18 See Chapter 3. 1. Intensive topical or systemic treatment of any infectious process. 2. Ensure that there is no active wound leak or corneal perforation (Seidel test). 1. Anesthesia: Retrobulbar or peribulbar plus lid block. May use general anesthesia for younger, hearing or mentally impaired, or uncooperative patient. 2. Prep and drape. a. Use povidone-iodide 5% on a cotton-tipped applicator to gently clean eyelashes and lid margins. b. Place one or two drops of povidone-iodide in the conjunctival fornix.
Conjunctival Flap
Indications
Indolent corneal epithelial defects with sterile stromal ulceration
Painful bullous keratopathy or other surface abnormalities eyes with little or no visual potential
Recalcitrant fungal keratitis
Blind eyes to allow comfortable placement of prosthetic shell
Other progressive corneal thinning disorders
Contraindications
Active bacterial keratitis
Corneal perforation
Preoperative Procedure
Instrumentation
Lid speculum (e.g., Lieberman)
Fine-toothed tissue forceps (e.g., 0.12 mm Castroviejo)
Westcott scissors
Sutures (6–0 silk, 10–0 nylon)
Smooth forceps (e.g., Chandler, Bracken, anatomic forceps)
Cellulose sponges
Calipers
Diluted alcohol (20%)
Lidocaine 1–2% with epinephrine
Scarifier (e.g., Beaver #57 blade, or Grieshaber #681.01)
Disposable cautery
Clamp
Operative Procedure
Total “Gunderson” Flap
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