Repositioning of Pedicle Conjunctival Flap Performed for Refractory Corneal Ulcer
A 50-year-old male had complaints of pain, redness, watering, and diminution of vision in the right eye for 4 weeks. The patient had a previous history of a 5.0 × 4.5 mm corneal ulcer and marked corneal thinning in the right eye. He did not show any improvement after 2 weeks of topical and systemic antifungal treatment. The referring ophthalmologist performed a CF in the right eye. After 2 weeks, patient did not show any improvement in symptoms and was referred to us for further treatment.\nOn examination, the patient's visual acuity was count fingers in the right eye and 20/20 in the left eye. Slit-lamp biomicroscopy revealed a thick CF including Tenon's capsule, extending 6.5 mm on the right cornea. The limbal conjunctiva had been removed from 6:30 to 9:30 clock h []. The projecting 10-0 nylon sutures were removed. Left eye on examination was normal. We elected to reposit the CF with the method described below.\nA low-dose peribulbar anesthesia (5 mL) was delivered containing 2.5 mL each, of xylocaine (2%) and bupivacaine (1%). The eye was prepared in a sterile fashion and draped. A Barraquer wire eyelid speculum was inserted for adequate globe exposure. First, the wound was evaluated. The peritomy area was deepithelialized. The CF was disengaged, fibrous tissue was excised and the CF was resutured to the original position with interrupted 8-0 vicryl sutures. The excision of the CF left behind a corneal epithelial defect, corneal opacity, and corneal thinning. A bandage contact lens (BCL) was applied. The patient was placed on moxifloxacin 0.3%, natamycin suspension 5%, and cyclopentolate hydrochloride 1% three times daily. The epithelial defect healed within a week and the BCL was removed. The corneal ulcer healed resulting in avascular corneal opacity [].\nAt 3 months follow-up, corneal opacity persisted and best corrected visual acuity was 20/200. The patient underwent an uneventful PKP. Over 4 years of follow-up, the patient achieved a best corrected visual acuity of 20/40 and the graft remained clear.