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Luo J, Zhou Z. Application of multi-layer porcine small intestinal submucosa for the reconstruction of deep corneal defects in cats. Vet Ophthalmol 2024. [PMID: 38413368 DOI: 10.1111/vop.13196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 01/26/2024] [Accepted: 02/11/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE This study documented the application of porcine small intestinal submucosa (SIS) as a stand-alone scaffold for treating deep corneal defects in cats. METHODS Medical records of 20 cats with deep stromal ulcers, perforations, or corneal sequestra that underwent surgical treatment with SIS grafts between 2021 and 2022 were retrospectively reviewed. Data on re-epithelialization time, corneal transparency score, and complications were collected to analyze the reconstruction of deep corneal defects after SIS biomaterial implantation. RESULTS All cats were unilaterally affected. The corneal defects varied in size, with a median diameter of 8.3 mm (range: 3-15 mm). Re-epithelialization of the SIS graft was completed 16-32 days after surgery (median, 22.3 days). No, mild, or moderate corneal transparency was detected in 90% of the cases. Complications were observed in eight cases (40%), including aqueous leakage (10%), partial SIS malacia (25%), and persistent bullous keratopathy (5%). The follow-up period ranged 90-725 days, with a median duration of 255 days. The SIS graft was successfully applied as a single scaffold in 17 of 20 cases (85%). CONCLUSION The results of this study suggest that the application of commercial SIS is an effective surgical technique for managing deep corneal defects in cats.
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Affiliation(s)
- JingWen Luo
- The Department of Clinical Sciences, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, Jiangsu, China
- Focu Pet hospital, WuXi, Jiangsu, China
| | - ZhenLei Zhou
- The Department of Clinical Sciences, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, Jiangsu, China
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2
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Han J, Cherry C, Mejías JC, Krishnan K, Ruta A, Maestas DR, Peña AN, Nguyen HH, Nagaraj S, Yang B, Gray-Gaillard EF, Rutkowski N, Browne M, Tam AJ, Fertig EJ, Housseau F, Ganguly S, Moore EM, Pardoll DM, Elisseeff JH. Age-associated Senescent - T Cell Signaling Promotes Type 3 Immunity that Inhibits the Biomaterial Regenerative Response. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2023:e2310476. [PMID: 38087458 DOI: 10.1002/adma.202310476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/20/2023] [Indexed: 12/30/2023]
Abstract
Aging is associated with immunological changes that compromise response to infections and vaccines, exacerbate inflammatory diseases and can potentially mitigate tissue repair. Even so, age-related changes to the immune response to tissue damage and regenerative medicine therapies remain unknown. Here, it is characterized how aging induces changes in immunological signatures that inhibit tissue repair and therapeutic response to a clinical regenerative biological scaffold derived from extracellular matrix. Signatures of inflammation and interleukin (IL)-17 signaling increased with injury and treatment both locally and regionally in aged animals, and computational analysis uncovered age-associated senescent-T cell communication that promotes type 3 immunity in T cells. Local inhibition of type 3 immune activation using IL17-neutralizing antibodies improves healing and restores therapeutic response to the regenerative biomaterial, promoting muscle repair in older animals. These results provide insights into tissue immune dysregulation that occurs with aging that can be targeted to rejuvenate repair.
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Affiliation(s)
- Jin Han
- Translational Tissue Engineering Center, Wilmer Eye Institute and Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21231, USA
| | - Christopher Cherry
- Translational Tissue Engineering Center, Wilmer Eye Institute and Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21231, USA
| | - Joscelyn C Mejías
- Translational Tissue Engineering Center, Wilmer Eye Institute and Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21231, USA
| | - Kavita Krishnan
- Translational Tissue Engineering Center, Wilmer Eye Institute and Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21231, USA
| | - Anna Ruta
- Translational Tissue Engineering Center, Wilmer Eye Institute and Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21231, USA
| | - David R Maestas
- Translational Tissue Engineering Center, Wilmer Eye Institute and Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21231, USA
| | - Alexis N Peña
- Translational Tissue Engineering Center, Wilmer Eye Institute and Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21231, USA
| | - Helen Hieu Nguyen
- Translational Tissue Engineering Center, Wilmer Eye Institute and Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21231, USA
| | - Sushma Nagaraj
- Department of Neurology, Brain Science Institute, Johns Hopkins University, Baltimore, MD, 21231, USA
| | - Brenda Yang
- Translational Tissue Engineering Center, Wilmer Eye Institute and Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21231, USA
| | - Elise F Gray-Gaillard
- Translational Tissue Engineering Center, Wilmer Eye Institute and Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21231, USA
| | - Natalie Rutkowski
- Translational Tissue Engineering Center, Wilmer Eye Institute and Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21231, USA
| | - Maria Browne
- Translational Tissue Engineering Center, Wilmer Eye Institute and Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21231, USA
| | - Ada J Tam
- Bloomberg∼Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Elana J Fertig
- Department of Biomedical Engineering and Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, 21218, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Franck Housseau
- Bloomberg∼Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Sudipto Ganguly
- Bloomberg∼Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Erika M Moore
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, 20742, USA
| | - Drew M Pardoll
- Bloomberg∼Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Jennifer H Elisseeff
- Translational Tissue Engineering Center, Wilmer Eye Institute and Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21231, USA
- Bloomberg∼Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
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Linn-Pearl R. Optimising treatment approaches for feline corneal sequestra to improve long-term clinical outcomes. Vet Rec 2023; 193:107-110. [PMID: 37539875 DOI: 10.1002/vetr.3334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
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Gómez AP, Mazzucchelli S, Smith K, de Lacerda RP. Long-term treatment outcomes and risk factors for recurrence in feline corneal sequestrum: 72 cases (2009-2017). Vet Rec 2023; 193:e2783. [PMID: 36912180 DOI: 10.1002/vetr.2783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 03/14/2023]
Abstract
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.
