Microsurgical Approach to the Conjunctival Flap

Abstract

To describe a microsurgical approach to a selective pedunculated conjunctival flap for the treatment of chronic corneal ulceration with or without corneal perforation, and to present the results of 50 consecutive cases. Design: Retrospective, noncomparative case series and case reports. Patients: All patients who had microsurgical conjunctival flap procedures for the treatment of chronic corneal ulcers between 1982 and 1996 at the Connecticut Eyecare Center, New Haven. Interventions: Partial pedunculated conjunctival flap surgery. Methods: Review of the initial ocular diagnoses and characteristics as well as retrospective study of the postoperative course. Main Outcome Measures: Resolution of the corneal ulcer and postoperative stability of the conjunctival flap. Results: Sixty-two percent of the corneal ulcers treated were nonperforated, and 38% were perforated. The diagnoses included herpes simplex virus (14 patients), bacterial ulcer (11 patients), rheumatoid arthritis (8 patients), aphakic bullous keratopathy (6 patients), graft rejection (4 patients), herpes zoster virus (5 patients), and other (2 patients). Postoperatively, 94% of the conjunctival flaps were stable, and 3% had failed. The procedures were definitive in 64% of cases and temporary in 36%; 61% of patients received a corneal transplant 6 to 24 months postoperatively, and in 38% the flaps were removed 6 to 12 months after the original lesion had healed. Conclusion: A selective pedunculated conjunctival flap is an effective and practical surgical approach to the treatment of perforated and nonperforated corneal ulcers that have not responded to other types of medical therapy.

Efeito terapêutico do crosslinking corneal na ceratite infecciosa

“…Thus, even with timely treatment, the inflammatory process may progress with worsening ulceration, corneal melting, and ocular perforation (4,8) . When medical treatment fails, surgical procedures such as a conjunctival flap or corneal transplantation can be used (14)(15)(16) . Studies show that therapeutic transplants represent 2.6% to 17.9% of total penetrating transplants (17) .…”

Management of inflammatory corneal melt leading to central perforation in children: a retrospective study and review of literature

“…Treatment options for corneal melt and perforations include medical therapy of underlying diseases and; simple measures such as BCL, corneal gluing, and tarsorrhaphy. 21 If these methods fail, then authors have described the use of conjunctival flaps, 22 AMT, 23 lamellar keratoplasty (LK), 24 deep lamellar keratoplasty (DLK), 25 patch graft, 12 or PKP. 18,19 Tissue adhesives can be used to close small perforation (up to 3 mm in diameter) and may slow down stromal melting.…”

Therapeutic deep lamellar keratoplasty for corneal perforations

“…6 If these methods fail, surgical intervention in the form of a scleral patch graft, CPG, or amniotic membrane transplantation may be performed. 1,5,7,[16][17][18] Conjunctival flaps restore ocular surface integrity, provide mechanical support, and are thought to promote healing by neutralising collagenases implicated in corneal melting. 5,7 Gundersen 19 described a technique that involved a 3601 peritomy, with coverage of the entire cornea with conjunctiva.…”

“…Recently described techniques use a partial, pedunculated conjunctival flap or graft, which does not limit visualisation of the anterior segment and allows corneal disease progression to be monitored. 5,7 However, this technique may still lead to significant vascularisation of the cornea, compromising visual potential and reducing the probability of success of subsequent keratoplasty.…”

“…Short-term measures have included therapeutic soft contact lenses, tissue adhesives, epithelial transplantation, scleral patch grafts, conjunctival flaps, and amniotic membrane transplantation. [1][2][3][4][5][6][7] Although these procedures may restore the integrity of the globe, they fail to achieve a clear visual axis. Penetrating keratoplasty (PK) eliminates the scar and corneal surface abnormalities, offering a chance of visual recovery, but its success in the presence of inflammation has been variable and generally poor.…”