Subcutaneous abdominal artificial tears pump-reservoir for severe dry eye

Abstract

Purpose: To assay a totally implanted pump-reservoir unit placed under the subcutaneous tissue of the abdomen for providing artificial tears to the ocular surface in patients with severe dry eye.

Design: Prospective non-randomized comparative (self-controlled) trial.

Participants: Six patients with severe dry eye, in whom intermittent moistening of the ocular surface with current collyria was clinically unsatisfactory.

Methods: The six patients were treated by implanting an artificial tear pump-reservoir unit under the subcutaneous tissues of the abdomen. The reservoir is operated by a gas pump, which pumps artificial tears to the eye from a 60-ml reservoir through a silicone tube leading subcutaneously from the reservoir, via the chest, neck and lateral part of the head, and entering the conjunctival sac over the lateral canthal ligament. The catheter is anchored to the aponeurosis of the temporal muscle at the lateral rim of the orbit with a butterfly sleeve. The terminal portion of the tube runs freely along the upper conjunctival fornix, and pours 1.5 ml/day of the artificial tears into the ocular lacrimal basin with a constant flow rate. The reservoir must be refilled by percutaneous injection of artificial tears every 45 days.

Main outcome measures: Schirmer test, corneal fluorescein staining, lacrimal film breakup time, lacrimal osmolarity, corneal impression cytology, best-corrected visual acuity, dryness sensation and blepharospasm before and after lacrimal reservoir implantation.

Results: The lacrimal subcutaneous abdominal reservoir was well tolerated with little discomfort. A delivery of 1.5 ml/day was enough to maintain a comfortable wet eye. After an average follow-up of 15 months the signs and symptoms of dry eye were dramatically improved. Four of the patients had a severe blepharospasm, which disappeared some weeks after the implantation of the lacrimal abdominal reservoir.

Conclusion: These are the first totally implanted lacrimal reservoirs in human beings. They have proved to be a good solution for severe dry eye. At present, this method is the only one that permits a maintained wet eye surface, and the performance of corneal, conjunctival, limbal and amniotic membrane transplants in total or almost total xerophthalmia. It may also be a good solution for some of the so-called essential blepharospasms, which are frequently triggered by an underlying dry eye.