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2023 OMIG Abstract

A Retrospective Analysis of the Outcomes of Conjunctival Flaps Used to Treat Infectious Corneal Ulcers

Cristina Llaneras^1,2, Ignacio Quintana^1,2, Jordan Huang^2,3, Brandon Chou^1,2, Heather Durkee², Anat Galor², Guillermo Amescua², Darlene Miller², and Jaime D. Martinez<sup>2

1</sup>University of Miami Miller School of Medicine, Miami, FL; ²Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL; ³University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada

Purpose: Conjunctival flaps are a therapeutic surgical option for refractory cases of infectious keratitis and corneal ulcers and may potentially serve as a less invasive and more affordable option compared to other surgeries (e.g., penetrating keratoplasties), especially in low-resource areas. This retrospective case series analyzes the outcomes of conjunctival flaps used to treat refractory infectious corneal ulcers in South Florida.

Methods: Current procedural terminology (CPT) codes for conjunctival flaps were used to identify patients and their records were retrospectively reviewed to determine which met inclusion criteria. Surgical success was defined as resolution of the infectious corneal ulcer without additional surgical intervention, either noted in the physicians' documentation or by discontinuation of antimicrobial therapies.

Results: 169 patients were identified by CPT codes, of which 21 were eligible to be included; 9 (42.9%) underwent complete conjunctival (Gunderson) flaps and 12 (57.1%) underwent partial conjunctival flaps. Of the Gunderson flaps, 4 had bacterial corneal ulcers, of which 3 (75%) were successful, 3 had viral corneal ulcers, of which 2 (66.7%) were successful, and 2 had fungal corneal ulcers, neither of which (0%) were successful. Of the partial flaps, 4 had bacterial corneal ulcers, of which 3 (75%) were successful, 1 had a viral corneal ulcer, which was successful (100%), 6 had fungal corneal ulcers, of which 4 (66.7%) were successful, and 1 had a combined bacterial and fungal corneal ulcer, which was unsuccessful (0%). Overall, 5 (55.6%) patients in the Gunderson flap group were classified as successes and 8 (66.7%) patients in the partial flap group were classified as successes.

Conclusions: Over 50% of patients undergoing complete or partial conjunctival flaps for treatment of infectious corneal ulcers were classified as surgical successes. A higher proportion of success was seen in the partial flap group, but this may be confounded by multiple factors, including the type of pathogen, size of the ulcer, and additional pre-, intra-, and post-operative therapies. Further randomized control studies are required to fully understand these outcomes.

Disclosure: N

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