Therapeutic effects of corneal ulcer debridement combined with conjunctival flap covering surgery for corneal infection

Abstract

Objective To study the therapeutic effects of corneal ulcer debridement combined with conjunctival flap covering surgery for corneal infection. Methods In a retrospective case series study, 102 patients with infectious corneal ulcers who underwent corneal ulcer debridement and conjunctival flap covering surgery in Qingdao Eye Hospital from May 2002 to June 2014 were reviewed. Pathogens of infection, surgical complications, surgical effects, and the change in visual acuity (logMAR) were analyzed. A rank sum test of paired samples was used for statistical analysis. Results Corneal infections were successfully controlled in 99 of the 102 patients (97.0%). Of the remaining three, two patients needed (2.0%) penetrating keratoplasty (PKP) for surgical failure and one patient (1.0%) developed conjunctival flap withdrawal but refused further treatment and was lost to the follow-up. No obvious abnormalities were seen in 89 cases during the follow-up period. There were abnormalities in the other 13 patients: conjunctival flap withdrawal was observed in six patients, of which one patient underwent PKP for corneal perforation after conjunctival flap resuture surgery, one patient refused a second surgery and was lost to follow-up after being discharged from the hospital, and ulcers healed in the other four patients after conjunctival flap resuture surgery. Corneal ulcer was observed during the follow-up in four patients after the primary corneal ulcer had healed. PKP was performed on two patients for an aggravated ocular situation after the surgery, including a patient with corneal perforation after conjunctival flap resuture surgery. Bullous keratopathy and an epithelial implantation cyst under the conjunctival flap were observed in one patient. In the 99 eyes with surgical success, preoperative uncorrected visual acuity (UCVA) was 3.90 (2.60, 4.30) and postoperative UCVA was 4.00 (2.60, 4.48). The difference was not statistically significant (Z=-1.77, P>0.05). Seventy-two patients were followed up regularly for more than 3 months (mean, 6.1 ± 5.0 months). Of these, the preoperative UCVA and postoperative UCVA at the final follow-up were 4.0(2.60, 4.40) and 4.3 (3.40,4.70), respectively, and the difference was statistically significant (Z=-2.74, P<0.01). Conclusion Corneal ulcer debridement combined with conjunctival flap covering is an effective surgery to control corneal infection. The surgery has a high success rate and infrequent complications, and it can help save the eyeball as much as possible and retain reliable postoperative visual acuity. Key words: Corneal ulcer; Debridement; Conjunctival flap covering