Perforated and perforating corneal ulcer are difficult to manage in the setting where eye bank are lacking
Gundersan flap are indicated especially in rural set up for
1) Impending perforation of Infective keratitis >3mm where glue doesn't work
2) Central deeper infiltrate with thinning
3) Recent small perforation in absence of donor/corneal tissue
4) Non-healing viral ulcers with impending perforation....
This procedure provides time for Penetrating Keratoplasty and saves many eyes from endophthalmitis/panophthalmitis.
Therefore it must be tried in every case where corneal graft are unavailable to save the eye which is very common in rural set up.
Gunderson conjunctival flap may be considered for non-infective, central ulcers with corneal thinning or impending corneal perforation. Pedical conjunctival flap may be considered for peripheral ulcers. Gunderson flap for large corneal, I have not tried. We have reposited conjunctival flap after healing of refractory corneal ulcers to avoid limbal stem cell deficiency. Sharma A, Mohan K, Sharma R, Nirankari VS. Repositioning of pedicle conjunctival flap performed for refractory corneal ulcer. Middle East Afr J Ophthalmol. 2014;21(1):89-91. doi:10.4103/0974-9233.124118
To relief pain, promote healing andetabolic support in Painful ocular surface condition such as Bulous Keratopahy which is a bad candidate for keratoplasty
Non healing painful corneal ulcer with or without risk of perforation
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