1. Ana Estela BPP Sant´Anna, Rossen Harzarbassanov, Aline L Araújo, Tammy H Osaki, Midori H Osaki, Vera LL Costa, Hellen PR Santos, Denise de Freitas, José AP Gomes Federal University of Sao Paulo Vision Institute Sao Paulo. SP. Brazil. We do not have any financial interests or relationships to disclose

2. Stevens-Jonhson Syndrome Stevens-Jonhson syndrome is an immunological disease that causes dry eye and severe cicatricial changes in the cornea, conjunctiva and eyelids.

3. Purpose  Evaluate salivary gland and labial mucous membrane transplantation in the treatment of patients with severe symblepharon and dry eye secondary to SSJ

4. Patients and Methods  Design Prospective interventional non-comparative case series Federal University of Sao Paulo. Sao Paulo. SP. Brazil. 2006 -2009  Inclusion criteria Stevens-Johnson syndrome ○ Severe dry eye Previous Schirmer I test = 0 ○ Severe Symblepharon ○ Poor visual acuity

5. Steps of surgery: A.pre operative, B.obtaining mucous membrane graft from inferior and superior lip with Ficas mucotome, C.labial mucous membrane attached to the sclera, D.obtaining the salivary glands, E.fixing the salivary glands, F.postoperative.

6. Results: Salivary Gland Transplantation Case Age/Sex Schirmer Pre (mm) Schirmer PO (mm) Visual acuity improvement Symptoms Improvements FU (months) 1. ANS 43 ♂ /0 →↑21 2. AAP 13 ♀ 01↑↑23 3. ALAJ 58 ♂ 02→↑5 4. CTO 18 ♀ 01↑↑27 5. CFS 52 ♂ 00→↑8 6. DMAA 41 ♀ 03↑↑20 7. FL 36 ♂ /0 →↑3 8. IG 45 ♀ 01→↑15 9. JLBS 10 ♂ 03→↑35 10. LBS 13 ♂ 01→↑26 11. LMC 31 ♂ 03→↑15 12. LCPG 35 ♂ 04↑↑13 13. MSA 37 ♀ 00↑↑17 14. MPSN 16 ♂ 011↑↑28 15. MLO 40 ♀ /0/3↑↑20 16. MRMS 24 ♀ /0/3→↑17 17. NRAO 17 ♀ /0 ↑→20 18. PAP 35 ♂ /0/5↑↑32 19. TMLL35 ♀ 04→↑26

7. Results Results 19 eyes (19 patients with SJS) 19 eyes (19 patients with SJS) Age: 10-58 yo (mean 31 yo) FU time: 3-35 months (mean 19) 47% improvement of VA 47% improvement of VA Salivary Gland Transplantation Federal University of Sao Paulo Sant´Anna & Gomes, 2009

8. Schirmer I test 14/19 patients (73%) 10 (52%) ≥ 2mm. 10 glands (p=0.0129) = increase tears Group1 (Schirmer =0mm) Group2 (Schirmer ≤2mm) Group3 (Schirmer <2mm) ϰ 2 test P= glands (0-5) 66.67(2/3)33.33(1/3)0(0/3)0.6065 glands (5-10) 28.57(2/7) 42.86(3/7)0.1826 glands ( > 10) 10(1/10)20(2/10)70(7/10) 0.0129 Schirmer I test versus transplanted salivary glands

9. 52.6% improvement corneal transparency 73.6% improvement corneal neovascularization Grade 3 (%)Grade 4 (%) chi- squared or ϰ 2 test PrePostPrePostPrePost Transparency 0 (0/19) 10.53 (2/19) 15.79 (3/19) 63.16 (12/19) 84.21 (16/19) 26.32 (5/19) 0.0014 Neovascularization 0 (0/19) 10.52 (2/19) 5.26 (1/19) 26.33 (5/19) 94.74 (18/19) 63.15 (12/19) 0.0532

10. Pre Post Pre

11. Pre and postoperative. Notice the labial mucosa harvesting the entire sclera, at right. It looks like a new conjunctiva Pre Post

12. Conclusions  Salivary gland and oral mucosa tp seems to be efficient in treating severe dry eye 2ry to SJS and maybe improve the results of limbal SC tp  The procedure is reproducible and needs to be performed under general anesthesia  More cases and longer FU time are needed to further confirm our findings anestela@uol.com.br