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Affiliation(s)
| | | | - Kinley Smith
- Willows Veterinary Centre & Referral Service, Solihull, UK
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Dulaurent T, Rozoy M, Steun L, Isard PF. Multidirectional corneoconjunctival transposition in the treatment of large keratomalacia in 7 dogs and 5 cats. Vet Ophthalmol 2023. [PMID: 36943897 DOI: 10.1111/vop.13086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/14/2023] [Accepted: 03/02/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE To describe the use of multidirectional corneoconjunctival transposition (CCT) as a surgical treatment for large keratomalacia. METHOD A prospective study including dogs and cats initially presenting with keratomalacia larger than 6 × 6 mm and affecting more than half of the corneal thickness. Signalment, concurrent eye diseases, ulcer size, bacterial culture and susceptibility testing results, follow-up, and outcome were recorded. The surgery consisted of harvesting of two or three opposite corneoconjunctival grafts, after removal of the malacic tissue using a square-edge keratectomy. The medical treatment consisted of administration of topical and systemic antibiotics, topical atropine, and N-acetylcysteine. Follow-up examinations were performed at D7, D14, D21, and D28, and then at various time points. The corneal clarity score (CCS) was recorded upon completion of the follow-up period. RESULTS Seven dogs and five cats were included. Brachycephalic dogs were overrepresented, with no breed predisposition in cats. Concurrent eye diseases were corneal pigmentation in three dogs, hypopyon in two dogs, nictitating membrane wound in one dog, and corneal perforation in one cat. The size of the keratomalacia ranged from 6 × 6 to 9.5 × 11.5 mm. The short-term complications were suture dehiscence (two of 12) and progression of the keratomalacia (one of 12). The long-term complications were corneal pigmentation (10 of 12), corneal epithelial inclusion cyst (two of 12), and marginal synechiae (one of 12). All animals were sighted at the last follow-up. The median CCS was G3 (range G2-G4). CONCLUSION Multidirectional CCT is an effective surgical treatment for large keratomalacia in dogs and cats.
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Affiliation(s)
- Thomas Dulaurent
- Centre Hospitalier Vétérinaire Saint-Martin, Allonzier-la-Caille, France
| | - Manon Rozoy
- Universitatea de Stiinte Agricole si Medicina Veterinara, Cluj-Napoca, Romania
| | - Laure Steun
- Centre Hospitalier Vétérinaire Saint-Martin, Allonzier-la-Caille, France
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Cognard S, Barnouin L, Bosc J, Gindraux F, Robin MC, Douet JY, Thuret G. New Devitalized Freeze-Dried Human Umbilical Cord Amniotic Membrane as an Innovative Treatment of Ocular Surface Defects: Preclinical Results. J Funct Biomater 2022; 13:jfb13030150. [PMID: 36135586 PMCID: PMC9502562 DOI: 10.3390/jfb13030150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/26/2022] [Accepted: 09/08/2022] [Indexed: 12/03/2022] Open
Abstract
A preclinical study was performed to investigate the efficacy and safety of a new viral inactivated, devitalized, freeze-dried and gamma-sterilized human umbilical cord amniotic membrane (lhUC-AM) for the treatment of deep scleral and corneal defects with or without perforation. Firstly, lhUC-AM was investigated on experimental deep sclerectomy in rabbit eyes (n = 12) and compared to autograft (n = 4) on cross section histology. Secondly, lhUC-AM was studied on a selected series of uncontrolled cases of corneal defects (n = 18) with or without perforation, in dogs and cats. lhUC-AM tolerance, reconstruction of the deep corneal lesion and recovery of the structural aspect of the tissue were followed post-surgery. In experimental deep sclerectomy, histology showed that the lhUC-AM was well tolerated and degraded completely in 45 days while allowing an overall quality and kinetic of scleral regeneration, similar to autograft. In the clinical situations, lhUC-AM was well tolerated, with ocular inflammatory signs quickly decreasing after surgery. Mean follow-up was 16.40 ± 11.43 months. In 15 out of 18 cases, lhUC-AM allowed ocular surface wound healing. The ocular surface was fully reconstructed three months after surgery. This study suggests a good safety and efficacy profile of lhUC-AM in the treatment of deep corneal or scleral defect in animals. This new tissue should now facilitate the treatment of severe ocular surface diseases in humans.
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Affiliation(s)
- Sophie Cognard
- Clinique Vétérinaire des Ducs de Bourgogne, 11 Ter Rue Paul Langevin, 21300 Chenove, France
| | - Laurence Barnouin
- Tissue Bank of France, 6 rue d’Italie, 69780 Mions, France
- Correspondence: ; Tel.: +33-4-72-68-69-09
| | - Justine Bosc
- Tissue Bank of France, 6 rue d’Italie, 69780 Mions, France
| | - Florelle Gindraux
- Service de Chirurgie Orthopédique, Traumatologique et Plastique, CHU Besançon, F-25000 Besançon, France
- Laboratoire de Nanomédecine, Imagerie, Thérapeutique EA 4662, Université Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Marie-Claire Robin
- Small Animal Clinic, Université de Toulouse, ENVT, 31300 Toulouse, France
| | - Jean-Yves Douet
- Small Animal Clinic, Université de Toulouse, ENVT, 31300 Toulouse, France
- IHAP, Université de Toulouse, INRAE, ENVT, 31300 Toulouse, France
| | - Gilles Thuret
- Biology, Engineering and IMAGING of Corneal Graft, BiiGC, Faculty of Medicine, Health Innovation Campus, 10 rue de la Marandière, 42270 Saint-Priest en Jarez, France
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Sarfaty H, Ezra-Elia R, Sebbag L. Prevalence and characteristics of ocular diseases in Sphynx cats: A retrospective assessment (2012-2021) and comparison with non-Sphynx cats. Vet Ophthalmol 2022; 25:367-375. [PMID: 35598106 DOI: 10.1111/vop.12994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 05/08/2022] [Accepted: 05/08/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To describe the prevalence of ocular diseases in Sphynx cats, and compare disease characteristics with other feline breeds. METHODS Medical records of Sphynx cats presented to an ophthalmology referral center between 1/2012 and 4/2021 were examined. Cats of other breeds examined during the same period served as controls. RESULTS One hundred ten Sphynx cats were examined during the study period, diagnosed with corneal sequestrum (n = 42 cats), lower eyelid entropion (n = 25), presumed herpetic keratoconjunctivitis (n = 19), conjunctivitis (n = 7), corneal ulcers (n = 6), nasolacrimal duct atresia/obstruction (n = 6), corneal dystrophy (n = 3), eosinophilic keratitis (n = 2), uveitis (n = 2), non-ulcerative keratitis (n = 1), and cataract (n = 1). Corneal sequestrum was significantly more common in Sphynx versus non-Sphynx cats (odds ratio = 8.0, 95% CI = 5.3-12.2, p < .001), and age of diagnosis was significantly younger in Sphynx cats (2.0 ± 1.5 years vs. 5.9 ± 4.0 years, p < .001). Corneal sequestrum recurrence was noted in 19.4% Sphynx eyes and 6.4% non-Sphynx eyes undergoing surgery (p = .015). Lower eyelid entropion-most often bilateral (80%)-was significantly more common in Sphynx versus non-Sphynx cats (odds ratio = 4.1, 95% CI = 2.3-7.1, p < .001), and age of diagnosis was significantly younger in Sphynx cats (0.9 ± 1.4 years vs. 3.5 ± 3.3 years, p < .005). CONCLUSIONS Corneal sequestrum and entropion were overrepresented and diagnosed at an earlier age in Sphynx cats when compared with the general feline population. Given the high prevalence, early age of onset, and relatively high recurrence of corneal sequestrum in Sphynx cats, further studies are warranted to better understand etiopathogenesis and preferred therapies.
