Gunderson Flap question

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Gunderson Flap question

Unread post by butterflynites » Sun Mar 18, 2012 12:44 am

Hi all,

We have been pursuing Gunderson Flap surgery for our 4 year old daughter (left eye micro, phpv). Our ped opthalmalogist - recommended it, ocularist also on board, we saw a corneal specialist (she seems to be a confident surgeon) she of course warned us of retraction or tearing (which has me nervous). We were advised to see an ocular plastic surgeon which we did to get him on board in case gunderson doesn't work.

Well, the ocular plastic surgeon (a very highly recommended) - didn't seem to be an advocate of the gunderson flap talking about how the congentiva is cut and reshaped and everything that goes along with it. This conversation of course made me think and think and start to lose sleep over the decision we have started thinking about.

My big question is:
Why wouldn't he (oc plastic surgeon) be a fan of this surgery - any other perspectives? Has anybody been advised against this surgery?

For those that have read my previous posts:
We tried adjusting the shell, we changed drops and it's not an allergy to acrylic, it's definitly the 5th cranial nerve getting bothered causing rashing - though none of the doctors have an explanation why. The cornea specialist is a little worried that the gunderson would help the cornea sensitivity but not sure if the rashing will stop (that worries me). Cornea specialist also said if Gunderson doesn't work, its only semi reversable and her eye after wouldn't look as it does now...preparing me in case.
The ocular plastic surgeon was definitly intrigued by this rashing (over the left side of her forehead and left side tip of nose) being an almost regular occurance but doesn't know why it keeps happening (so frustrating). He too asked if it was an allergy - which it turns out is not, or if the shells are fitting right which they are being fitted under anesthesia so the fit should be perfect. I asked if I should take her to a neurologist but was told no, it would be a waste of time. I'm waiting on the silicone eye trial piece to arrive, I will update you on that once we get it - since we found out its not an allergy to acrylic, im thinking the silicone isn't going to help our case.

thank you in advance for the replies and thank you for your support!

Korin (Isabella's mommy)
Isabella's MoM

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Re: Gunderson Flap question

Unread post by Moby » Sun Mar 18, 2012 1:05 am

Hi Korin,
Why not shoot our resident Ocuplastic Ophthalmologist this query. "cslonim" is the name. His answers are very easily understood.
Good luck.
F/ Amblyopia, intra-ocular lens both eyes, cornea transplant, blind in L/Eye due to retinal detachment.Glaucoma. Capsulotomy seeing eye.
Seek someone who communicates with you in laughter for laughter can turn a sad day into a joyful one.

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Re: Gunderson Flap question

Unread post by mike6024 » Sun Mar 18, 2012 3:45 am

"didn't seem to be an advocate ... how the congentiva is cut and reshaped and everything that goes along with it."

So I think the conjunctiva is a critical barrier to infection. Do you think this is what the surgeon was referring to? Maybe meant the operation could compromise things and increase risk of infection in the future?

Or did that refer to some other downside other than potential for infection?
M/54 Trauma Nov 2011, Damaged retina, iridodialysis, cataract

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Re: Gunderson Flap question

Unread post by Irish_In_Oz » Sun Mar 18, 2012 4:10 am

Hi Korin; it is so confusion when you get different opinions for experts. My specialist (by his experience) does not insert coral implants ..... his decision based on many years experience. I went with his advice no coral. But then I had only the one piece of advice so easier. I'm sure cslonim could tell you all for pros/cons so you know exactly what you're deciding on. I wish you peace of mind on the end decision; this must be so very much harder and complicated deciding for your child; most of us were adults making our own choices. Best wishes always vera
f/1952 cholodial melanoma
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Re: Gunderson Flap question

Unread post by ward » Sun Mar 18, 2012 11:29 am

Hello Korin,
I would ask the surgeon more questions as to why he is not an advocate of the procedure. Sometimes surgeons think that too much information might confuse us and give us conflicting information whereas we need as much information and experiences of the surgeon to be able to make a fully informed decision.
Ultimately we are the ones having to make the decision so I would try to get more answers.

I am not a shell wearer but I would wait to get the silicone eye if you have waited thus far. You never know it might be better.
Fully agree , as Moby suggests with sending a P.M to Cslonim, I have never met a surgeon who explains everything so well and in so much detail. We are very lucky to have him visiting L.E.

