Evaluation of conjunctival graft procedures and factors that lead to graft complications in canine cases

Partial incision blunt scissors lamellar keratectomy under topical anesthesia for the treatment of presumed calcific corneal degeneration in dogs

OBJECTIVE

The aim of the study was to investigate clinical features of lamellar keratectomy for presumed calcific corneal degeneration in a population of geriatric dogs using blunt scissors dissection under topical anesthesia.

ANIMALS STUDIED AND PROCEDURES

Retrospective analysis of dogs with clinically diagnosed calcific degeneration treated by keratectomy under topical anesthesia between 2015 and 2021 at two veterinary ophthalmology practices was performed. Descriptive data regarding signalment, concurrent systemic and ocular disease, complications, healing time, and recurrence were collected. Kaplan-Meier survival analysis was performed to calculate 1-year recurrence probability.

RESULTS

Sixty-five eyes in 57 dogs met inclusion criteria. All 54 eyes with follow-up healed within a median of 14 days (7-74), including 17 with complicating factors of infection or deep stromal ulceration. Globe rupture occurred intraoperatively in three eyes (4.6%), for which subsequent conjunctival graft was performed. Calculated 1-year recurrence probability from 47 eyes followed long term was 25%. Multivariate Cox proportional hazard modeling showed a significant association between documented systemic disease and time to recurrence (p = .035), irrespective of topical EDTA use (p = .432). Median follow-up time available for all cases was 249 days.

CONCLUSIONS

Blunt lamellar dissection with corneal scissors can be performed in dogs under topical anesthesia, yielding healing times and recurrence comparable to previously reported treatments for calcific corneal degeneration. Globe rupture is an inherent risk of both the disease and procedure and occurred in 4.6% of treated eyes. This approach expands non-anesthetic treatment options for affected patients but should only be performed with advanced microsurgical training and client counseling on individual risk and benefit.

Risk factors for corneal conjunctival grafting failure in dogs at four referral centers in the southern United States (203 patients): 2015-2021

OBJECTIVE

To report risk factors associated with conjunctival graft failure in dogs at four referral specialty centers.

PROCEDURES

Records of 203 dogs (229 eyes) undergoing conjunctival graft repair of ulcerative keratitis at four hospitals from 2015 to 2021 were reviewed. Success was defined as full graft integration with globe retention at the last postoperative evaluation; vision status was reported separately. Factors assessed included patient signalment, ophthalmic examination findings, surgical factors, and follow-up information.

RESULTS

Conjunctival graft failure occurred in 11% (25/229) of eyes and was significantly associated with ulcer depth, with corneal perforations having increased odds of graft failure compared with descemetoceles (odds ratio [OR] = 3.22, 95% confidence interval [CI] 1.11-9.32; p = .03) and stromal ulcers (OR = 10.89 [95% CI 1.38-86.18], p = .02). Brachycephalic dogs were significantly more likely than non-brachycephalic dogs to experience graft failure (OR = 5.02 [95% CI 1.42-17.74], p < .01). Surgery on the opposite eye relative to surgeon handedness was significantly associated with an increased risk of graft failure (OR 4.28 [95% CI 1.53-11.94], p < .01). The use of 7-0 and 8-0 suture versus 9-0 (p = .03) and the use of a combined simple continuous and interrupted pattern (p = .03) were significantly associated with an increased risk of graft failure. At the last follow-up, (median 61.5 days), 87% of dogs were visual.

CONCLUSIONS

Corneal perforations, surgery on the opposite eye relative to surgeon handedness, suture size and pattern, and brachycephalic conformation were significantly associated with an increased risk of graft failure in this study. These characteristics can be considered when determining prognosis for ulcerative keratitis requiring surgical intervention.

Kinetics and minimal inhibitory concentrations of ceftiofur in tear film following extended-release parenteral administration (Excede®) in dogs

Purpose

Describe the pharmacokinetics of extended-release parenteral ceftiofur (Excede^®) in canine tear film and compare these concentrations to minimal inhibitory concentrations (MICs) of ceftiofur against common ocular pathogens in dogs.

Method

Six dogs of various breeds were enrolled. Disruption of blood-tear barrier was achieved with histamine-induced conjunctivitis to ensure clinical relevance of the results. Each dog received a single subcutaneous injection of 5 mg/kg Excede^®, followed by tear collection with Schirmer strips at times 0, 0.25, 0.5, 1, 2, 4, 8, 12, 24, 36, 48, 72, 96, 120, 144, 168, 192, 216 and 240 h. Drug quantification was performed with liquid chromatography-mass spectrometry. MICs were determined for Staphylococcus pseudintermedius, Streptococcus canis and Pseudomonas aeruginosa by assessing bacterial growth (n = 10 per bacterial species) in the presence of ceftiofur at increasing concentrations.

Results

Blood-tear barrier breakdown provided tear film concentrations of ceftiofur 3.2–28.9-fold higher than in the contralateral healthy eye (n = 1 dog, pilot experiment). In all six dogs, ceftiofur concentrations in tears varied from 2.3 to 637.5 ng/mL and were detectable up to 10 days (240 h) after subcutaneous injection. However, tear levels always remained below MICs for common ocular isolates (≥640 ng/mL).

Conclusions

Ceftiofur reached the tear compartment (for up to 10 days) after a single parenteral injection, however tear concentrations were extremely variable and too low to be effective against common bacterial pathogens in dogs. Further studies with different ceftiofur dosage or other long-acting injectable antibiotics are warranted.