Conjunctival flaps

Abstract

The authors believe conjunctival flaps are underused and should be considered seriously for bullous keratopathy, neurotrophic keratitis, recalcitrant keratitis, and persistent nonhealing epithelial defects.

Fungal infections of the cornea

“…For management of small superficial ulcers, the methods advocated include debridement or pedicle (racquet) conjunctival flaps (for small peripheral ulcers) in association with antifungal therapy; tissue adhesives (n-butyl cyanoacrylate glue) and a bandage contact lens have also been advocated. 5,10,13,55 For more severe ulcers, a Gunderson flap may be tried; however, this procedure is technically difficult to perform since the tissue bleeds profusely, the view of the ulcer is obscured therein precluding monitoring, perforation of the flap and ulcer may occur, the infected material is not removed, and penetration of antifungals may be hindered 55 . Fullthickness corneal grafting (penetrating keratoplasty) is indicated if there is impending perforation, if a perforation exceeding 2 mm has occurred, or if there is no response to medical therapy.…”

Superior forniceal conjunctival advancement pedicles (SFCAP) in the management of acute and impending corneal perforations

“…6,8,12 Restoration of the integrity of the globe is paramount to restore vision. Nontraumatic corneal perforations often occur in eyes with debilitating ocular surface disorders, which further compromise the therapeutic approach.…”

“…The extent of conjunctival dissection is very much less than in Gunderson and other similar techniques, where fairly extensive perilimbal conjunctival dissection and mobilisation is required. 2,[8][9][10]13 Furthermore, in the superior forniceal region, conjunctiva is fairly redundant, vascular, and usually well preserved. These are features that facilitate dissection and mobilisation without compromising the donor site, for example should future procedures such as trabeculectomy be contemplated.…”

“…The Gunderson flap requires extensive dissection of the conjunctiva and furthermore, the flap may totally obscure the view of the cornea after the procedure. [6][7][8][9][10] In Cies's racquet conjunctival flap procedure, a smaller racquet-shaped perilimbal conjunctival flap is mobilised to cover the corneal ulcer. 11 Generally, these conjunctival flaps are considered not suitable to deal with impending perforation and perforated corneas as only a very thin layer of conjunctiva covers the ulcer.…”

Sight and comfort: complex procedures in end-stage Stevens–Johnson syndrome

“…Its intact primary vascularisation and superior tensile strength provide a major advantage over thin conjunctival flaps or avascular grafts. 9,10 The disadvantages of the procedure such as poor cosmesis, a most profound reduction of vision and the need to reconstruct the lower lid in a second procedure are justified only in cases such as ours when mucous membrane grafts are likely to fail, especially on the avascular bed of a fresh corneal graft.…”