Comparison of the outcomes of phacoemulsification versus topical medication alone in canine diabetic cataracts: a retrospective study

BACKGROUND

Long-term comparisons of phacoemulsification with topical medication are limited in canine diabetic cataracts.

OBJECTIVES

To compare outcomes of eyes submitted to phacoemulsification with those of topical medication for canine diabetic cataracts and identify risk factors for complications.

METHODS

Through medical records review, 150 eyes (76 dogs) with diabetic cataracts were included; 58 eyes (31 dogs) underwent phacoemulsification (phaco-group) and 92 eyes (48 dogs) received ophthalmic solution alone (medication-group). The medication-group was divided into owner-led and vet-led groups depending on who elected not to perform surgery. Comparisons involved time-to-complications, vision, and the number and type of ophthalmic solutions administered. The association between complications and pretreatment clinical findings was investigated.

RESULTS

No difference was found in complication risk between the phaco and owner-led medication groups. Conversely, the vet-led medication-group had a higher complication risk than the other groups. At the last follow-up, 94.8% of the phaco-group had vision, whereas 7.6% of the medication-group restored some visual axis. Poor glycemic control in the medication-group and younger age in the phaco-group increased complication risk. At 1-year post-treatment, the average number of ophthalmic solutions administered was 1.7 and 2.6 in the phaco and medication groups, respectively. The medication-group used anti-inflammatories the most throughout the follow-up, whereas the phaco-group used anti-inflammatories the most until 1-year post-treatment and lacrimostimulants at 1.5-year post-treatment.

CONCLUSIONS

For canine diabetic cataracts, phacoemulsification is recommended because it is superior to topical management alone in terms of maintaining vision and reducing the number of ophthalmic solutions required in the long term.

Anesthetic Considerations in Dogs and Cats with Diabetes Mellitus

Understanding the effects of diabetes and hyperglycemia on hydration, acid-base status, and immune function is paramount to safely anesthetizing diabetic cats and dogs. Preoperative stabilization of glucose concentrations, hydration, and electrolyte imbalances is key to minimizing morbidity and mortality. Blood glucose monitoring perioperatively will help guide insulin and dextrose administration. Specific anesthetic considerations, and peri-anesthetic management of animals with diabetes mellitus, including anesthetic drugs and recommended insulin protocols are discussed.

Comparison of two protocols for insulin administration and fasting time in diabetic dogs anaesthetised for phacoemulsification: A prospective clinical trial

BACKGROUND

There is a lack of evidence-based guidelines on perioperative insulin administration and fasting time in diabetic dogs. The aim of this study was to compare two protocols with respect to intraoperative changes in blood glucose (BG) concentrations compared to preoperative values.

METHODS

Thirty-two dogs were included. Dogs of group AM (n = 15) underwent anaesthesia in the morning after 12 hours fasting and received half their usual insulin dose, while dogs of group PM (n = 17) had surgery in the afternoon after 6 hours fasting and received their usual insulin dose; BG was measured before premedication (baseline), after anaesthetic induction, every 30 minutes throughout surgery, at extubation and after anaesthetic recovery. The occurrence of intraoperative complications was recorded.

RESULTS

There were no differences between groups in perioperative changes in BG over time, and in the proportion of dogs experiencing complications. Common complications were hypotension (53 per cent of dogs in either groups), hyperglycaemia (67 and 65 per cent in groups AM and PM) and hyperkalaemia (20 and 11 per cent in groups AM and PM).

CONCLUSIONS

Either protocols may be used in diabetic dogs undergoing anaesthesia. The occurrence of hyperkalaemia in the study population supports routine intraoperative monitoring of blood potassium concentration.

Effect of Insulin and Fasting Regimen on Blood Glucose Concentrations of Diabetic Dogs During Phacoemulsification

This study aimed to compare four protocols for preanesthetic insulin administration and fasting time with respect to the variation of intraoperative blood glucose (BG) concentrations versus preanesthetic values (baseline). The patient records of dogs undergoing cataract surgery were included. Data on anesthetic protocols, comorbidities, and intraoperative complications (hyper- and hypoglycemia, hypotension, hypothermia, and bradycardia) were analyzed. The insulin/fasting protocols included (A) 12 hr fasting and half insulin dose, (B) 6 hr fasting and half insulin dose, (C) 12 hr fasting and full insulin dose, and (D) 12 hr fasting and no insulin. Forty-eight dogs were included (14 in A, 10 in B, 13 in C, and 11 in D). Protocol D resulted in a significant increase of intraoperative BG concentrations compared with baseline (P = .001), whereas in the remaining groups, the baseline BG did not differ from intraoperative values. There were no statistically significant associations between the treatment group and the occurrence of intraoperative complications or the presence of diagnosed comorbidities. In conclusion, different insulin and fasting regimen protocols may be used for diabetic patients with no apparent benefit or risk from one protocol versus another. The use of insulin before surgery results in lesser increase of BG intraoperatively as compared with preanesthetic values. However, whether this should be interpreted as better perioperative control of glycemia remains debatable.

Management of Multiple Dental Infections in a Dog with Diabetes Mellitus

A dog with diabetes mellitus was treated for multiple dental fractures and refractory hyperglycemia. Five teeth were found to have endodontic infections. Three extractions and two root canal procedures were performed to resolve these infections, resulting in improved regulation of blood glucose levels. Treatment planning included special considerations in management of diabetes in the anesthetic and perioperative periods.

A comparison of anesthetic complications between diabetic and nondiabetic dogs undergoing phacoemulsification cataract surgery: a retrospective study

OBJECTIVE

To compare the incidence of anesthetic complications in diabetic and nondiabetic dogs undergoing general anesthesia and phacoemulsification cataract surgery.

PROCEDURE

The medical and anesthetic records of all dogs undergoing phacoemulsification cataract surgery at Davies Veterinary Specialists between 2005 and 2008 were reviewed. Anesthetic records were evaluated by an ECVAA Diplomate. Dogs for which records were incomplete were excluded. The anesthetic technique, including all drugs administered in the perioperative period, was recorded. The anesthetic complications investigated included hypotension (MAP (mmHg): >or=55 none/mild; <or=54 moderate/severe), bradycardia (<60 bpm associated with hypotension) and hypothermia (esophageal temperature <36.7 degrees C). Where hypotension was present, the method of and response to treatment was recorded. The incidence of severe hyperglycemia (blood glucose >13.75 mmol/L (250 mg/dL)) in the diabetic group was also assessed.

RESULTS

66 diabetic and 64 nondiabetic dogs were included in the study. Diabetic dogs were more likely to develop moderate and severe intraoperative hypotension than nondiabetic dogs. Forty-four percent of diabetic dogs had at least one episode of severe hyperglycemia whilst anesthetized.

CONCLUSIONS

Diabetic dogs undergoing phacoemulsification are more likely to suffer the anesthetic complications of moderate and severe hypotension than nondiabetic dogs. The increased incidence and severity of hypotension in diabetic dogs may be explained by hypovolemia secondary to hyperglycemia and resultant osmotic diuresis.