COECSA, Journal, Ophthalmology
Outcomes of conjunctival flap in severe microbial keratitis
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Conjunctival flap
Corneal ulcer
Microbial keratitis

How to Cite

Tran T, Kanji R, Al-ramady A, Kintoki G, Onyango J, Leck A, Macleod D, Hu V, Burton M, Arunga S. (2023). Outcomes of conjunctival flap in severe microbial keratitis. The Journal of Ophthalmology of Eastern, Central and Southern Africa, 15(01). Retrieved from


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.

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