Outcome of conjunctival flap surgery in case of non-healing corneal ulcer in a multi-specialty eye hospital of Northern Bangladesh
Keywords:Non-healing corneal ulcer, Conjunctival flap, Gunderson flap
Background: This retrospective study evaluates the outcomes of conjunctival flap surgery for non-healing corneal ulcers at a tertiary eye hospital that were resistant to medical treatment.
Methods: The study included 47 eyes of 47 patients with deep corneal ulcers who underwent conjunctival flap surgery in a multi-specialty eye hospital between April 2020 and January 2022. The follow-up period was 12 months. Primary outcome measures included the restoration of ocular surface integrity, while secondary outcomes assessed improvements in visual acuity and postoperative complications.
Results: Among the 47 patients, 30 (63.82%) were male, and 17 (36.17%) were female, with a mean age of 52.13±14.91 years. The mean ulcer diameter was 4.52±2.02 mm, and the mean ulcer depth was 65±22.20% of the corneal thickness. An anatomic cure was achieved in 34 (72.34%) of the 47 eyes. Three eyes that failed to respond to conjunctival flap surgery required evisceration. Postoperative visual acuity improved in 15 eyes with peripheral ulcers. Common postoperative complications included flap retraction, flap necrosis, granuloma formation, and perforation.
Conclusions: Conjunctival flap surgery is an effective treatment for non-healing corneal ulcers, providing ocular surface integrity and supporting corneal healing. It can potentially eliminate the need for emergency penetrating keratoplasty or prepare the eye for future optical keratoplasty.
Raj A, Bahadur H, Dhasmana R. Outcome of therapeutic penetrating keratoplasty in advanced infectious keratitis. J Curr Ophthalmol. 2018;30(4):315-20.
Austin A, Lietman T, Rose-Nussbaumer J. Update on the Management of Infectious Keratitis. Ophthalmology. 2017;124(11):1678-89.
Bhatt P, Lim L, Ramaesh K. Therapeutic deep lamellar keratoplasty for corneal perforations. Eye. 2007;21:1168-73.
Gundersen T, Pearlson HR. Conjunctival flaps for corneal disease: their usefulness and complications. Trans Am Ophthalmol Soc. 1969;67:78-95.
Lim LS, How AC, Ang LP, Tan DT. Gundersen flaps in the management of ocular surface disease in an Asian population. Cornea. 2009-08;28(7):747-51.
Zemba M, Stamate AC, Tataru CP, Branisteanu DC, Balta F. Conjunctival flap surgery in the management of ocular surface disease (Review). Exp Ther Med. 2020;20(4):3412-6.
Stamate AC, Tătaru CP, Zemba M. Emergency penetrating keratoplasty in corneal perforations. Rom J Ophthalmol. 2018;62(4):253-9.
Sandinha T, Zaher SS, Roberts F, Devlin HC, Dhillon B, Ramaesh K. Superior forniceal conjunctival advancement pedicles (SFCAP) in the management of acute and impending corneal perforations. Eye (Lond). 2006;20(1):84-9.
Jhanji V, Young AL, Mehta JS, Sharma N, Agarwal T, Vajpayee RB. Management of corneal perforation. Surv Ophthalmol. 2011;56(6):522-38.
Stamate AC, Tătaru CP, Zemba M. Update on surgical management of corneal ulceration and perforation. Rom J Ophthalmol. 2019;63(2):166-73.
Sharma A, Mohan K, Sharma R, Nirankari VS. Repositioning of pedicle conjunctival flap performed for refractory corneal ulcer. Middle East Afr J Ophthalmol. 2014; 21(1):89- 91.
Abdulhalim BE, Wagih MM, Gad AA, Boghdadi G, Nagy RR. Amniotic membrane graft to conjunctival flap in treatment of non-viral resistant infectious keratitis: a randomised clinical study. Br J Ophthalmol. 2015;99(1):59-63.
Zhou Q, Long X, Zhu X. Improved conjunctival transplantation for corneal ulcer. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2010;35(8):814-8.