can improve the lubrication and discomfort of absolute tear deficiency on a long term basis, but the salivary tear film only partially stabilises the ocular surface. The procedure is however able to provide symptomatic relief in extreme cases of absolute dry eyes.

[Treatment of xerophthalmia by transplantation of autologous vascularized submandibular gland].

OBJECTIVE: To investigate the feasibility of treatment of xerophthalmia by transplantation of autologous vascularized submandibular gland (SMG). METHODS: The SMGs of 19 patients with severe keratoconjunctivitis were transferred to their temporal region by microsurgery. The arteries and veins of the SMGs were anastomosed to the super-temporal arteries and veins, the SMG ducts were implanted into the conjunctival fornix of the eye. The saliva secreted by the SMG was used as the substitute of tear. RESULTS: The transplantation succeeded in 14 patients and failed in 4. Follow up lastred for 3 months to 2 years. The symptom of corneal xerosis disappeared, the symptoms of photophobia and anemophobia were alleviated, and artificial tear substitutes were not used any more. Epiphora appeared in 4 cases and disappeared after partial resection of the transplanted gland. Atresia of orifice occurred in one case and was cured by reconstruction of the duct. CONCLUSION: Transplantation of autologous vascularized SMG is effective in treating severe keratoconjunctivitis sicca.

Bilateral corneal ulcers in primary vitamin A deficiency.

PURPOSE: To report a case of bilateral corneal ulcers and perforations resulting from hypovitaminosis A in an alcoholic patient. METHODS: A 38-year-old cachetic man presented with bilateral corneal ulcerations and severe visual loss. He was hospitalized, developed bilateral corneal perforations, and was treated with bilateral corneal transplants. RESULTS: Serum vitamin A level was 0.01 microg/dL (normal, 0.30-0.75). The electroretinogram was consistent with vitamin A deficiency. His clinical status improved after vitamin A replacement. CONCLUSIONS: Although rare in developed countries, the ophthalmologist must consider avitaminosis A in the differential diagnosis of corneal ulcerations in cachetic, alcoholic, or chronically ill patients. Early diagnosis and treatment can prevent unwanted outcomes.

[Reconstructive lacrimal gland with free submandibular gland transfer for management of xerophthalmia].

OBJECTIVE: In order to seek more efficient surgical method to treat total xerophthalmia. METHOD: Microvascular submandibular gland transfer was used to reconstruct lacrimal gland for management of the dry eye. 5 cases (6 eyes) with total xerophthalmia were operated with this method. RESULTS: All the patients were followed up for 1 - 30 months. The results were satisfactory, the submandibular salivary gland relieved the dryness and improved visual acuities with negligible side effect. CONCLUSION: Microvascular submandibular gland transfer is potentially the best surgical solution to total xerophthalmia.

Management of postblepharoplasty lower eyelid retraction with hard palate grafts and lateral tarsal strip.