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Affiliation(s)
| | | | - Lionel Sebbag
- Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
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Telle MR, Betbeze C. Corneal Surgery in the Cat: Diseases, considerations and techniques. J Feline Med Surg 2022; 24:429-441. [PMID: 34844459 PMCID: PMC11104038 DOI: 10.1177/1098612x211061049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PRACTICAL RELEVANCE The ability to recognize, diagnose and treat corneal disease is essential for maintaining vision and comfort in feline patients. Being able to correctly identify appropriate techniques for surgical cases is of particular importance for success when performing corneal surgery. CLINICAL CHALLENGES Many different corneal diseases present with similar clinical signs, and it can be hard to determine the appropriate treatment for individual patients. It is essential for the clinician to understand the indications for corneal surgery, instrumentation needed and microsurgical principles prior to attempting these procedures. The prognosis following surgery and potential complications should be discussed with the client. AUDIENCE This review article aims to assist in decision-making and to provide detailed guidance for primary care clinicians considering referral of cats for corneal surgery. The review outlines common feline corneal diseases and associated surgical therapies performed by veterinary ophthalmologists, highlighting appropriate instrumentation and case selection. Some surgeries are explained in depth for ophthalmologists and residents in training. EQUIPMENT Although some procedures may be performed with common surgical equipment and supplies, most require specialized ophthalmic instrumentation and expertise, which entails significant microsurgical training and practice, as well as financial investment. Most of the procedures require an operating microscope for the best surgical outcomes; however, surgical loupes may be sufficient in some cases. Evidence base: This review article compiles information from many published references on feline corneal diseases and surgeries, complemented by the experience of the authors.
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Affiliation(s)
- Mary Rebecca Telle
- Mississippi State University College of Veterinary Medicine, 240 Wise Center Drive, PO Box 6100, MS 39762, USA
| | - Caroline Betbeze
- Mississippi State University College of Veterinary Medicine, 240 Wise Center Drive, PO Box 6100, MS 39762, USA
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Xu H, Sapienza JS, Jin Y, Lin J, Zheng X, Dong H, Diao H, Zhao Y, Gao J, Tang J, Feng X, Micceri D, Zeng H, Lin D. Lamellar Keratoplasty Using Acellular Bioengineering Cornea (BioCorneaVetTM) for the Treatment of Feline Corneal Sequestrum: A Retrospective Study of 62 Eyes (2018–2021). Animals (Basel) 2022; 12:ani12081016. [PMID: 35454262 PMCID: PMC9026742 DOI: 10.3390/ani12081016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/03/2022] [Accepted: 04/12/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Corneal sequestrum is a specific and common corneal disease in cats. Surgery treatment is the recommended option. Acellular bioengineering cornea (ABC) is a popular and effective corneal transplantation material. However, no study has been published to evaluate the effectiveness and outcome of ABC lamellar transplantation for the treatment of feline corneal sequestrum (FCS). The purpose of this retrospective study was to evaluate the surgical effect of ABC lamellar transplantation in the treatment of FCS. All cats were diagnosed with FCS. All eyes received ABC lamellar transplantation for the first time, including 61 cats (62 eyes), aged 6–120 months. The average sequestrum size was 7.98 mm, with a medium of 7.75 mm (range, 4.75–11.75 mm), and the sequestrum thickness included 200 microns for 1 eye (1.61%), 300 microns for 28 eyes (45.16%), 400 microns for 29 eyes (46.77%), and 450 microns for 4 eyes (6.45%). All eyes retained vision after surgical treatment, and there was no recurrence during the follow-up period. This study has several limitations, including incomplete unification and standardization of data collection, some vacancies of follow-up time, inconsistency between then optical coherence tomography(OCT) examination and postoperative photo collection. Despite several limitations, our results show that ABC is easy to obtain and store, and has the choice of different sizes and thicknesses to achieve rapid corneal healing, and satisfactory visual and cosmetic effects in FCS treatment. Acellular bioengineering cornea can be a good alternative for the treatment of FCS. Abstract To retrospectively evaluate the effectiveness and outcome of lamellar keratoplasty using acellular bioengineering cornea (BioCorneaVetTM) for the treatment of feline corneal sequestrum (FCS). The medical records of cats diagnosed with FCS that underwent lamellar keratoplasty with BioCorneaVetTM between 2018 and 2021 with a minimum of 3 months of follow-up were reviewed. Follow-up examinations were performed weekly for 3 months, and then optical coherence tomography (OCT) examination was performed on select patients at 0, 3, 6, and 12 months post-operatively. A total of 61 cats (30 left eyes and 32 right eyes) were included. The Persian breed was overrepresented, 48/61 (78.69%). Four different thicknesses of acellular bioengineering cornea were used (200, 300, 400, or 450 microns), and the mean graft size was 8.23 mm (range, 5.00–12.00 mm). Minor complications were composed of partial dehiscence, and protrusion of the graft occurred in 7/62 eyes (11.29%). The median postoperative follow-up was 12.00 months (range, 3–41 months). A good visual outcome was achieved in 60/62 eyes (96.77%), and a mild to moderate corneal opacification occurred in 2/62 (3.23%). No recurrence of corneal sequestrum was observed. From the results, lamellar keratoplasty using acellular bioengineering cornea (BioCorneaVetTM) is an effective treatment for FCS, providing a good tectonic support and natural collagen framework, and resulting in satisfactory visual and cosmetic effects.
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Affiliation(s)
- Huihao Xu
- College of Veterinary Medicine, China Agricultural University, No. 2, Yuanmingyuan West Road, Haidian District, Beijing 100193, China; (H.X.); (Y.J.); (J.L.); (H.D.); (H.D.); (Y.Z.); (J.G.)
- College of Veterinary Medicine, Southwest University, No. 160, Xueyuan Road, Rongchang District, Chongqing 402460, China; (X.Z.); (J.T.); (X.F.); (H.Z.)
| | - John S. Sapienza
- Long Island Veterinary Specialists, Plainview, NY 11803, USA; (J.S.S.); (D.M.)
| | - Yipeng Jin
- College of Veterinary Medicine, China Agricultural University, No. 2, Yuanmingyuan West Road, Haidian District, Beijing 100193, China; (H.X.); (Y.J.); (J.L.); (H.D.); (H.D.); (Y.Z.); (J.G.)
| | - Jiahao Lin
- College of Veterinary Medicine, China Agricultural University, No. 2, Yuanmingyuan West Road, Haidian District, Beijing 100193, China; (H.X.); (Y.J.); (J.L.); (H.D.); (H.D.); (Y.Z.); (J.G.)
| | - Xiaobo Zheng
- College of Veterinary Medicine, Southwest University, No. 160, Xueyuan Road, Rongchang District, Chongqing 402460, China; (X.Z.); (J.T.); (X.F.); (H.Z.)
