Conjunctival Flaps: A Case Series and Review of the Literature

Abstract

Purpose: The purpose of this study was to examine the outcomes of conjunctival flaps performed at our institution. Methods: The medical records of all patients who underwent a total or partial conjunctival flap surgery over the course of a 6-year period from 2010 to 2015 were reviewed to identify the ocular diagnoses and perform a retrospective review of the preoperative and postoperative course. Results: Thirty-five patients received a conjunctival flap during the 6-year period, 20 partial flaps and 15 total flaps. Infectious keratitis or corneal ulceration accounted for 25 (71.4%) of the cases. The remaining flaps were performed for corneal perforation, graft rejection, bullous keratopathy, and secondary corneal edema. Seven patients had recession of their flap postoperatively, and 14 went on to have further surgical intervention. Conjunctival flap surgery successfully stabilized the patient's ocular surface in 97.1% of the cases. Conclusion: Conjunctival flap surgery is an important and useful surgical option in the treatment of ocular surface disease, especially recalcitrant infectious keratitis and corneal ulcers.

Diabetic Corneal Neuropathy

“…Conjunctival flaps may be useful in the management of non-healing corneal epithelial defects where medical management has failed because they provide vascular blood supply and serum-derived growth factors to the non-healed area [106][107][108]. This facilitates the inhibition of the ongoing inflammatory process and promotes epithelial healing.…”

“…This facilitates the inhibition of the ongoing inflammatory process and promotes epithelial healing. However, disadvantages of conjunctival flaps include reversibility issues, flap retraction and risk of corneal perforation under the flap [106][107][108]. Despite disadvantages, conjunctival flaps, such as Gundersen's flap and pedicle flap, are commonly used to treat non-healing neurotrophic ulcers [109,110].…”

Spontaneous intraocular lens extrusion through Gundersen conjunctival graft after multiple failed keratoplasties: A report of two cases

“…Although its usage has been in part replaced by tectonic PK or amniotic membrane transplantation, the Gunderson flap still has indication for globe salvage in case of multiple graft failures, unresponsive infectious keratitis, corneal ulcer with or without perforation; in eyes with visual potential, it can represent a bridge therapy to optical PK for visual rehabilitation. 7 Both our cases are unique since IOL extrusion occurred spontaneously through a Gunderson conjunctival graft performed to cover a failed PK. This series raises various open questions that deserve mentioning.…”

“…This flap has been used for decades in a variety of ocular surface diseases, such as corneal melting and perforation, severe DED, neurotrophic keratopathy and recalcitrant corneal ulcers, among others. 6–8 The flap covers the cornea and protects it from further stromal lysis and erosion caused by tear enzymes, forming a resilient, vascular surface that provides nutrients, growth factors, anti-collagenases, and infection resistance. Although its usage has been in part replaced by tectonic PK or amniotic membrane transplantation, the Gunderson flap still has indication for globe salvage in case of multiple graft failures, unresponsive infectious keratitis, corneal ulcer with or without perforation; in eyes with visual potential, it can represent a bridge therapy to optical PK for visual rehabilitation.…”

Combined Rothia dentocariosa and Streptococcus viridans Corneal Ulcer in an Immunocompromised Patient

“…Conjunctival flaps were first started in the 1800s and used for corneal ulcerations and thinning disorders. Their purpose is to restore the integrity of the compromised corneal surface and provide metabolic and mechanical support for corneal healing [17,18]. They can be used in cases where medical treatment has been exhausted to resolve infection such as our patient but are usually used for cases with marginal fungal ulcers but have also been shown to benefit in other infectious keratitis such as Acanthamoeba [19].…”