Gunderson Flap

This is Richard Allen at oculosurg.com.  This video demonstrates a Gunderson flap.  A retrobulbar block has been given.  Additional anesthesia is given with 1% lidocaine with epinephrine subconjunctivally.  A 360 degree conjunctival peritomy is performed with Westcott scissors.  Dissection is then performed along the anterior surface of the sclera with Westcott scissors to mobilize the conjunctiva and Tenons.  This is performed 360 degrees.  The cornea is then deepithelialized.  This is performed with a 15 blade.  This could also be performed with absolute alcohol if desired.  This is performed along the entire surface of the cornea. Care is taken to deepithelialized the limbus to remove the limbal stem cells.  This prevents the development of a potential epithelial inclusion cyst postoperatively. The 15 blade is then used to score the cornea.  A traction suture is then placed partial thickness through the superior cornea to provide traction.  The eye is then placed in an infraducted position.  The calipers are then placed at 14 mm.  An incision is then made through the conjunctiva 12 to 14 mm superior to the superior limbus with Westcott scissors.  Dissection is then carried out in the subconjunctival space between the Tenons and conjunctiva.  This dissection is relatively careful.  If a buttonhole occurs, it is not a problem.  At the conjunctival edge, penetration is performed through the Tenons to fully mobilize the conjunctiva.  The conjunctiva is then mobilized over the cornea.  The edges of the conjunctiva are then sutured together inferiorly with interrupted 7-0 Vicryl sutures.  Some colleagues will engage the limbus with the 7-0 Vicryl suture so that the sutures remain at the limbus.  The superior conjunctival edges are then sutured together with 7-0 Vicryl sutures.  At the conclusion of the case, a conformer is placed followed by antibiotic ointment.  A double eye pad is placed.  The patient will return to the clinic in one week for evaluation.