Clinical Outcomes of Conjunctival Flap Surgery for Refractory Infectious Keratitis: A Retrospective Case Series

To evaluate clinical outcomes of conjunctival flap surgery in the management of refractory infectious keratitis at a tertiary care center.

This retrospective, single-center case series included patients who underwent complete or partial conjunctival flaps for infectious keratitis at the Bascom Palmer Eye Institute between January 2015 and March 2023. Cases were identified via Current Procedural Terminology codes and confirmed by chart review. Surgical success was defined as infection resolution without further surgery or ongoing antimicrobial therapy. Independent samples t tests and χ 2 tests compared continuous and categorical variables, respectively. Kaplan-Meier survival analysis evaluated time to resolution, with group differences assessed using log-rank and generalized Wilcoxon tests.

Nine patients (43%) received complete flaps, and 12 (57%) received partial flaps. Surgical success was achieved in 55.6% of complete flaps and 66.7% of partial flaps. Larger ulcer area was associated with flap failure ( P = 0.021). Best-corrected visual acuity at last follow-up was better ( P = 0.043) among partial flap cases (1.7 ± 1.0 logMAR) compared with those of complete flaps (2.7 ± 0.7 logMAR). Kaplan-Meier survival analysis showed that time to resolution differed by flap type according to the Wilcoxon test ( P = 0.029) and a trend toward significance by the log-rank test ( P = 0.053), suggesting earlier resolution among partial flap cases.

Conjunctival flaps achieved infection resolution in most cases of refractory infectious keratitis, with partial flaps showing slightly higher overall success and earlier resolution. These findings support conjunctival flaps as a salvage option, particularly in resource-limited or refractory settings, although further prospective evaluation is warranted.