Treatment of symptomatic bullous keratopathy with poor visual prognosis using a modified Gundersen conjunctival flap and amniotic membrane . Jose L. Güell MD Merce Morral MD Oscar Gris MD Instituto Microcirugia Ocular Barcelona, Spain
Treatment of symptomatic bullous keratopathy with poor visual prognosis using a modified Gundersen conjunctival flap and amniotic membrane
Jose L. Güell MD
Merce Morral MD
Oscar Gris MD
Instituto Microcirugia Ocular
The authors have no financial interest in the subject matter of this poster
1. 360º conjunctival peritomy 2mm from the limbus
2. Deepithelialization of the decompensated cornea preserving, if healthy, the limbal conjunctiva where the stem cell niches are located
3. Graft of AM sutured epithelial side up using a running 10-0 nylon suture at the periphery of the cornea with the knot buried in the corneal stroma.
Attach the edges of the AM and the border of the peritomized conjunctiva using single 9/0 vycril sutures. The conjunctival border should lie over the AM.
The AM graft covers the whole decompensated cornea and provides a basement membrane for conjunctival cells to grow on. Epithelialization occurs over the AM, which remains trapped until reabsortion is completed (Observe the section figure).
Recurrent epithelial defects in a patient with post penetrating keratoplasty BK.
Modified Gundersen conjunctival flap with amniotic membrane grafting was performed.
Twelve months postoperatively, conjunctival vascular epithelium covers the cornea completely, providing sustained relief of the symptoms