Modified Gundersen Flap Using Inferior Palpebral–Bulbar Conjunctiva

Abstract

The purpose of this article was to describe a modification to the traditional Gundersen flap technique that expands eligible eyes to include those with severe conjunctival scarring and to report results from a clinical case.Methods: A 68-year-old woman with a history of herpes simplex keratitis, multiple failed penetrating keratoplasties, lagophthalmos, persistent epithelial defect, and low visual potential in the left eye presented for the evaluation of a Gundersen flap. Severe superior bulbar conjunctival scarring precluded a traditional approach. A modified Gundersen flap technique using a contiguous flap of inferior palpebral-bulbar conjunctiva extending from the inferior tarsal border to the limbus was devised and performed. Results:The modified Gundersen flap technique successfully stabilized the ocular surface, obviating the need for a cosmetically disfiguring permanent tarsorrhaphy or an evisceration.Conclusions: This modified Gundersen flap technique expands the indications to eyes with severe conjunctival scarring and can be offered in eyes with previous trabeculectomies, glaucoma drainage implants, and scleral buckles, which were previously excluded from the globe-preserving option.

Levator Palpebrae Superioris With Inferior Oblique Muscle Flaps for Total Ocular Surface Reconstruction

“…Furthermore, in ocular surface reconstruction, a well-vascularized flap is oftentimes integral in treating corneal-scleral pathology using techniques, such as conjunctival-Muller muscle, Gunderson, or local forniceal-derived conjunctival flaps. 6–8 Although it is possible that the patient could have developed postoperative intraocular complications related to extensive thermal injury, the tissue overlying the surface remained pink and well-vascularized, without external signs of panophthalmitis or necrosis that would otherwise be expected in the setting of infectious keratitis or endophthalmitis.…”

Herpes simplex keratitis: A brief clinical overview

“…There are several surgical interventions for the management of HSK but it basically involves either the replacement of the infected tissue or support of the tissue to aid healing. Cornea neurotization is gaining more acceptance today[ 442 - 444 ]. Lin and Lai reported a novel technique where the supratrochlear nerve of the same side as the affected eye was tunneled to the cornea to re-innervate damaged trigeminal nerve fibers with good results[ 445 ].…”