Please keep us informed of Isabella's progress and all the best to you all.
Orbital bone fracture resulting in loss of vision R eye. Fixed dilated pupil. Sensitive to light. (May 2008)

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Re: Gunderson Flap question

Unread post by cslonim » Sun Mar 18, 2012 9:50 pm

got your pm but i trhought i would answer here for the benefit of others. never underestimate a surgeon who might not advocate a particular procedure even if it has been suggested by another surgeon. this could mean that the surgeon has not performed a lot of them in his or her career or feels that another procedure in his or her hands under similar patient situations works better for him or her. it is usually the latter. i say this because a gunderson flap procedure is not a very difficult procedure to perform. we scrape the surface of the cornea off (big corneal abrasion). we mobilize some conjunctiva from above and below the cornea and sew the edges together over the middle of the cornea. the conjunctival surface becomes the new corneal surface which is not as sensitive to the shell. most ophthalmic surgeons have performed them in their training. the key is the condition of your daughter's microphthalmic eye and the size of her cornea and the amount of available conjunctiva around it that can be safely used to cover the cornea. may microphthalmic eyes are phthisical (shruken) and, therefore, the amount of conjunctiva that can be used (mobilized) to cover the cornea is significantly compromised. that may be the reason your oculoplastic surgeon is hesitating with the gunderson flap. (mike6024) pulling the conjunctiva down from above the cornea and pushing the conjunctiva up from below the cornea might compromise the conjunctival fornices (upper and lower grooves between the eye and the back of the eyelids) where the scleral shell or prosthesis is placed. if the fornices are compromised, a scleral shell may have a problem staying in place and future prostheses might have the same problem. what did the oculoplastic surgeon suggest? it sounds like a good idea to wait and see what the silicone shell does. vera - i was the first in my area inserting coral (hydroxyapatite) implants. i inserted a lot of them. now i don't insert any because i like the porous polyethylene (ppe) implants better. in my hands, i have had better success with ppe. i also had good success with the coral but i like the handling of ppe better. i have many colleagues who still use coral and will tell you the opposite. both products are good (that's the science of medicine). different surgeons prefer different implants (that's the art of medicine). good luck isabella.
oculoplastic surgeon
tampa, florida

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Re: Gunderson Flap question

Unread post by Pumpkins » Tue Jul 23, 2013 4:17 am

My 8 y/o dd just went thru GF surgery on May 23rd. Her recovery has been very slow and depressing for her. The surgery itself looks well in terms of the stitches, but she can't open her eyelid now. She's had so many follow ups and different eyedrops it's not even funning. She has lost her spark and spunk, withdrawn from her friends. It's been very frustrating watching her go thru this as her mother. She went for an EUA and there was no foreign bodies in her eye, i.e. eyelash, etc. her doc gave her a steroid injection, after the couple days of swelling went down and her lid is open slightly. Another follow up, more drops. We go back again Aug 2nd for yet another follow up and possibly she will go under for another injection. My dd was born with micro and PFVS in her left eye. Cataract at 4 weeks and detached retina surgery at 11 months old. Bleeding on the eye, scar tissue, no chance to patch. Several EAU's, pressure has always been good. Band Karatopathy since last fall and now blind in her left eye. She hasn't worn her scleral lens for serveral months due to irratation from Band Karatopathy and now complications from GF surgery 2 months ago.

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Re: Gunderson Flap question

Unread post by chemgal » Wed Jul 24, 2013 12:17 am

I almost want to ask which doctor's you are using as your situation sounds very similar to mine. My corneal specialist, also a woman, suggest a GF and a shell. The ocular plastic surgeon she sent me too is who suggested I don't do it and do an enucleation. His feeling was that I was in pain and/or discomfort and it was time to cut bait (my term, he used much better and professional terms).

While I absolutely admire and respect my corneal specialist (I still visit her every time I go to Boston to have a check up with the glaucoma specialist or when I have my prosthesis polished) and I would recommend her highly to anyone, I am so glad I listened to the ocular surgeon.
Left eye damaged due to parasitic infection 2007. Enucleation November 3, 2011.

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