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Rectal mucous membrance graft in dry eye

In dry eye due to S. J. Syndrome & chemical burn the main problem is conjunctiva is destroyed. There is extensive conjunctival damage resulting mainly in deficiency of the mucin component of tear film, which is secreted by the goblet cells of the conjunctiva. The conjunctiva contains goblet cells. This results in mucin deficiency dry eye. So the ideal way of treating this will be replacing the goblet cells. To replace these goblet cells, I am doing rectal mucous membrane graft in these patients. Why to use rectal mucous membrane only? Because, it, is studded with goblet cells. The buccal mucous membrane does not contain goblet cells. So even if you transplant it, that serves the purpose of mucous membrane but does not replace the goblet cells. If we use the rectal mucous membrane of the patient then that replaces the goblet cells. This becomes the natural continuous source of mucin.

In this procedure rectal mucous membrane of the patient is obtained with the help of general surgeon. Patient is operated under spinal anesthesia. The mucous membrane is obtained from posterior wall of rectum. Nearly 30 mm x 60 mm is sufficient for both eyes and both fornices. This mucous membrane is kept in povidone-iodine solution 0.5%, which is used for cleansing mucous membrane for 30 minutes.

The conjunctiva is incised in lower & upper fornix. No part of conjunctiva is excised. To the free edges of conjunctiva the rectal mucous membrane of 30 mm x 15 mm is sutured. (See fig. 4) Fornix deepening sutures are taken (as in any other shallow fornix repair surgery refer to J.R.O.Collin systematic eyelid surgery.) the surgery is same as any other fornix deepening surgery but instead of buccal mucous membrane use rectal mucous membrane. There is no need of any shell to be put.

This gives continuous source of mucin. The results of this procedure are quite encouraging. Of course the other surgeries may be needed like stem cell graft and keratoplasty.

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It must have high chances of infection?

Really speaking no. The mucous membrane really has great resistance against infection. This is some thing similar to buccal mucous membrane graft. The buccal mucous membrane also has high bacterial flora. But it does not cause infection in the eye and the oral wound also gets healed up without infection.
Refer to Indian journal of Ophthalmology issue no. TBD*****