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Heidrun Gollogly, Leo Maguire; Indications and Outcomes of the Needle Dissection Technique for the Full Gundersen Conjunctival Flap in 76 eyes. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5419.
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© ARVO (1962-2015); The Authors (2016-present)
The needle dissection modification of Gundersen flap surgery (Arch Ophthalmol 1991:Aug109(8):1168-9) has been used by one author (LJM) since 1991. The paper analyzes incidence of intra- and early post-operative complications, late complications, and indications for flaps.
Study method: Retrospective chart review. Patient population: 76 eyes in 74 patients who underwent full Gundersen flaps by LJM from January 1991 to June 2012. Pre-operatively, 20 eyes had high risk features (conjunctival scarring, severe exposure, prior lid/orbit surgery). 49/76 eyes had follow-up ≥ 2 months. Outcome measures: intra- and early post-operative complications; late complications; indication for surgery.
Intra-operative complications: 1/76 (1.3%) buttonholes overlying the corneal surface (occurred in the high risk group) but did not result in secondary flap retraction. Early (<2 months) complications: 1/27 flap retractions, and 1/27 conjunctival cysts. Late (≥2 months) complications: 5/49 (10.2%) flap retractions, 5/49 (10.2%) flap dehiscence, 9/49 (18.4%) conjunctival cysts; 10/49 (20.4%) eyes required re-operation including 5 flap revisions (3/5 high risk); 5 eviscerations/enucleations (1/5 related to flap integrity, 2/5 related to HSV/VZV stromal inflammation, 2/5 other factors); and 4/49 conjunctival cyst excisions. Indications for surgery: exposure keratopathy (31.6%), bullous keratopathy (26.3%), bacterial ulcer (23.7%), and neurotrophic ulcer (15.8%), HSV (10.5%), VZV (15.8%), with some patients having more than one indication.
The full Gundersen flap with needle dissection modification results in low flap retraction and buttonholes in low risks patients, and relatively low complications in high risk patients. Late HSV/VZV stromal inflammation can affect flap integrity.
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