| | - Haodi Dong
- College of Veterinary Medicine, China Agricultural University, No. 2, Yuanmingyuan West Road, Haidian District, Beijing 100193, China; (H.X.); (Y.J.); (J.L.); (H.D.); (H.D.); (Y.Z.); (J.G.)
| | - Hongxiu Diao
- College of Veterinary Medicine, China Agricultural University, No. 2, Yuanmingyuan West Road, Haidian District, Beijing 100193, China; (H.X.); (Y.J.); (J.L.); (H.D.); (H.D.); (Y.Z.); (J.G.)
| | - Ying Zhao
- College of Veterinary Medicine, China Agricultural University, No. 2, Yuanmingyuan West Road, Haidian District, Beijing 100193, China; (H.X.); (Y.J.); (J.L.); (H.D.); (H.D.); (Y.Z.); (J.G.)
| | - Jiafeng Gao
- College of Veterinary Medicine, China Agricultural University, No. 2, Yuanmingyuan West Road, Haidian District, Beijing 100193, China; (H.X.); (Y.J.); (J.L.); (H.D.); (H.D.); (Y.Z.); (J.G.)
| | - Jing Tang
- College of Veterinary Medicine, Southwest University, No. 160, Xueyuan Road, Rongchang District, Chongqing 402460, China; (X.Z.); (J.T.); (X.F.); (H.Z.)
| | - Xueqian Feng
- College of Veterinary Medicine, Southwest University, No. 160, Xueyuan Road, Rongchang District, Chongqing 402460, China; (X.Z.); (J.T.); (X.F.); (H.Z.)
| | - Danielle Micceri
- Long Island Veterinary Specialists, Plainview, NY 11803, USA; (J.S.S.); (D.M.)
| | - Haoran Zeng
- College of Veterinary Medicine, Southwest University, No. 160, Xueyuan Road, Rongchang District, Chongqing 402460, China; (X.Z.); (J.T.); (X.F.); (H.Z.)
| | - Degui Lin
- College of Veterinary Medicine, China Agricultural University, No. 2, Yuanmingyuan West Road, Haidian District, Beijing 100193, China; (H.X.); (Y.J.); (J.L.); (H.D.); (H.D.); (Y.Z.); (J.G.)
- Correspondence:
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Michel J, Vigan M, Douet JY. Autologous lamellar keratoplasty for the treatment of feline corneal sequestrum: A retrospective study of 35 eyes (2012-2020). Vet Ophthalmol 2021; 24:491-502. [PMID: 34480401 DOI: 10.1111/vop.12930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/12/2021] [Accepted: 08/23/2021] [Indexed: 12/14/2022]
Abstract
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.
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Affiliation(s)
- Julien Michel
- Clinique Vétérinaire VPLUS, Saint-Germain-en-Laye, France
| | - Marie Vigan
- Unité de Recherche Clinique Paris Saclay, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Jean-Yves Douet
- Small Animal Clinic, ENVT, Université de Toulouse, Toulouse, France.,IHAP, INRAE, ENVT, Université de Toulouse, Toulouse, France
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Mezzadri V, Crotti A, Nardi S, Barsotti G. Surgical treatment of canine and feline descemetoceles, deep and perforated corneal ulcers with autologous buccal mucous membrane grafts. Vet Ophthalmol 2021; 24:599-609. [PMID: 34085742 PMCID: PMC9292918 DOI: 10.1111/vop.12907] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 03/03/2021] [Accepted: 05/15/2021] [Indexed: 12/01/2022]
Abstract
Objectives To report the surgical technique and postoperative outcome of corneal repair with autologous buccal mucous membrane grafts in dogs and cats with descemetoceles, deep corneal ulcers, and perforated corneal ulcers with or without iris prolapse. Animal studied Twelve cats (13 eyes) and fourteen dogs (14 eyes) were treated. Procedures Grafts were harvested from the unpigmented superior labial mucosa using a biopsy punch. The corneal lesion was carefully debrided and cleaned. The graft was secured to the healthy cornea with a combination of simple interrupted and continuous 9–0 polyglycolic acid sutures. In 25/27 treated eyes, an overlying pedicle conjunctival graft was also performed. A temporary nictitating membrane flap was used in all cases. The pedicle conjunctival graft was trimmed about 10–20 days postoperatively. The median follow‐up period was 549.2 days (range 14–2691 days). Results No surgical intra‐operative complications were observed. The ulcers healed and the integrity of the globe was restored in 24/27 treated eyes. Different grades of corneal fibrosis and/or vascularization and/or pigmentation were observed in all cases at the long‐term follow‐up. In two cases, enucleation was performed due to postoperative complications and one animal developed phthisis bulbi. A total of 22/27 treated eyes appeared to have regained effective visual function at the last clinical evaluation. Conclusions Autologous buccal mucous membrane grafts appear to successfully manage severe corneal ulcers in dogs and cats, providing a useful and economical alternative to other corneal grafts.
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Affiliation(s)
- Valentina Mezzadri
- Oculistica Veterinaria Genova, Genova, Italy.,Department of Veterinary Science, University of Pisa, Pisa, Italy
| | | | - Samanta Nardi
- Department of Veterinary Science, University of Pisa, Pisa, Italy
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12
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Hartley C. Outcomes of treatments for keratomalacia in dogs and cats: a systematic review of the published literature including non-randomised controlled and non-controlled studies. J Small Anim Pract 2021; 62:840-849. [PMID: 33934337 DOI: 10.1111/jsap.13326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/14/2021] [Accepted: 02/19/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this review was to interrogate the evidence base for treatment of keratomalacia in dogs and cats, through examination of the applicable literature. MATERIALS AND METHODS Studies were screened for evidence to answer the following question Which of the treatment options for keratomalacia in dogs and cats offers the best chance of globe survival, the fastest time to resolution with globe survival, and the best visual outcome. The search utilised the PubMed (http://www.pubmed.gov/) and ISI Web of Science (http://wok.mimas.ac.uk/) databases. Databases were searched using the following terms: (keratomalacia OR corneal melt OR corneal malacia) AND (dog OR canine OR canid OR cat OR feline OR felid) AND (treatment OR outcome OR morbidity OR complications). Studies were assessed by one author (CH) and excluded if they related to less than three keratomalacia cases, experimental treatments, in vitro studies, or did not provide information regarding outcome. Studies were classified to a level of evidence according to the system described by the Oxford Centre for EvidenceBased Medicine. RESULTS Eighteen (18) studies were identified as providing information to answer the proposed question, one as level 3, 10 as level 4 and seven as level 5 evidence. Only one study compared two treatments, the remaining were prospective or retrospective case series of a single treatment intervention. Study design was highly variable with respect to population size, followup and outcome assessment, making direct comparison difficult, and metaanalysis was not applied. CLINICAL SIGNIFICANCE Overall, the evidence for improved outcome of one proposed treatment over another proposed treatment for keratomalacia in dogs and/or cats is very weak.
