The use of hyaluronic acid subdermal filler for entropion in canines and felines: 40 cases.

PURPOSE: To evaluate the use of hyaluronic acid (HA) subdermal filler in canines and felines for entropion. METHODS: Complete ophthalmologic examination was performed by a board-certified veterinary ophthalmologist or ABVO-approved resident. Each case was characterized as primary, secondary, spastic or cicatricial entropion. HA subdermal filler, specifically Restylane® and Restylane Silk® , were utilized in dogs and cats, respectively. Subdermal injection was performed 1-2 mm from the eyelid margin in the affected area until normal eyelid conformation was achieved. All patients did not require sedation or general anesthesia. RESULTS: Forty animals (28 dogs and 12 cats) were included in the study. No local reaction to the HA dermal filler or any other complications other than minor skin bleeding at the injection sites were noted in all patients. Resolution of entropion and secondary complications including corneal ulceration, epiphora, and blepharospasm were noted by the first week after injection in the majority of cases. Three canines and one feline case failed to resolve the entropion, necessitating additional permanent surgical intervention. Two cases were submitted for histopathological analysis. Median follow-up time for all cases was 152.5 days (mean: 194.6 ± 142.7 days; range 9-419 days). Five patients died or were euthanized during the study for unrelated causes. CONCLUSIONS: Hyaluronic acid (HA) subdermal filler appears to be a safe, easy, reliable method for mild to moderate eyelid entropion not requiring general anesthesia. This procedure may be especially appropriate for geriatric patients and those with high anesthetic risk with entropion.

Use of equine amniotic membrane free-island grafts for treatment of a midstromal corneal ulcer and descemetocele in a snow leopard (Panthera uncia).

CASE DESCRIPTION A 7-year-old sexually intact female snow leopard (Panthera uncia) was examined because of blepharospasm, periocular discharge, ventral deviation of the upper eyelid cilia, third eyelid prolapse, and corneal opacity of the right eye. CLINICAL FINDINGS An ophthalmic examination performed with the patient anesthetized revealed a 3 × 3-mm ulcer that extended approximately 60% of the depth of the right cornea and was accompanied by perilesional and intralesional cellular infiltrates and active vascularization. The upper eyelid of the right eye also had a previously repaired coloboma resulting in trichiasis. TREATMENT AND OUTCOME Surgical intervention was elected after 5 weeks of medical management including topical administration of autologous serum and topical, subconjunctival, and systemic administration of antimicrobials failed to yield any improvement in the ulcer. Equine amniotic membrane free-island graft placement and eyelid revision surgeries were performed. Two and a half weeks later, a descemetocele was diagnosed ventrolateral to the original ulcer, and a second equine amniotic membrane free-island grafting procedure was performed. Both grafts healed without further intervention. CLINICAL RELEVANCE Equine amniotic membrane free-island grafts were used to successfully repair a corneal ulcer and descemetocele in a snow leopard. The grafting procedure spared the affected globe and resulted in satisfactory cosmesis and functional vision. This procedure should be considered as an option for corneal repair in nondomestic species for which postoperative care and medical treatment options are limited.

Determination of Schirmer tear test-1 values in clinically normal alpacas (Vicugña pacos) in North America.

PURPOSE: To determine the normal reference range for Schirmer tear test-1 (STT-1) values in eyes of healthy alpacas (Vicugña pacos). METHODS: Complete ophthalmic examinations were performed on forty healthy alpacas (80 eyes). STT-1 values were obtained in both eyes of all alpacas using a commercial STT strip of a single lot number. Data were analyzed, using a doubly repeated measures ANOVA design, Student's paired t-test, and Pearson correlation test, with P ≤ 0.05 considered significant. RESULTS: The STT-1 values ± standard deviation (SD) were 20.80 ± 4.01 mm/min OD, 20.00 ± 4.13 mm/min OS, and 20.88 ± 4.04 mm/min OU (range 15.50-30.50 mm/min). No significant differences in STT-1 were found between OD and OS. STT-1 was not significantly affected by breed. Schirmer tear test-1 values were significantly increased by 3.45 mm/min for every 10 year increase in age. CONCLUSIONS: This study provides a reference range of STT-1 in the healthy alpaca which can assist veterinarians in diagnosing potential keratoconjunctivitis sicca, tear film abnormalities, as well as ocular surface diseases in alpacas.

