Conjunctival Flap Surgery Research Articles

Gundersen Flaps in the Management of Ocular Surface Disease in an Asian Population

To evaluate the indications, complications, and long-term outcomes with the use of a Gundersen flap for the treatment of various ocular surface conditions in an Asian population. Retrospective case series. Twenty-five eyes of 25 subjects who had undergone conjunctival flap surgery performed from 1999 to 2004 at the Singapore National Eye Centre. Review of case records for indications and outcomes of patients undergoing Gundersen flap surgery. Surgical success was defined as attainment of a stable ocular surface with resolution of symptoms and no flap retraction or dehiscence resulting in reexposure of the corneal surface. Complications to be noted included infection, progression of the inflammatory or infectious disease process beneath the flap, flap loss from epithelial ingrowth, and epithelial cyst formation. Surgical success was achieved in all eyes. Intraoperative and postoperative complications were encountered in 6 patients (24%). One case had a buttonhole, 3 cases had partial flap retractions, and 2 had epithelial inclusion cysts. The Gundersen flap is still an important procedure and should be considered as a means of stabilizing globe integrity in the management of cases of severe ocular surface disease, particularly when visual potential is poor.

Ulcerative keratitis caused by beta-hemolytic Streptococcus equi in 11 horses.

Purpose To describe 11 clinical cases of ulcerative keratitis in horses associated with beta-hemolytic Streptococcus equi in Florida, USA. METHODS: Retrospective clinical study (1996-99). RESULTS: Beta-hemolytic Streptococcus equi was cultured from 11 horses with deep ulcers, descemetoceles or iris prolapse (n = 8), a suture abscess found with a penetrating keratoplasty for a stromal abscess (n = 1), and ulceration that developed following keratectomy/irradiation for corneal squamous cell carcinoma (n = 2). Beta-hemolytic Streptococcus equi subspecies zooepidemicus was found in 10 eyes and subspecies equi in one. Marked signs of uveitis including miosis and hypopyon were present in 8/11 (72.7%) eyes. Keratomalacia was severe in all eyes. The mean diameter of the ulcers associated with beta-hemolytic Streptococcus was 10.2 +/- 6.1 mm. Eight of the eyes required conjunctival flap surgery (four grafts dehisced) and one eye corneal transplantation. Two eyes were treated with medication only. Isolate sensitivity to antibiotics included ampicillin (6/11), bacitracin (11/11), cephalothin (11/11), chloramphenicol (11/11), gentamicin (5/11), polymyxin B (2/11), and tobramycin (1/11). All isolates were resistant to neomycin. The average healing time was 44.7 +/- 26.7 days. The visual outcome was positive in 8/11 eyes, and the globe retained in 9/11 eyes. CONCLUSIONS: Although Gram-positive bacteria predominate in the normal conjunctival microflora of horses throughout the world, Gram-negative bacteria and fungi are more often isolated from equine ulcers. Beta-hemolytic Streptococcus spp. are associated with a very aggressive ulcerative keratitis with the capability to digest conjunctival graft tissue. Clinical signs are pronounced. Aggressive surgical and intensive medical therapy with topical antibiotics and protease inhibitors is indicated.

Ulcerative keratitis caused by beta‐hemolyticStreptococcus equiin 11 horses

AbstractPurposeTo describe 11 clinical cases of ulcerative keratitis in horses associated with betahemolyticStreptococcus equiin Florida, USA.MethodsRetrospective clinical study (1996–99).ResultsBeta‐hemolyticStreptococcus equiwas cultured from 11 horses with deep ulcers, descemetoceles or iris prolapse (n= 8), a suture abscess found with a penetrating keratoplasty for a stromal abscess (n= 1), and ulceration that developed following keratectomy/irradiation for corneal squamous cell carcinoma (n= 2). Beta‐hemolyticStreptococcus equisubspecieszooepidemicuswas found in 10 eyes and subspeciesequiin one. Marked signs of uveitis including miosis and hypopyon were present in 8/11 (72.7%) eyes. Keratomalacia was severe in all eyes. The mean diameter of the ulcers associated with betahemolyticStreptococcuswas 10.2 ± 6.1 mm. Eight of the eyes required conjunctival flap surgery (four grafts dehisced) and one eye corneal transplantation. Two eyes were treated with medication only. Isolate sensitivity to antibiotics included ampicillin (6/11), bacitracin (11/11), cephalothin (11/11), chloramphenicol (11/11), gentamicin (5/11), polymyxin B (2/11), and tobramycin (1/11). All isolates were resistant to neomycin. The average healing time was 44.7 ± 26.7 days. The visual outcome was positive in 8/11 eyes, and the globe retained in 9/11 eyes.ConclusionsAlthough Gram‐positive bacteria predominate in the normal conjunctival microflora of horses throughout the world, Gram‐negative bacteria and fungi are more often isolated from equine ulcers. Beta‐hemolyticStreptococcusspp. are associated with a very aggressive ulcerative keratitis with the capability to digest conjunctival graft tissue. Clinical signs are pronounced. Aggressive surgical and intensive medical therapy with topical antibiotics and protease inhibitors is indicated.