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Affiliation(s)
- C Hartley
- Langford Vets, University of Bristol Veterinary School, Bristol, BS40 5DU, UK
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13
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Foote BC, Smith JS, Allbaugh RA, Sebbag L, Ben-Shlomo G. Novel use of a combination of extracellular matrices for wound healing following resection of a large inferior eyelid mass in a miniature Hereford. J Am Vet Med Assoc 2021; 257:833-839. [PMID: 33021453 DOI: 10.2460/javma.257.8.833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 9-month-old miniature Hereford heifer was evaluated for a mass on the right inferior eyelid that had progressed in size over 3 months. CLINICAL FINDINGS Physical examination revealed a firm, ulcerated, pedunculated mass on the right inferior eyelid that extended from the medial quarter to beyond the lateral canthus of the eye. The base of the mass measured 7.4 × 6.7 cm, and the dorsal margin of the base of the mass was approximately 3 mm ventral to the inferior eyelid margin. Histologic evaluation of incisional biopsy specimens from the mass was consistent with fibrosarcoma. TREATMENT AND OUTCOME The mass was surgically resected with care taken to preserve the eyelid margin. The resulting 10 × 8.5-cm surgical wound was treated with adjunct CO2 laser therapy and closed by primary closure at its medial and central aspects and placement of a 4.6 × 2.6-cm lyophilized equine amnion multilayer graft and 2 sheets of 4-ply porcine small intestinal submucosa at its lateral aspect. The grafts were kept moist by alternating topical antimicrobial and artificial tear ointments for 3 weeks. The wound healed without complications, resulting in a functional and aesthetically pleasing outcome despite the development of moderate ectropion at the lateral aspect of the inferior eyelid. CLINICAL RELEVANCE Results suggested that a combination of extracellular matrix scaffolds may be an alternative to extensive skin flaps for management of large dermal wounds, particularly wounds resulting from blepharoplasty where preservation of an eyelid margin is desired.
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Steinmetz A, Theyse LF. Treatment of deep corneal ulcers with porcine small intestinal submusosa using a modified surgical technique in dogs. Clin Case Rep 2021; 9:812-817. [PMID: 33598250 PMCID: PMC7869326 DOI: 10.1002/ccr3.3661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/12/2020] [Accepted: 11/25/2020] [Indexed: 01/10/2023] Open
Abstract
Treatment of deep corneal ulcers using small intestinal submucosa (SIS) without corneal sutures in combination with a third eyelid flap seems a promising technical modification. Advantages are a reduction in surgery time and no additional damage of healthy corneal tissue.
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15
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Multari D, Perazzi A, Contiero B, Carobbi B, Bertoldi M, Iacopetti I. Corneal sequestra in cats: 175 eyes from 172 cases (2000-2016). J Small Anim Pract 2021; 62:462-467. [PMID: 33511632 DOI: 10.1111/jsap.13303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 11/27/2020] [Accepted: 12/29/2020] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- D Multari
- CVO Fontane, Centro Veterinario Oculistico, Fontane di Villorba, Treviso, 31020, Italy
| | - A Perazzi
- Department of Animal Medicine, Production and Health, University of Padova, Legnaro, Padua, 35122, Italy
| | - B Contiero
- Department of Animal Medicine, Production and Health, University of Padova, Legnaro, Padua, 35122, Italy
| | - B Carobbi
- Department of Animal Medicine, Production and Health, University of Padova, Legnaro, Padua, 35122, Italy
| | | | - I Iacopetti
- Department of Animal Medicine, Production and Health, University of Padova, Legnaro, Padua, 35122, Italy
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16
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Jaksz M, Fischer MC, Fenollosa-Romero E, Busse C. Autologous corneal graft for the treatment of deep corneal defects in dogs: 15 cases (2014-2017). J Small Anim Pract 2020; 62:123-130. [PMID: 33258490 DOI: 10.1111/jsap.13262] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/27/2020] [Accepted: 10/14/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To describe the use of corneal autografts for repair of deep corneal defects in dogs. MATERIALS AND METHODS Retrospective analysis of clinical records of dogs that received autologous corneal grafts. RESULTS Fifteen dogs (16 eyes) of different breed, age and gender were included. Brachycephalic breeds were overrepresented (10/15 dogs). Defects were unilateral in 14 dogs and bilateral in one dog, extended to at least 80% of the stromal thickness in all eyes, with descemetoceles in four eyes and corneal perforations in five eyes. Most ulcers (13/16 eyes) were located centrally. Corneal autografts were harvested from healthy peripheral cornea of the ipsilateral eye. The thickness of the autograft was limited to a set depth of 0.3 mm. The autograft was sutured into a previously debrided ulcer bed with a continuous or simple interrupted suture pattern using absorbable or non-absorbable suture material. Additional interventions included a partial temporary tarsorrhaphy and bandage contact lenses. Postoperatively patients received topical antibiotics and systemic anti-inflammatory drugs, and 12/15 dogs also received systemic antibiotics. Mean follow-up time was 54 days (2 to 462). In all eyes the donor site healed uneventfully with mild, persistent corneal fibrosis. Postoperative complications included autograft keratomalacia, graft dehiscence and corneal pigmentation. No patient required additional surgery. Good structural and functional outcome was accomplished in 14 of 16 eyes. CLINICAL SIGNIFICANCE Autologous corneal grafts provide tectonic support and result in good corneal transparency in selected cases of dogs with deep to perforated corneal ulcerations.