Orbital rhabdomyosarcoma and traumatic neuroma following enucleation for a uveal schwannoma in a dog: a case report.

A 4-year-old, female spayed Siberian husky with history of a uveal schwannoma presented for orbital swelling 9 months after enucleation. A second, malignant tumor developed in the same orbit. Therefore, uveal schwannomas may warrant early surgical intervention in the dog.

Effect of bandage contact lens wear and postoperative medical therapies on corneal healing rate after diamond burr debridement in dogs.

PURPOSE: To determine the effect of bandage contact lens wear and type of post-operative medical treatment on corneal healing rates in dogs after diamond burr debridement. ANIMALS STUDIED: 237 client-owned dogs. PROCEDURES: Canine patients having undergone diamond burr debridement (DBD) for treatment of spontaneous chronic corneal epithelial defects (SCCEDs) were included. Patients were put into 1 of 12 different groups based on type of postoperative medical regimen and whether a bandage contact lens (BCL) was utilized. Each dog was examined on a routine basis until the cornea was fluorescein negative. Data points collected included age, sex, breed, diabetic status, eye affected, Schirmer tear test 1, rebound tonometry, type and frequency of topical antibiotic, use of topical sodium chloride, use and retention of BCL, and days until healed. RESULTS: A total of 237 dogs, each contributing one eye to the study, underwent DBD for SCCEDs. All eyes treated had estimated median ± standard error (SE) days to heal of 9.37 ± 0.42 days. When sodium chloride and BCL were utilized, ofloxacin had a significantly shorter median healing time when compared to oxytetracycline (adjusted P = 0.0158) and tobramycin (adjusted P = 0.0261). BCL use significantly improved healing times (P = 0.0002). Overall BCL retention rate was 62.02% (80 of 129). PureVision lenses were retained more often compared to Acrivet lenses (P < 0.0001). Overall, BCL retention significantly improved healing rates (P = <0.0001). CONCLUSIONS: Postdebridement antibiotic type or use of sodium chloride ointment had minor effects on healing rates. Bandage contact lens use and retention significantly improves healing times.

Comparison of intraocular pressure measurements using rebound (TonoVet® ) and applanation (TonoPen-XL® ) tonometry in clinically normal alpacas (Vicugña pacos).

PURPOSE: To evaluate intraocular pressure (IOP) estimates in eyes of healthy alpacas (Vicugña pacos) using rebound (TonoVet® ) in comparison with applanation (TonoPen-XL® ) tonometry. METHODS: Complete ophthalmic examinations were performed on forty healthy alpacas (80 eyes). IOP measurements using both TonoVet® and TonoPen-XL® tonometers were obtained OU. Data were analyzed, using a doubly repeated-measures anova design and Student's paired t-test, with P ≤ 0.05 considered significant. RESULTS: The mean IOP values ±SD via rebound tonometry were 14.20 mm ± 2.58 mm OD, 14.22 mm ± 2.90 mm OS, and 14.21 ± 2.73 mmHg OU (range 8.67-20.67 mmHg). The IOP values ±SD via applanation tonometry were 12.49 ± 2.81 mmHg OD, 12.53 ± 2.79 mmHg OS, and 12.51 ± 2.78 mmHg OU (range 6.00-19.33 mmHg). There was a significant difference (P = 0.002) in the IOP obtained between the tonometers, with the rebound tonometer having a 1.7 mmHg (0.69-2.71 mmHg, 95% confidence interval (CI)) higher IOP compared to the applanation tonometer. No significant differences in IOP were found between OD and OS. Age, gender, and breed did not significantly affect IOP values. CONCLUSIONS: IOP readings from the rebound tonometer were statistically higher than those from the applanation tonometer; however, this is not considered clinically significant. The accuracy of rebound tonometry in diseased alpaca eyes remains to be determined.

