Conjunctival flap; total (such as Gunderson thin flap or purse string flap)
CPT4 code
Name of the Procedure:
Conjunctival Flap; Total (such as Gunderson thin flap or purse string flap)
Summary
A conjunctival flap is a surgical procedure where a portion of the conjunctiva (the transparent membrane that covers the white part of the eye) is moved to cover a defect or diseased part of the cornea. This provides protection and aids in healing.
Purpose
The procedure is designed to treat severe corneal disease, non-healing corneal ulcers, or corneal perforations. The goal is to provide a protective cover, promote healing, and potentially restore vision.
Indications
- Non-healing corneal ulcers
- Severe corneal infections
- Corneal perforations
- Recurrent epithelial erosion
- When other medical therapies have failed
Preparation
- Pre-procedure fasting (usually after midnight before the surgery).
- Medication review and adjustments, especially blood thinners.
- Routine blood tests and possibly an eye examination including visual acuity testing and corneal assessment.
Procedure Description
- Administration of local or general anesthesia based on patient’s condition.
- The surgeon makes an incision in the conjunctiva to create a flap.
- The flap is positioned over the diseased cornea.
- The flap is sutured in place to cover the defect completely.
- Antibiotic or steroid drops may be applied during the procedure.
- An eye patch or shield is placed over the operated eye.
Duration
The procedure typically takes about 1 to 2 hours.
Setting
The procedure is usually performed in a hospital or outpatient surgical center.
Personnel
- Ophthalmologist (eye surgeon)
- Anesthesiologist or nurse anesthetist
- Surgical nurses
- Surgical technician
Risks and Complications
- Infection
- Bleeding
- Graft rejection
- Scarring
- Vision loss (rare)
- Discomfort or irritation
Benefits
- Promotes healing of corneal ulcers
- Protects the eye from further damage
- Can improve or stabilize vision
- May eliminate the need for more invasive surgery in the future
Recovery
- Use prescribed eye drops as directed.
- Avoid rubbing or touching the eye.
- Follow-up appointments for monitoring recovery and suture removal if necessary.
- Typical recovery time is several weeks, but may vary depending on the individual case.
Alternatives
- Medical therapy (antibiotic or anti-inflammatory eye drops)
- Amniotic membrane transplantation
- Corneal transplantation (keratoplasty)
- Con: less invasive options may not be effective in severe cases; corneal transplant carries its own set of risks and longer recovery time.
Patient Experience
During the procedure, the patient will be under anesthesia and should not feel pain. Post-procedure, some discomfort, redness, and swelling are common. Pain can generally be managed with prescribed medications. The eye may be sensitive to light and may require protective eyewear during recovery. Regular follow-up visits are essential to ensure proper healing.