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Affiliation(s)
- M Jaksz
- Dick White Referrals, Station Farm, London Road, Six Mile Bottom, Suffolk, CB8 0UH, UK
| | - M-C Fischer
- Dick White Referrals, Station Farm, London Road, Six Mile Bottom, Suffolk, CB8 0UH, UK
| | - E Fenollosa-Romero
- Dick White Referrals, Station Farm, London Road, Six Mile Bottom, Suffolk, CB8 0UH, UK
| | - C Busse
- Dick White Referrals, Station Farm, London Road, Six Mile Bottom, Suffolk, CB8 0UH, UK
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Thajunnisa AS, Sainulabdeen A, Dileepkumar KM, Philip LM, Vasudevan VN, Devanand CB. Comparative evaluation of decellularized bovine omentum alone and in combination with mitomycin-C in the management of corneal injuries in dogs. Vet World 2020; 13:2401-2410. [PMID: 33363333 PMCID: PMC7750223 DOI: 10.14202/vetworld.2020.2401-2410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 10/07/2020] [Indexed: 11/20/2022] Open
Abstract
Background and Aim: Ulcerative corneal lesions are common ocular affections encountered in veterinary ophthalmology, having a higher incidence in dogs with brachycephalic conformation. Prompt and effective diagnosis and repair are necessary to avoid corneal perforation and restore vision. Corneal wound healing is a complex phenomenon often resulting in vision impairment as a consequence of corneal fibrosis and pigmentation. The present study investigated the efficacy of decellularized and gamma-irradiated bovine omentum as an extracellular matrix scaffold in the reconstruction of extensive and full-thickness corneal defects, and the cytotoxic effects of mitomycin-C (MMC) to prevent corneal fibrosis and pigmentation. Materials and Methods: Twelve injured corneas of eleven dogs irrespective of breed, age, and sex were randomly divided into Groups I and II, consisting of six corneas each. Under general anesthesia, corneal grafting with decellularized and gamma-irradiated bovine omentum was carried out in Group I, whereas Group II corneas underwent single time intra-operative application of topical MMC for 2 min before corneal grafting with the same material. Epithelialization of cornea and observations including corneal edema, neovascularization, the extent of pigmentation, corneal clarity, and scarring was recorded on days 7, 14, 21, and 60 postoperatively. Results: All corneas in Group I showed early epithelialization by day 7 compared to Group II where the MMC delayed epithelialization in 50% of the corneas. Visual function scores improved greatly from 0.17±0.17 in Group II on the day of presentation to 1.0±00 by the end of the observation period compared to Group I (from 0.33±0.15 to 0.88±0.11). Although epithelialization and corneal healing were delayed, 50% of the corneas recovered with undetectable corneal scar and melanosis at the end of the observation period in Group II due to the anti-fibrotic effect of MMC. Conclusion: From the present study, it was concluded that re-epithelialization of the cornea was enhanced by corneal grafting with decellularized bovine omentum, and application of MMC was effective in delaying corneal fibrosis and pigmentation.
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Affiliation(s)
- A S Thajunnisa
- Department of Veterinary Surgery and Radiology, College of Veterinary and Animal Sciences, Kerala Veterinary and Animal Sciences University, Mannuthy, Kerala, India
| | - Anoop Sainulabdeen
- Department of Veterinary Surgery and Radiology, College of Veterinary and Animal Sciences, Kerala Veterinary and Animal Sciences University, Mannuthy, Kerala, India
| | - K M Dileepkumar
- Department of Veterinary Surgery and Radiology, College of Veterinary and Animal Sciences, Kerala Veterinary and Animal Sciences University, Mannuthy, Kerala, India
| | - Laiju M Philip
- Department of Veterinary Surgery and Radiology, College of Veterinary and Animal Sciences, Kerala Veterinary and Animal Sciences University, Mannuthy, Kerala, India
| | - V N Vasudevan
- Department of Livestock Products Technology, College of Veterinary and Animal Sciences, Kerala Veterinary and Animal Sciences University, Mannuthy, Kerala, India
| | - C B Devanand
- Department of Veterinary Surgery and Radiology, College of Veterinary and Animal Sciences, Kerala Veterinary and Animal Sciences University, Mannuthy, Kerala, India
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Cebrian P, Escanilla N, Lowe RC, Dawson C, Sanchez RF. 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. Vet Ophthalmol 2020; 24:48-58. [PMID: 33034144 DOI: 10.1111/vop.12833] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 01/19/2023]
Abstract
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.
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Affiliation(s)
| | | | | | | | - Rick F Sanchez
- Specialistische Dierenkliniek (Anicura) Utrecht, Utrecht, Netherlands
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Maini S, Hurley-Bennett K, Dawson C. Case Series Describing the Use of Low-Temperature Vacuum-Dehydrated Amnion (Omnigen) for the Treatment of Corneal Ulcers in Cats and Dogs: 46 Cases (2016-2017). Top Companion Anim Med 2020; 41:100474. [PMID: 32919060 DOI: 10.1016/j.tcam.2020.100474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 08/26/2020] [Accepted: 09/04/2020] [Indexed: 12/13/2022]
Abstract
Amniotic membrane is widely used in the treatment of ocular surface disorders in human and veterinary patients. Preservation and storage of amnion has proven challenging, prompting the development of new preservation techniques. Omnigen, a novel low-temperature vacuum-dehydrated amnion, is reported to possess enhanced structural properties and biochemical stability in vitro, but its clinical use in veterinary patients is not well described. This study aims to document and describe the varied use of Omnigen for the surgical treatment of corneal ulceration in cats and dogs. A total of 45 patients (46 eyes) were recruited from the clinical record system of the Royal Veterinary College (London) between January 2016 and December 2017. Brachycephalic breeds were over-represented (37/45; 82.2%). Omnigen was used as a standalone graft in 5/46 (10.9%) eyes, as a supplementary graft in 29/46 (63.0%) eyes and as a patch in 12/46 (26.1%) eyes. Graft failure occurred in 10/46 eyes (21.7%). At final examination 43/46 eyes (93.5%) had healed and 31/33 eyes (93.9%) were visual. This study demonstrates the successful use of Omnigen for the surgical treatment of corneal ulceration in cats and dogs. Further studies are needed to clarify its properties and benefits in the clinical field.
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Affiliation(s)
- Serena Maini
- Department of Clinical Science and Services, The Royal Veterinary College, Ophthalmology Service, University of London, North Mymms, Herts, UK.
| | - Kiera Hurley-Bennett
- Department of Clinical Science and Services, The Royal Veterinary College, Ophthalmology Service, University of London, North Mymms, Herts, UK
| | - Charlotte Dawson
- Department of Clinical Science and Services, The Royal Veterinary College, Ophthalmology Service, University of London, North Mymms, Herts, UK
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20
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Keenan AV, Boveland SD, Rodriguez Galarza R, Moore PA. Corneoconjunctival transposition with and without ACell ® for deep corneal ulcer repair in 18 dogs. Vet Ophthalmol 2020; 23:884-891. [PMID: 32790061 DOI: 10.1111/vop.12815] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/07/2020] [Accepted: 07/28/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To document a case series using corneoconjunctival transposition (CCT) surgery with and without bioscaffolding matrix (ACell® ) to repair deep corneal ulcers and perforations in dogs. ANIMALS STUDIED Eighteen dogs of various breeds that presented with deep or perforating corneal ulcers. PROCEDURES Corneoconjunctival transposition grafts with or without ACell® were sutured using a simple interrupted 8-0 or 9-0 polyglactin 910 pattern. RESULTS A total of eighteen dogs (19 eyes) were diagnosed with deep corneal ulcers (n = 7) and perforating corneal ulcers (n = 12). A CCT was performed in all eyes, with ten of them additionally receiving an ACell® graft. The majority of lesions were located axially in 14/19 (81%) eyes. Grafts were harvested from dorsal (n = 8), temporal (n = 5), ventral (n = 4), or nasal (n = 2) quadrants. Brachycephalic breeds (13/18) were over-represented. Keratoconjunctivitis sicca was present in 10/19 eyes (52.6%). Bacterial isolates were cultured from 8/19 eyes. Post-operative therapy included topical antibiotics, plasma, cycloplegics, oral antibiotics, and oral nonsteroidal anti-inflammatory drugs. CCT integration with and without ACell® occurred at a median of 20 days (range 7-38 days) post-operatively with no significant difference between groups. Median follow-up time was 188 days. Short-term post-operative complications included granulation tissue formation (19/19), corneal edema (4/19), graft retraction (4/19), and anterior synechia (1/19). Long-term complications in 14 eyes with follow-up >30 days included superficial corneal pigmentation (6/14) and epithelial inclusion cysts (5/14). Two eyes were nonvisual at last follow-up due to cataract formation. CONCLUSIONS Corneoconjunctival transposition with ACell® can be utilized for corneal ulcer repair in dogs.
