Effectiveness of Conjunctival Flap Surgery in Managing Non-Healing Corneal Ulcers

Background: Non-healing corneal ulcers pose a significant challenge in ophthalmology, often resulting in persistent pain, visual impairment, and corneal perforation. Conventional medical treatments may fail to promote healing in refractory cases, necessitating surgical intervention. Conjunctival flap surgery provides a vascularized and protective layer that facilitates corneal healing and structural preservation. Objective: This study aims to evaluate the effectiveness of conjunctival flap surgery in managing non-healing corneal ulcers by assessing its impact on corneal healing, symptom relief, and overall visual prognosis. Methods: A retrospective study was conducted at a tertiary eye hospital in Bangladesh, including 47 patients who underwent conjunctival flap surgery for non-healing corneal ulcers between April 2020 and January 2022. Patients were assessed preoperatively and postoperatively using visual acuity testing, slit-lamp examination, fluorescein staining, and anterior segment optical coherence tomography. Data were analyzed using SPSS version 25. Results: The study population consisted of 63.82% males and 36.17% females, with the majority (57.4%) aged between 41 and 60 years. Infectious etiology was the most common cause of corneal ulcers (65.96%). Postoperatively, best-corrected visual acuity (BCVA) improved in 31.91% of patients, decreased in 46.81%, and remained unchanged in 21.28%. Anatomic cure was achieved in 72.34% of cases, with only 3 eyes requiring evisceration. Postoperative complications included flap necrosis (14.89%), flap displacement (8.51%), anterior corneal staphyloma (2.13%), and corneal perforation (2.13%), while 72.34% experienced no complications. Conclusion: Conjunctival flap surgery is an effective treatment for refractory corneal ulcers, preserving ocular integrity and facilitating corneal healing. While visual acuity may not always improve, the procedure remains a crucial alternative to emergency penetrating keratoplasty, particularly in regions with limited access to corneal tissue.