June 2013
Volume 54, Issue 15
ARVO Annual Meeting Abstract  |   June 2013
Indications and Outcomes of the Needle Dissection Technique for the Full Gundersen Conjunctival Flap in 76 eyes
Author Affiliations & Notes
  • Heidrun Gollogly
    Ophthalmology, Mayo Clinic, Rochester, MN
  • Leo Maguire
    Ophthalmology, Mayo Clinic, Rochester, MN
  • Footnotes
    Commercial Relationships Heidrun Gollogly, None; Leo Maguire, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 5419. doi:
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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)

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Purpose: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: 462 clinical (human) or epidemiologic studies: outcomes/complications • 474 conjunctiva • 479 cornea: clinical science  

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