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 (23â-â87 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.
Subject(s)
Corneal Diseases , Corneal Transplantation , Adult , Aged , Aged, 80 and over , Amnion/transplantation , Conjunctiva/surgery , Cornea , Corneal Diseases/surgery , Female , Humans , Male , Middle Aged , Young AdultABSTRACT
BACKGROUND: Tectonic eccentric sclerokeratoplasty à chaud is a very complex corneal operation and aims to preserve the eyeball and possibly to improve visual acuity in patients with peripheral corneal ulcerations or perforating corneal trauma. METHODS: 1650 eyes received corneal transplants in our clinic between 2006 and 2019. 14 of these 1650 eyes (0.8%) had a perforated or predescemetal peripheral corneal ulceration and these were treated between 2006 and 2019 with a tectonic eccentric sclerokeratoplasty à chaud. The mean age of the 8 women and 6 men included in this case series was 63 years (22â-â91 years). RESULTS: In the postoperative follow-up period, most complications and reoperations occurred in the first 6 months. Re-ulceration was observed in 2 cases as well as early suture loosening in 12 patients. These 2 cases were treated with a partial conjunctival flap. Additionally, prolonged superficial wound healing process was shown in 12 patients. Therefore 27 amniotic membrane transplantations, 12 suture replacements, and 6 partial conjunctival flaps were performed in total. No re-keratoplasties were required in this case series. All eyes could be stabilised through the sclerokeratoplasty as well as subsequent operations and intensive local or even systemic treatment. After removal of the corneal suture, the best-corrected visual acuity improved only insignificantly to hand movement in 1 case, finger counting in 3 cases, 0.1 in 5 cases, 0.2 in 4 cases and 0.5 in 1 case. Preservation of the eyeball with pain relief was achieved in all 14 eyes. CONCLUSIONS: Eccentric sclerokeratoplasty is a very demanding surgical procedure and is extremely rarely performed. The goal is to preserve the eye.