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Affiliation(s)
- Alessandra V Keenan
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
| | - Shannon D Boveland
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
| | | | - Phillip A Moore
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
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Davis RL, Reilly CM, Moore PA. Surgical excision of iridociliary tumors using a postero-anterior cyclo-iridectomy and thermocautery in two dogs. Vet Ophthalmol 2020; 23:579-587. [PMID: 32237209 DOI: 10.1111/vop.12755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/23/2020] [Accepted: 02/05/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To report the surgical excision of an iridociliary adenoma and iridal melanocytoma using a postero-anterior cyclo-iridectomy in two dogs. PROCEDURE A 7 year old neutered male English springer spaniel (case 1) and a 7 year old neutered male Labrador mix (case 2) were presented for evaluation of an intrairidal mass OS. RESULTS Complete ophthalmic examination revealed a large, dorsonasal, well-demarcated, intrairidal mass OS. A tan to pink intrairidal mass extending into the iridocorneal angle (case 1) and a pigmented intrairidal mass (case 2) were present. B-mode ultrasonography showed a focal, soft tissue, homogenous mass within the uvea adjacent to and contacting the lens. Neither pars plana involvement nor vitreal extension was present. A postero-anterior cyclo-iridectomy was performed through a polyhedral scleral flap. Thermocautery was used to complete the cyclo-iridectomy (case 1) and partial iridectomy (case 2) to excise the mass en bloc. Histopathology revealed a completely excised iridociliary adenoma (case 1) and iris melanocytoma (case 2). The surgery sites healed without complication. Mild uveitis (cases 1 and 2), scant vitreal hemorrhage (case 1), and mild hyphema (case 2) were present three days postoperatively but had resolved ten days postoperatively. The patients remain visual twenty-two months (case 1) and seven months (case 2) postoperatively with a normal intraocular examination other than an iridal defect and mild dorsonasal lens capsular opacities. CONCLUSIONS The surgical approach described in these cases is utilized in physician-based medicine. This approach and the use of thermocautery provide a viable surgical option for excision of large iridociliary tumors in dogs.
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Affiliation(s)
| | | | - Phillip A Moore
- Department of Clinical Science, Auburn University, Auburn, Alabama
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22
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Gogova S, Leiva M, Ortillés Á, Lacerda RP, Seruca C, Laguna F, Crasta M, Ríos J, Peña MT. Corneoconjunctival transposition for the treatment of deep stromal to full-thickness corneal defects in dogs: A multicentric retrospective study of 100 cases (2012-2018). Vet Ophthalmol 2020; 23:450-459. [PMID: 31950569 DOI: 10.1111/vop.12740] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/22/2019] [Accepted: 12/20/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To describe and evaluate the use of corneoconjunctival transposition (CTT) as a surgical treatment for canine deep stromal ulcers, descemetoceles, and full-thickness corneal defects and to determine its efficacy in preserving corneal graft transparency and vision. ANIMALS STUDIED One hundred client-owned dogs with deep stromal ulcers, descemetoceles, or full-thickness corneal defects. METHODS Medical records of canine patients that underwent CCT, from 2012 to 2018, were reviewed. Only, patients with preoperative positive consensual pupillary light and dazzle reflexes were included. RESULTS There were 59 males and 41 females, from 0.3 to 17 years. Brachycephalic breeds were overrepresented (65%). All patients were unilaterally affected, with 16 deep stromal ulcers, 33 descemetoceles, and 51 corneal perforations, of a median (range) size of 4 (2-8) mm. The central cornea was affected in the majority of cases (57%), and euryblepharon and keratoconjunctivitis sicca were the most common concurrent ocular diseases (42% and 40%, respectively). The graft was most frequently harvested from dorsal (67%), and 9/0 absorbable suture material was used. Intraoperative and postoperative complications were seen in 7 and 21 cases, respectively. Mean follow-up time was 107.8 days. Vision was preserved in 96% patients, with 62% showing faint to mild opacification. Among the statistically analyzed variables, euryblepharon and pigmentary keratitis were found to be significantly associated with greater corneal graft opacification (P = .040 and P = .028, respectively). CONCLUSIONS Corneoconjunctival transposition is an effective surgical treatment for deep stromal, descemetocele, and full-thickness corneal defects in dogs, achieving a highly satisfactory degree of corneal graft transparency and preserving vision.
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Affiliation(s)
- Savina Gogova
- Fundació Hospital Clínic Veterinari, Campus Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Marta Leiva
- Fundació Hospital Clínic Veterinari, Campus Universitat Autònoma de Barcelona, Bellaterra, Spain.,Departament de Medicina i Cirurgia Animal, Facultat de Veterinaria, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Ángel Ortillés
- Fundació Hospital Clínic Veterinari, Campus Universitat Autònoma de Barcelona, Bellaterra, Spain
| | | | | | | | | | - Jose Ríos
- Laboratory of Biostatistics & Epidemiology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Maria Teresa Peña
- Fundació Hospital Clínic Veterinari, Campus Universitat Autònoma de Barcelona, Bellaterra, Spain.,Departament de Medicina i Cirurgia Animal, Facultat de Veterinaria, Universitat Autònoma de Barcelona, Bellaterra, Spain
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Martin de Bustamante MG, Good KL, Leonard BC, Hollingsworth SR, Edwards SG, Knickelbein KE, Cooper AE, Thomasy SM, Maggs DJ. Medical management of deep ulcerative keratitis in cats: 13 cases. J Feline Med Surg 2019; 21:387-393. [PMID: 29767565 PMCID: PMC10814642 DOI: 10.1177/1098612x18770514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
CASE SERIES SUMMARY Described are 13 cats diagnosed with deep ulcerative keratitis and successfully managed medically without grafting procedures. Typical treatment involved frequent topical application of serum and antibiotics (usually a fluoroquinolone and a cephalosporin). Seven cats also received systemic antibiotics. Analgesia was achieved using various combinations of topical atropine and systemic buprenorphine, robenacoxib or corticosteroids. Six cats were hospitalized for a median (range) period of 2.5 (1-8) days, typically because of frequent medication administration. Median (range) follow-up time was 41.5 (9-103) days. Median (range) number of recheck examinations was 4 (2-6). Median (range) time to corneal re-epithelialization was 21 (9-103) days. Median (range) topical antibiotic course was 29.5 (16-103) days. Median (range) duration of Elizabethan collar use was 28 (13-73) days. At the time of writing, no further recheck examinations were recommended for 10 cats; median (range) time between initial to final examinations in these cats was 35 (20-103) days. All cats retained the affected globes and were apparently comfortable and visual at the latest recheck examination. RELEVANCE AND NOVEL INFORMATION These cases reveal that aggressive medical management is highly successful in select cats with deep ulcerative keratitis, and can result in a cosmetically acceptable, apparently comfortable and visual globe. However, therapy is intensive with frequent administration of multiple topical and sometimes systemic medications, and requires multiple veterinary visits over many weeks. Referral to a veterinary ophthalmologist for consideration of surgical stabilization is recommended, as not all cases may be amenable to the medical therapy described here.