Ventral transpalpebral anterior orbitotomy: surgical description and report of 3 cases.

PURPOSE: To describe a surgical approach to allow access to the ventral anterior canine orbit and report outcomes of three cases. SURGICAL TECHNIQUE: After induction of general anesthesia and aseptic preparation of the surgical site, a 2.5- to 3-cm curvilinear skin incision was created through the inferior eyelid at the level of the ventral orbital rim. A combination of sharp and blunt dissection facilitated entrance into the ventral anterior orbital space for the removal of diseased tissues or allows for drainage of purulent debris. Two-layer closure was performed, and postoperative lateral temporary tarsorrhaphy sutures were retained to provide globe protection. RESULTS: Three dogs underwent unilateral ventral transpalpebral anterior orbitotomy. Prior to surgery, apart from a complete ophthalmic examination, ocular ultrasound was used to diagnose orbital disease in two cases, and MRI was utilized in the third case. Exploratory orbitotomy revealed a large mucocele in case 1, orbital bacterial abscessation in case 2, and necrotizing zygomatic sialoadenitis in case 3. Clinical exophthalmos resolved immediately after surgery. The surgical site in all cases healed within 2 weeks. One patient had a superficial corneal ulceration 2 weeks after surgery which healed uneventfully. Recurrence of orbital disease was not noted in any case. CONCLUSIONS: Ventral transpalpebral anterior orbitotomy is a simple procedure that allows easy access to the ventral anterior orbit to allow for removal of diseased tissues or to facilitate drainage of abscessation. Recurrence of orbital disease was not seen in any patient, with one patient experiencing blindness as a long-term complication following the procedure.

Carbon dioxide (CO2) laser third eyelid excision: surgical description and report of 7 cases.

PURPOSE: To describe a novel technique for third eyelid (TEL) excision using a carbon dioxide (CO2) laser. STUDY DESIGN: Prospective. ANIMALS STUDIED: The procedure was performed on six canine patients and one feline patient. METHODS: The laser was set to 6 Watts (W) of power and a linear continuous setting. Forceps were used to elevate the TEL and, with a protective shield covering the cornea, the base was cut and cauterized simultaneously. Minimal to no hemorrhage was observed, and the conjunctiva was left to heal by second intention. RESULTS: Seven patients underwent unilateral surgical TEL excision. All patients had suspected neoplasms affecting either the glandular tissues or conjunctival surfaces of the TEL. Clean surgical margins were achieved in all but one patient. All surgical sites were considered healed by 14 days showing mild-to-moderate conjunctival hyperemia and accumulation of mucoid discharge at the ventronasal fornix. One patient experienced postoperative keratoconjunctivitis sicca. Prolapse of orbital fat was not observed in any patient. CONCLUSION: Use of CO2 laser appears to be an efficient and effective means for surgical third eyelid removal with excellent postoperative comfort and minimal complications.

Efficacy of prophylactic antiglaucoma and anti-inflammatory medications in canine primary angle-closure glaucoma: a multicenter retrospective study (2004-2012).

