Name a surgical option for a persistent corneal ulcer not responding to medical therapy.

• A. Conjunctival flap or graft; other options include amniotic membrane graft or corneal patch graft.
• B. LASIK.
• C. Cataract extraction.
• D. Intraocular lens implantation.

Answer: (A)

When a corneal ulcer remains nonresponsive to medical therapy, the goal shifts to providing structural support and facilitating healing of the cornea. A conjunctival flap or graft delivers vascularized tissue to the ulcer bed, bringing blood supply and healing factors that help halt thinning and prevent perforation. This tectonic approach is especially valuable for stubborn ulcers with progressive thinning, as it strengthens the corneal surface and creates a better environment for epithelial regrowth.

Amniotic membrane graft offers an additional option or adjunct. The membrane acts as a biologic bandage: it serves as a scaffold for epithelial cells, reduces inflammation, and lowers scarring, which can improve healing in difficult ulcers. A corneal patch graft, using donor corneal tissue, provides immediate tissue replacement for thinned or necrotic stroma, restoring integrity of the globe.

The other procedures listed—refractive surgery with LASIK, cataract extraction, or intraocular lens implantation—do not address surface ulcers or corneal thinning and are not appropriate for managing a persistent nonhealing corneal ulcer.