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Updated: Oct 6, 2025

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Modified Gundersen Flap Using Inferior Palpebral-Bulbar Conjunctiva.

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A modified Gundersen flap technique addresses severe conjunctival scarring, offering a globe-preserving option for complex ocular surface cases. This surgical modification expands treatment possibilities for patients previously excluded from traditional methods.

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Area of Science:

  • Ophthalmology
  • Ophthalmic Surgery

Background:

  • The Gundersen flap is a standard surgical technique for ocular surface reconstruction.
  • Severe conjunctival scarring can limit the applicability of traditional surgical approaches.

Observation:

  • A modified Gundersen flap technique was developed for a patient with severe conjunctival scarring, lagophthalmos, and persistent epithelial defect after multiple failed corneal transplants.
  • The modification involved using a contiguous flap of inferior palpebral-bulbar conjunctiva.

Findings:

  • The modified Gundersen flap successfully stabilized the ocular surface.
  • This technique obviated the need for a permanent tarsorrhaphy or evisceration.

Implications:

  • This modified technique expands the indications for Gundersen flaps to include eyes with severe conjunctival scarring.
  • It offers a globe-preserving option for eyes with complex histories, including previous glaucoma surgery (trabeculectomies, glaucoma drainage implants, scleral buckles).