Plastic repair of conjunctiva with peritoneum transplantation.

THE repair of conjunctival defects has always been a difficult problem. From time to time various tissues, such as Thier'sch's graft, mucous membrane from the oral cavity (lower lip and cheeks), inferior turbinates of the nose, amniotic membrane, and even skin from the prepuce and labia minora have been utilized. Mucous membrane from the oral cavity is most commonly used for grafting into the conjunctival sac. However, it is difficult to obtain the required extent of mucous membrane from the oral cavity, and, when such a graft takes, it tends to stand out thick and prominent and to differ in colour from the rest of the conjunctiva, so that the cosmetic results are generally unsatisfactory. In 1954, while working in the general surgical department at Hexham Hospital, Northumberland, England, I was struck with the extreme thinness and transparency of the inguinal hernial sac and with its suitability for transplantation into the conjunctival sac. It was not until late 1956 that I was able to undertake an experimental study of this problem. To date, I have successfully transplanted slips of peritoneum on to palpebral conjunctiva in 23 cases of entropion (modified Webster's operation), and on to bulbar conjunctiva in two other cases. In another case, the whole of the mucous membrane of the contracted socket was dissected out and replaced with peritoneum. The results of these trials are described below.