PURPOSE: To evaluate long-term efficacy of antiglaucoma medications with or without combined topical anti-inflammatory treatment in preventing increased intraocular pressure and clinical signs of glaucoma in eyes considered at risk of the development of the disease. METHODS: Retrospective analysis identified 88 canine patients presenting with unilateral acute congestive primary angle-closure glaucoma (IOP > 25 mm Hg) and gonioscopic findings of pectinate ligament dysplasia and/or narrow or closed iridocorneal angle in the contralateral nonglaucomatous eye. Patients with histopathologic confirmation of pectinate ligament dysplasia or angle closure in the initial glaucomatous eye receiving prophylactic medical therapy in the contralateral eye were included. Time to medical failure for each antiglaucoma medication and efficacy of the combination therapy were evaluated. RESULTS: The most commonly affected pure-breds were the American Cocker Spaniel (20.4%) and Basset Hound (11.36%). The patients receiving demecarium bromide 0.125% had the longest estimated median time to medical failure at 330.0 days, followed by latanoprost 0.005%, dorzolamide hydrochloride 2.0%, and demecarium bromide 0.25% at 284.0 days, 272.5 days, and 143.0 days, respectively. The estimated median time to medical failure for patients receiving topical antiglaucoma and anti-inflammatory medication was 324.0 days versus 195.0 days in patients receiving antiglaucoma medication alone. Survival analysis showed no statistical significance. CONCLUSIONS: None of the four antiglaucoma medications evaluated statistically delayed medical failure when compared to each other. Although significance was not achieved, our data suggest that adjunctive use of topical anti-inflammatory medications may be beneficial in these cases.

Genomic deletion of CNGB3 is identical by descent in multiple canine breeds and causes achromatopsia.

BACKGROUND: Achromatopsia is an autosomal recessive disease characterized by the loss of cone photoreceptor function that results in day-blindness, total colorblindness, and decreased central visual acuity. The most common causes for the disease are mutations in the CNGB3 gene, coding for the beta subunit of the cyclic nucleotide-gated channels in cones. CNGB3-achromatopsia, or cone degeneration (cd), is also known to occur in two canine breeds, the Alaskan malamute (AM) and the German shorthaired pointer. RESULTS: Here we report an in-depth characterization of the achromatopsia phenotype in a new canine breed, the miniature Australian shepherd (MAS). Genotyping revealed that the dog was homozygous for a complete genomic deletion of the CNGB3 gene, as has been previously observed in the AM. Identical breakpoints on chromosome 29 were identified in both the affected AM and MAS with a resulting deletion of 404,820 bp. Pooled DNA samples of unrelated purebred Australian shepherd, MAS, Siberian husky, Samoyed and Alaskan sled dogs were screened for the presence of the affected allele; one Siberian husky and three Alaskan sled dogs were identified as carriers. The affected chromosomes from the AM, MAS, and Siberian husky were genotyped for 147 SNPs in a 3.93 Mb interval within the cd locus. An identical shared affected haplotype, 0.5 Mb long, was observed in all three breeds and defined the minimal linkage disequilibrium (LD) across breeds. This supports the idea that the mutated allele was identical by descent (IBD). CONCLUSION: We report the occurrence of CNGB3-achromatopsia in a new canine breed, the MAS. The CNGB3-deletion allele previously described in the AM was also observed in a homozygous state in the affected MAS, as well as in a heterozygous carrier state in a Siberian husky and Alaskan sled dogs. All affected alleles were shown to be IBD, strongly suggesting an affected founder effect. Since the MAS is not known to be genetically related to the AM, other breeds may potentially carry the same cd-allele and be affected by achromatopsia.

Magnetic resonance imaging susceptibility artifact due to pigmented intraorbital silicone prosthesis.

Magnetic resonance imaging (MRI) findings of two cases with intracranial disease and pigmented intraorbital prosthetics are presented. A brown prosthetic (Case 1) caused a significant magnetic susceptibility artifact, which necessitated removal to properly image the brain. The artifact observed on MRI images is likely due to ferromagnetic pigments used for coloring. A black prosthetic (Case 2) caused no imaging artifact. The carbon-based pigments used to color the black prosthetic implant do not appear to cause imaging artifact. The pigments currently used to color the brown pigmented orbital prostheses cause significant magnetic susceptibility artifact and may require removal to evaluate the brain and surrounding structures completely.

Modified evisceration technique in a golden eagle (Aquila chrysaetos).

