Treatment of Chronic and Painful Corneal Defects with a Complete or Partial Conjunctival Flap

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.

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).

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.

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.