title: Treatment of symptomatic bullous keratopathy with poor visual prognosis using a modified Gundersen conjunctival flap and amniotic membrane.
abstract: A modified Gundersen conjunctival flap combined with amniotic membrane to treat symptomatic bullous keratopathy and poor visual prognosis is described. A 360° conjunctival peritomy was performed 2 mm from the limbus. After complete epithelial removal of the corneo-conjunctival surface, an amniotic membrane graft was sutured at the peripheral cornea with a running 10-0 nylon suture. Single 9-0 polyglactin sutures attached the edges of the amniotic membrane with the peritomized conjunctiva, which lay over the amniotic membrane. Five eyes were treated. Epithelialization, resolution of the pain, presence of ocular surface inflammation, and reinterventions were assessed. All eyes showed immediate resolution of the pain and minimal inflammation. In 1 eye, the amniotic membrane was reabsorbed before complete epithelialization. No reinterventions were required. All eyes were asymptomatic for at least 16 months. This technique provided sustained relief of symptomatic bullous keratopathy while significantly reducing the conjunctival manipulation and the anatomical distortion associated with classic sliding conjunctival flaps.
authors.affiliation: Cornea and Refractive Surgery Unit, Instituto Microcirugia Ocular, Universitat Autonoma de Barcelona, Barcelona, Spain. guell@imo.es
authors.forename: Jose L
authors.initials: JL
authors.lastname: Güell
authors.forename: Merce
authors.initials: M
authors.lastname: Morral
authors.forename: Oscar
authors.initials: O
authors.lastname: Gris
authors.forename: Daniel
authors.initials: D
authors.lastname: Elies
authors.forename: Felicidad
authors.initials: F
authors.lastname: Manero
mesh_terms: D000650:Amnion / Q000637:transplantation*; D001768:Blister / Q000503:physiopathology / Q000601:surgery; D003228:Conjunctiva / Q000637:transplantation*; D003316:Corneal Diseases / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D011379:Prognosis; D013524:Surgical Flaps; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology