Keratoplasty after gundersen flap for corneal ulcers resistant to conservative management
First Author: L.Furiosi ITALY
Co Author(s): C. Bovone R. Spena S. Socea A. Yu F. Fusco M. Busin
To report ouctcomes of corneal ulcers resistant to conservative management treated with staged surgery (Gundersen flap = step1; penetrating keratoplasty = step 2)
Tertiary Care Referral Center (Ospedali Privati Forlì, Villa Igea, Italy)
This retrospective interventional case series reviewed the clinical outcomes of ingravescent corneal ulcers unresponsive to conservative therapy that underwent staged surgical tratment with an initial Gundersen flap surgery followed by definitive corneal transplantation. Outcomes examined were BSCVA and rate of complication.
In all 6 cacases, conjunctival flap surgery halted the progression of the infection leading to clinical quiescence with stable ocular surface, arrested inflammatory response and preserved globe integrity. Mean interval to 2-piece mushroom PK was 9±2 months. BSCVA(logMAR) was 0.10±0.10 (range 0.0-0.2) at final postoperative visit with all eyes achieving Snellen BSCVA of 20/40 or better. With a minimum postoperative follow-up of 1 yesr, complete epithelial healing with no episode of rejection, recurrence of failure was documented.
Gundersen flap surgery is instrumental in achiving clinical quiescence and initial infection control. As an alternative PK à chaud, this temporizing measure can be employed prior to definitive keratoplasty as a two-stage procedure for corneal ulcers recalcitrant to conservative management.