Lower eyelid malposition is the most common long-term complication following transcutaneous lower eyelid blepharoplasty. The malposition may include rounding of the lateral canthal angle, lower eyelid retraction with inferior scleral show, or frank ectropion. The result is cosmetically unacceptable and may be associated with tearing, irritation, and other exposure keratitis symptoms. Multiple factors, including lower eyelid laxity, shortage of skin, and scarring of the middle lamella, may be responsible for this malposition. A systematic examination of the lower eyelid, as presented, helps to assess the degree to which each of these factors is responsible for the malposition. Patients with the most severe degree of lower eyelid malposition generally have middle lamella scarring. If this abnormality is not addressed, lower eyelid procedures aimed at correcting the malposition are doomed to failure. In the presence of significant middle lamella scarring, a spacer is required to provide vertical height and stiffness to support the lower eyelid following release of the cicatrix. A systematic approach aimed at addressing the underlying abnormalities was developed. In patients with significant middle lamella scarring, hard palate mucosa grafts were used as spacers in 29 eyelids (17 patients). A lateral canthotomy and transconjunctival incision allow access to the scarring in the lower eyelid retractors and septum. After careful release of all cicatrix, a hard palate mucosa graft is inserted between the lower border of the tarsal plate and the recessed conjunctiva, lower eyelid retractors, and septum. Horizontal lower eyelid laxity, when present, is corrected by performing a lateral tarsal strip. Most patients do not have a true deficiency of the anterior lamella (skin and orbicularis oculi muscle). When a moderate amount of anterior lamella deficiency is present with significant scarring of the middle lamella, the technique we describe allows correction of the lower eyelid malposition without a skin graft. After a follow-up interval of 6 to 30 months (mean 14 months), excellent results were obtained in all eyelids. Complications included corneal abrasions in two eyes before routine use of bandage cornea contact lenses at the end of surgery and a secondary bleed from the roof of the mouth in one patient. Palate mucosa closely resembles tarsus and provides excellent vertical support to the eyelid. It is stiff enough to maintain eyelid contour without causing a cosmetically unacceptable bump. Tissue can be obtained with ease. The technique, as described, addresses the underlying causes of lower eyelid malposition and gives excellent functional and cosmetic results.

Treatment of dry eye by blocking the lacrimal canaliculi.

Occlusion of the lacrimal canaliculi improves the objective signs and subjective symptoms of dry eye. In this review, methods of occlusion are classified as surgical, thermal and tamponade. Surgical methods include dacryocystectomy, canalicular ligature, canalicular offset, canalicular excision, transfer of the punctum to dry dock, punctal tarsorrhaphy and punctal patch. Thermal methods include cautery, diathermy and laser burn. Tamponade methods use absorbable inserts of hydroxypropyl cellulose, gelatin, collagen and catgut, and nonabsorbable inserts of silicone (punctum plugs, canalicular plugs), polyethylene, cyanoacrylate, and others. The characteristics of all these methods are analyzed.

[Management of the dry eye with parotid duct transplantation: a summary on 40 cases].

PURPOSE: As today the effect of parotid duct transplantation is clinically regarded as uncertainty, and there is still absent of effective managenent of the dry eye, this paper tries to clarify its value, and see if it can be used clinically. METHODS: Forty dry eyes were operated with a follow up of 3 weeks to more than 6 years in the past 42 years. The pre- and postoperative changes of tear flow and vision, and the cause of dry eye, operative method, length of parotid duct and complications of bilateral operation were briefly summarized. RESULTS: Of these 40 operated eyes postoperatively, 82.5% had tearing, but no tearing occurred in 27.5%. Finally: vision increased in 72.5% with out any decrease. There was no difference in the results whether the procedure done extraorally or intraorally. The parotid duct being shorter was only seen in 7.5%, which were satisfactorily managed by tube making with oral mucosa. Four cases operated binocularly and silmutaneously, only 1 occurred aveolar abscess with complaining dry mouth, but cured 1 week later. After operation, profusive tearing occurred in 25 dry eyes caused by trachoma during eating and 96% usually, but tearing stopped finally in 3 eyes (2, due to infection). Four dry eyes with ocular pemphigoid failed. Among 9 dry eyes resulted from Stevens-Johnson syndrome, 6 had little tearing postoperatively, 2 of which attained a nearly normal results. One of the two dry eyes resulted from alkali eye burn failed and the other, occurred tearing but only followed-up for 1 month, the result was uncertain. CONCLUSION: As the technique of the parotid duct transplantation is simple and easy with no much complications, and for treating the dry eye, there is up to now still absent of effective management, therefore, the parotid duct transplantation should be considered to be indicated in dry eyes esp, caused by Stevens-Johnson syndrome. Though its success rate is lower than that of traucomatous ones, the satisfactory result of nearly normal postoperative tearing may be got. In ocular pemphigoid, however, it is contraindicated.