Two different modified techniques have been described for enucleation in raptors, including the transaural approach and the globe-collapsing procedure. This case report describes an alternative, modified evisceration procedure in a mature female Golden Eagle (Aquila chrysaetos). The advantages of this procedure are decreased anesthetic time, ease of procedure, decreased risk of excessive traction of the optic nerve, decreased intraoperative orbital trauma, and preservation of the natural symmetry of the head. The major disadvantage of this procedure is that it does not allow complete histologic examination of the globe. Patients with intraocular infection or neoplasia, or significant orbital disease may be poor candidates for this technique.

Canine conjunctival hemangioma and hemangiosarcoma: a retrospective evaluation of 108 cases (1989-2004).

Canine conjunctival tumors of vascular endothelial origin are common, although under-reported. The purpose of this study was to evaluate the epidemiology of and potential risk factors for these tumors. This study evaluated 108 cases (70 hemangiomas, 38 hemangiosarcomas) from 8300 canine submissions between 1989 and 2004. Signalment, location, pigmentation, size, duration, diagnosis, margins, ancillary therapy, and geographic location were recorded. Follow-up information was available for 49 cases. Each case was matched with two unaffected controls and compared using logistic regression analysis. Average age upon presentation was 8.6 years; there was no sex predilection. Risk of conjunctival tumors was statistically different among breed groups (P = 0.0010), demonstrating a propensity to occur in groups likely to have increased outdoor activity. Primary involvement occurred within nonpigmented epithelium along the leading edge of the nictitating membrane (41/108) and temporal bulbar conjunctiva (33/108). The etiology remains unknown; however, the strong site predilection, involvement of nonpigmented epithelium, and development within specific breed classes strongly suggest ultraviolet (UV) light as a significant risk factor. In a full-logistic model including breed, gender, age, and UV exposure, UV was not a statistically significant variable (P = 0.1215). In a reduced-model including UV only, significance was approached (P = 0.0696) and posthoc contrast demonstrated a significant linear trend with increasing UV exposure (P = 0.0147). In separate analysis of risks associated with hemangiosarcoma, compared with hemangioma, breed was not significant while increasing UV exposure was significant (P = 0.0381). Early surgical therapy is recommended and may be curative; however, recurrence is possible and more likely with hemangiosarcomas (11/20).

Evaluation of a rebound tonometer for measuring intraocular pressure in dogs and horses.

OBJECTIVE: To compare intraocular pressure (IOP) measurements obtained with a rebound tonometer in dogs and horses with values obtained by means of applanation tonometry and direct manometry. DESIGN: Prospective study. ANIMALS: 100 dogs and 35 horses with clinically normal eyes, 10 enucleated eyes from 5 dogs, and 6 enucleated eyes from 3 horses. PROCEDURES: In the enucleated eyes, IOP measured by means of direct manometry was sequentially increased from 5 to 80 mm Hg, and IOP was measured with the rebound tonometer. In the dogs and horses, results of rebound tonometry were compared with results of applanation tonometry. RESULTS: For the enucleated dog and horse eyes, there was a strong (r2 = 0.99) linear relationship between pressures obtained by means of direct manometry and those obtained by means of rebound tonometry. Mean +/- SD IOPs obtained with the rebound tonometer were 10.8 +/- 3.1 mm Hg (range, 5 to 17 mm Hg) and 22.1 +/- 5.9 mm Hg (range, 10 to 34 mm Hg) for the dogs and horses, respectively. Mean IOPs obtained with the applanation tonometer were 12.9 +/- 2.7 mm Hg (range, 8 to 18 mm Hg) and 21.0 +/- 5.9 mm Hg (range, 9 to 33 mm Hg), respectively. Values obtained with the rebound tonometer were, on average, 2 mm Hg lower in the dogs and 1 mm Hg higher in the horses, compared with values obtained with the applanation tonometer. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that the rebound tonometer provides accurate estimates of IOP in clinically normal eyes in dogs and horses.