Long-term treatment outcomes and risk factors for recurrence in feline corneal sequestrum: 72 cases (2009-2017)

BACKGROUND

This study aimed to evaluate long-term treatment outcomes in feline corneal sequestrum (FCS), compare the recurrence rates between different surgical techniques, identify possible recurrence risk factors and monitor the development of FCS in the contralateral eye.

METHODS

The medical records of 72 cats (79 eyes) with FCS treated between 2009 and 2017 were retrospectively analysed.

RESULTS

The most commonly affected breeds were Persian, domestic shorthaired and Burmesecats. The mean age was 6.9 years. Sixty-five cats (90%) were affected unilaterally. Sixty-six eyes (83%) underwent surgery: keratectomy in 34 eyes (52%) and keratectomy followed by a graft procedure in 32 eyes (48%). Recurrence occurred in 13 out of 66 eyes (19%) at a median of 245 days after surgery. Skull conformation, location of the FCS, type of surgical procedure and concurrent ocular surgery did not significantly affect the recurrence rate. Eighteen cats (27%) developed FCS in the contralateral eye at a median of 635 days after surgery.

LIMITATIONS

Limitations are related to the retrospective nature of the study, the use of telephone follow-up for assessment of recurrence in some cats and the small number of cases.

CONCLUSIONS

Surgical excision had a successful outcome in most cases. The type of surgical procedure and skull conformation did not affect the recurrence rate. One-quarter of the cats developed FCS in the contralateral eye.

Autologous lamellar keratoplasty for the treatment of feline corneal sequestrum: A retrospective study of 35 eyes (2012-2020)

OBJECTIVE

To evaluate the use of autologous lamellar keratoplasty for the treatment of feline corneal sequestrum (FCS).

PROCEDURE

The medical records of cats diagnosed with FCS that underwent autologous lamellar keratoplasty between 2012 and 2020 with a minimum of 2 months of follow-up were reviewed. After keratectomy of FCS, a button adjacent to the corneal limbus was harvested on the same eye and sutured to the recipient bed. A nictitating membrane flap was left in place until the first recheck except for one patient. Postoperative treatment with topical and systemic antibiotics and systemic nonsteroidal anti-inflammatory medications was prescribed. Follow-up examinations were carried out 2 weeks, 1 month and 2 months post-operatively and consisted of a complete ophthalmic examination.

RESULTS

A total of 35 cats (35 eyes) were included. The median follow-up time was 3.2 months (range, 2-59 months). Brachycephalic cats were overrepresented (85.7%). The mean graft size was 6.5 mm (range, 6-9 mm). Minor complications consisting of melting and partial integration of the graft occurred in 2/35 eyes (5.7%). Recurrence was observed in 1/35 eyes (2.9%) and was managed by a superficial keratectomy. A good visual outcome was achieved in all eyes, and a faint or mild corneal opacification occurred in 15/35 (42.9%).

CONCLUSIONS

Autologous lamellar keratoplasty is an effective treatment for FCS, providing good tectonic support to the affected cornea and resulting in good visual and cosmetic outcomes. These results should be verified in future prospective studies that include a larger number of cases and longer-term follow-up.

Corneal sequestra in cats: 175 eyes from 172 cases (2000-2016)

OBJECTIVES

To report the clinical outcomes of different surgical treatments used to manage feline corneal sequestra in a large number of cases.

MATERIALS AND METHODS

Medical records of 172 cats affected by feline corneal sequestra and surgically managed by different techniques were retrospectively evaluated. Signalment, surgical technique, visual outcomes, postoperative corneal clarity and recurrence were evaluated.

RESULTS

One hundred and seventy-two cats (175 eyes) of different breeds, ages and sex were included in the retrospective case series. The Persian was the most represented breed (123/172; 71.5%), followed by Exotic Shorthair breed (21/172; 12.2%), Domestic shorthair breed (21/172; 12.2%) and a smaller group of other different breeds (7/172). Surgical management included a superficial (84/175 eyes) or deep (91/175 eyes) lamellar keratectomy in association with the following covering techniques (tectonic support and/or protective support): nictitans membrane flap (n=84), conjunctival pedicle graft (n=52), BioSISt graft (n=9), corneoconjunctival transposition (n=7), corneoconjunctival transposition+nictitans membrane flap (n=6), conjunctival free island graft (n=6), BioSISt+conjunctival pedicle graft (n=6), BioSISt+nictitans membrane flap (n=4) and bridge conjunctival graft (n=1). At the end of the retrospective case series, visus was present in all patients and no or mild corneal opacity was detected in 86% (151/175 eyes) of the patients. Sequestra recurred in 20 eyes (20/175; 11.4%) within 2 years.

CLINICAL SIGNIFICANCE

This paper describes the clinical outcomes of a large number of cases of feline corneal sequestra treated with varying surgical techniques and provides useful insight regarding the prognosis and outcomes of these techniques within feline ophthalmology.

Corneo-limbo-conjunctival transposition to treat deep and perforating corneal ulcers in dogs: A review of 418 eyes and corneal clarity scoring in 111 eyes

PURPOSE

To report surgical and corneal clarity scores (CCSs) of corneo-limbo-conjunctival transpositions (CLCTs) in a large number of canine cases.

METHODS

Retrospective review of records that underwent CLCT to repair deep ulcers or perforations between 2002 and 2018. Signalment, concurrent eye disease, additional procedures, pathogenesis, medication, graft orientation, follow-up, and CCSs were recorded.

RESULTS

418 eyes of 399 dogs were included. Brachycephalics were most commonly affected, comprising 325/418 (77.75%) of the eyes. The most commonly affected breeds were Pugs, Shih Tzus, Cavalier King Charles Spaniels, and French Bulldogs, with 116/418 (27.75%), 64/418 (15.31%), 34/418 (8.13%), and 34/418 (8.13%) ulcerated eyes, respectively. Mean age at surgery was 5.5 years (range 59 days-17.7 years), and median follow-up time was 100 days (range 3 days-7.64 years). The most common etiopathogenesis was spontaneous ulceration in 205/418 eyes (49.04%) of which 191 (93.17%) occurred in brachycephalics. Primary keratoconjunctivitis sicca affected 122/418 eyes (29.19%) and injury 39/418 eyes (9.33%). Mean ulcer width was 3.5 mm (0.5-10 mm). Success rate was 97.13% (406/418 eyes). Failure end points recorded included no menace response, secondary glaucoma, and endophthalmitis. Pre-existing perforation was found in 101/418 (24.16%) of the eyes and significantly increased failure rate (P < .001). The median CCS was G3 (G0-G4), which was lower for Pugs (G2). Graft orientation affected CCS, but did not reach statistical significance.

CONCLUSION

The high success rate and CCS for CLCT in dogs make it a good technique to treat deep ulcers but a less desirable outcome is anticipated when treating perforations and Pugs.