Bovis ISSN 2398-2993

Bulbar conjunctival pedicle flap

Synonym(s): ophthalmic surgery

Contributor(s): Lucy Jerram , Kristina Mueller

RVC logoMassey School of Veterinary Science logo

Introduction

  • This technique is not commonly used in cattle, but given the effectiveness of this technique in companion animals, perhaps it should be considered more often!
  • This technique is used to physically support a weakened cornea and provide blood supply directly to a corneal ulcer or injury.
  • The conjunctival flap will adhere to any areas where corneal epithelium is missing providing increased blood supply, nutrition and immune response.

Uses

Advantages

  • Provides direct supply of blood and therefore vascular based growth factors, fibroblasts and anti-proteases to the cornea.
  • Provides physical support to the thin cornea.
  • Allows continued visualization of the cornea and intraocular structures.

Disadvantages

  • Conjunctival flap techniques all require dissection of conjunctiva from Tenon's capsule (episcleral fascia); if this is not performed, then flap elasticity may be reduced, which can increase the tendency of graft or flap failure.
  • Will cause a degree of long term corneal opacity at the ulcer site.

Requirements

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Preparation

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Procedure

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Aftercare

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Outcomes

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Prognosis

  • If technically correct, the majority of even deep ulcers will heal with conjunctival flaps.
  • Scars will form at the ulcer site.

Further Reading

Publications

Refereed Papers

  • Recent references from PubMed and VetMedResource.
  • Plummer C, Smith S, Andrew S, Lassaline M, Gelatt K, Brooks D, Kallberg M & Ollivier F (2007) Combined keratectomy, strontium‐90 irradiation and permanent bulbar conjunctival grafts for corneolimbal squamous cell carcinomas in horses (1990–2002): 38 horses. Veterinary ophthalmology 10, 37-42 PubMed.
  • Ollivier F J (2005) Medical and Surgical Management of Melting Corneal Ulcers Exhibiting Hyperproteinase Activity in the Horse. Clinical Techniques in Equine Practice 4, 50-71 Sciencedirect.
  • Holmberg D L (1981) Conjunctival Pedicle Grafts Used to Repair Corneal Perforations in the Horse. The Canadian Veterinary Journal 22, 86-89 PubMed.

Other sources of information


ADDED