Abstract
Background The coverage of chronic and painful corneal defects with a
complete or partial conjunctival flap is a surgical practice that is still
applied to advanced stage of keratopathies, which insist despite repeated
treatments with a therapeutic contact lens, corneal transplantation or amniotic
membrane transplantation.
Material and Methods 37 cases of refractory corneal defects were treated
between January 2006 and December 2019 with conjunctival flap. 27 cases
underwent a complete and 10 cases a partial conjunctival flap. The mean age of
the patients (n = 37, 23 women and 14 men subjects) was 73 years (23 – 87
years). Unsuccessful efforts of intensive conservative treatment and repetitive
surgical procedures for several weeks or even months ended up to the indication
of performance of a conjunctival flap. Conjunctival flap was performed using the
Gundersen technique. A very thin flap of the upper bulbar conjunctiva is
dissected downward towards the limbus without creating buttonholes. When the
limbus is reached, the resultant flap is freed and without tension it is pulled
over the corneal defect and sutured with nylon sutures placed at the limbus
(complete conjunctival flap) or at the stroma of healthy cornea (partial
conjunctival flap).
Results This kind of conjunctival flap has low rates of complication. The
postoperative follow-up after the partial or complete conjunctival flap was
satisfying in 34 cases and showed a good healing process without major
complications. Partial conjunctival flap shrinkage was observed in 3 cases,
which could be revised in 2 of them. One case underwent enucleation, because of
recurrent severe keratopathy.
Conclusion Conjunctival flap is an established surgical procedure that is
applied rarely. The more frequent performance of this technique is suggested as
it consists the ultima ratio for the treatment of refractory neurotrophic
keratitis and non-healing epithelial defects.
Key words
conjunctival flap - neurotrophic keratopathy - corneal ulcer - Gundersen technique
