Use of free oral mucosal graft for treatment of feline eyelid agenesis in seven patients

Free labial mucocutaneous graft for eyelid reconstruction in four dogs

PURPOSE

To describe a technique for eyelid margin reconstruction following large mass resection utilizing a free labial mucocutaneous graft.

METHODS

Four dogs (4 eyes) underwent en bloc eyelid mass excision under general anesthesia. Measurements were made of the mass followed by free labial mucocutaneous graft retrieval, resection of the mass, and then transplantation of retrieved region of labial mucocutaneous tissue into the resulting defect.

RESULTS

Three patients underwent eyelid margin reconstruction with a free labial mucocutaneous graft. One patient received a pedicle advancement graft combined with a free labial mucocutaneous graft. In all cases, a length of 120%-150% of the eyelid defect was retrieved from the oral labia. Postoperative follow-up ranged from 6 weeks to 4 months. All cases had superficial graft necrosis and depigmentation of the donor tissue with total healing time taking up to 8 weeks. All cases had an esthetic and functional reconstruction.

CONCLUSIONS

This technique allows reconstruction of the majority of the eyelid margin, greater than that which can be closed primarily. Due to tissue sloughing, the healing time can be extended but cosmetic outcomes are good. Eyelid reconstruction utilizing a free labial graft restored a mucocutaneous margin and recreated a functional eyelid, thus avoiding trichiasis or secondary keratitis.

Use of subdermal hyaluronic acid injections and a free labial mucocutaneous graft for the repair of feline eyelid agenesis

OBJECTIVE

To describe a technique to repair feline eyelid agenesis using a hyaluronic acid (HA) subdermal filler injection to allow for acute soft tissue expansion, followed by a free labial mucocutaneous graft.

MATERIALS AND METHODS

Thirty-nine colobomatous eyelids in 24 feline patients with secondary keratitis were recruited to the study group.

RESULTS

Keratitis and trichiasis were markedly resolved in 27/39 (69.2%) eyelids after a single procedure. Post-operative HA subdermal filler injections were required to resolve 5/39 (12.8%) eyelids that had mild post-operative trichiasis, and 1/39 (2.5%) eyelids that had post-operative lateral canthal collapse. Complications occurred in 6/39 (15.4%) cases, consisting of distal graft necrosis (n = 2 eyes), suture rubbing the cornea (n = 2 eyes), moderate trichiasis (n = 1 eye) and graft adherence to the episclera (n = 1 eye).

CONCLUSION

The technique was successful in enhancing corneal protection, cosmesis and eyelid function and should be considered as a surgical option for any degree of eyelid agenesis in feline patients.

Lip Commissure to Eyelid Transposition Flap to Correct Eyelid Agenesis in Cats in a Shelter Setting - a Case Series

Five cats were diagnosed with eyelid agenesis in a 6-month period at the Miami-Dade Animal Services, and a total of 9 blepharoplasties were performed using the lip commissure to eyelid transposition flap (LCET) technique. Eyelid agenesis affected 50%-80% of the superiolateral lid in all cats. Postoperatively, partial necrosis of the flap was observed in 4 and partial dehiscence was observed in 1 of the corrected eyelids, occurring where the buccal mucosa was sutured to the conjunctival mucosa. No cats with partial necrosis of the flap were known to have developed trichiasis due to scar tissue formed at the necrotic site. The single case in which dehiscence occurred developed slight trichiasis that may warrant further intervention to ensure permanent hair ablation. Eyelids were cosmetically acceptable and functional at final examination. Patients showed no evidence of initial discomfort at the surgical sites, nor discomfort or progression of corneal disease during the follow-up time. This case series documents a suitable technique to treat cat eyelid agenesis when referral to a specialist is not an option due to lack of resources, such as in shelters or low-cost veterinary clinics. The surgical technique, outcome and complications presented in this case series are evaluated, and discussed.

Surgical treatment of canine and feline descemetoceles, deep and perforated corneal ulcers with autologous buccal mucous membrane grafts

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.