Outcomes of conjunctival flap in severe microbial keratitis

Abstract

Objectives: To describe the 3-month outcomes of conjunctival flap in managing severe Microbial Keratitis (MK).
Design: This was a prospective cohort study.
Setting: Patients were enrolled at two major eye hospitals in Mbarara, a major city in the Southwestern sub-region
of Uganda, over a one year period.
Subjects: Individuals of any age that met the case definition of severe microbial keratitis, in which perforation
occurred acutely or was impending.
Interventions: A complete Gunderson conjunctival flap was done in all suitable patients. Demographics, health
access, clinical, and microbiological data were recorded.
Main outcome measures: Statistical significance testing was done to assess predictors of evisceration at the
3-month follow-up time point.
Results: Among 57 patients (57 affected eyes), median age was 44 years (IQR 38, 60) and 47.4% were women.
Trauma was associated with 35.1% of cases. Median time to presentation was 23 days (IQR 12, 34). Etiology was
80.7% purely fungal pathogens, 10.5% mixed bacterial/fungal, and 8.8% undetermined. Mean infiltrate and epithelial
defect sizes were 7.2mm (SD 2.3) and 6.0mm (SD 2.5), respectively. Presenting visual acuity was <3/60 in
78% of eyes. At 3-months, 19 eyes (34.5%, 95%CI 23.5-48.2) had improved best-corrected visual acuity, though 9
eyes required evisceration (15.8%, 95%CI 8.3-28.0). There were no clinically or statistically significant predictors
for evisceration at 3 months.
Conclusions: Conjunctival flap is a reasonable rescue procedure, especially if therapeutic penetrating keratoplasty
is an eventually feasible option. However, there are considerable risks of vision loss or lack of improvement
and eventual need for evisceration.