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Affiliation(s)
| | - Kathryn L Good
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Brian C Leonard
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Steven R Hollingsworth
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Sydney G Edwards
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Kelly E Knickelbein
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Ann E Cooper
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Sara M Thomasy
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - David J Maggs
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, USA
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Greenberg S. Ulcerative keratitis and keratomalacia in horses: Medical management and surgical considerations. EQUINE VET EDUC 2019. [DOI: 10.1111/eve.12808] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- S. Greenberg
- Ophthalmology New England Veterinary Center and Cancer Care Windsor Connecticut USA
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25
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Pumphrey SA, Desai SJ, Pizzirani S. Use of cyanoacrylate adhesive in the surgical management of feline corneal sequestrum: 16 cases (2011-2018). Vet Ophthalmol 2019; 22:859-863. [PMID: 30869191 DOI: 10.1111/vop.12663] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/22/2019] [Accepted: 02/24/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the use of cyanoacrylate adhesive as an adjunct to lamellar keratectomy in cats with corneal sequestrum. METHODS Medical records were reviewed to identify cats with naturally occurring midstromal corneal sequestra treated with lamellar keratectomy and cyanoacrylate adhesive. All cats also had a bandage contact lens placed for postoperative comfort. Data collected included breed, age, sex, and reproductive status of the cat, eye involved, presence or absence of neovascularization at the time of surgery, history of prior sequestra, additional ocular procedures performed, use of neuromuscular blocking agents, procedure time, time to cessation of topical medications, time to recurrence or last follow-up, and complications aside from recurrence. RESULTS Sixteen cats met study criteria, with a median follow-up time of 17.5 months in those without recurrence. Median time to cessation of topical medications was 4 weeks. Fourteen cats (87%) have not experienced recurrence. Other than recurrence in two cats, no significant complications were noted. Aside from purebred status, no commonalities were found between the two cats with recurrence. Neuromuscular blocking agents were not used during surgery in most cases. Median procedure time was 10 minutes. CONCLUSIONS Cyanoacrylate adhesive is an effective and safe alternative to grafting procedures in cats undergoing lamellar keratectomy for treatment of corneal sequestrum. Recurrence rates are comparable to those seen with grafting techniques. Benefits of this approach include decreased anesthesia time, lower procedure costs, and short duration of postoperative treatment.
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Affiliation(s)
- Stephanie A Pumphrey
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts
| | - Sujata J Desai
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts
| | - Stefano Pizzirani
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts
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26
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A bidirectional corneoconjunctival transposition for the treatment of feline corneal sequestrum. Vet Ophthalmol 2018; 22:192-195. [DOI: 10.1111/vop.12586] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Amorim T, Ribeiro A, Ruiz T, Dower N, Madruga G, Schroder D, Monteiro G, Rodrigues B. Impacto do grau de uveíte em diferentes tipos de úlceras de córneas em cães submetidos ao enxerto pediculado de conjuntiva bulbar - 34 casos. ARQ BRAS MED VET ZOO 2018. [DOI: 10.1590/1678-4162-9290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O presente trabalho objetivou avaliar os resultados de 34 olhos submetidos ao enxerto conjuntival pediculado (ECP) em ceratites ulcerativas profundas (n=5), em ceratites ulcerativas com colagenólise (n=2), descemetocele (n=7), perfuração corneal (n=15) e prolapso de íris (n=5). Os impactos do grau de uveíte e da integridade da córnea foram correlacionados com presença e ausência de visão por tabelas de contingência. Raças braquicefálicas foram acometidas em 91,11% dos casos. O número de córneas consideradas perfuradas [20/34 (58,82%)] foi maior que o de córneas íntegras [14/34 (41,17%)]. Ao 50º dia de pós-operatório, o número de olhos visuais que apresentavam córneas íntegras previamente às cirurgias (n=13) não diferiu significativamente dos olhos com córneas perfuradas (n=12) (P=0,05). Avaliações relativas ao grau de uveíte, revelaram que a metade dos casos foi considerada severa [17/34 (50%)] e na outra metade as uveítes foram consideradas discretas. Dos 17 casos que apresentaram uveíte severa, oito recuperaram a visão. Já nos 17 olhos onde a uveíte foi considerada leve, 15 mantiveram a visão ao final do período de avaliação. Apesar de a integridade da córnea não se correlacionar com a severidade da uveíte (P=0,48), constatou-se que o número de olhos visuais com uveíte discreta foi significativamente maior que os olhos com uveíte severa (P=0,006). Neste estudo, a taxa geral de sucesso visual após ECP foi de 73,52% e a integridade da córnea não exerceu impacto significativo sobre a manutenção da visão. Todavia, olhos acometidos por uveítes severas apresentaram menor chance de recuperar a visão.
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Affiliation(s)
| | | | - T. Ruiz
- Universidade Federal de Mato Grosso, Brazil
| | | | - G. Madruga
- Universidade Federal de Mato Grosso, Brazil
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Davis AM, Riggs CM, Chow DWY. The use of porcine urinary bladder matrix (
UBM
) to repair a perforated corneal ulcer with iris prolapse in a horse. EQUINE VET EDUC 2017. [DOI: 10.1111/eve.12779] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- A. M. Davis
- Veterinary Clinical Services The Hong Kong Jockey Club Sha TinHong Kong
| | - C. M. Riggs
- Veterinary Clinical Services The Hong Kong Jockey Club Sha TinHong Kong
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