Evaluation of the short- and long-term complications and outcomes of phacoemulsification surgery in alpacas.

OBJECTIVE: To describe the complications and determine the visual outcomes associated with phacoemulsification surgery in alpacas. ANIMALS: Five alpacas (nine operated eyes). PROCEDURES: Medical records of alpacas with a clinical diagnosis of cataracts that received elective phacoemulsification surgery at Cornell University over a 15 year period were reviewed. RESULTS: The mean (± standard deviation) age of the five operated alpacas was 104 days (±64 days). The cataracts were suspected to be congenital in all alpacas. Concurrent congenital ocular abnormalities were common in the operated eyes and included microphakia, persistent patent hyaloid arteries, and persistent patent tunica vasculosa lentis. No significant intraoperative complications were identified in any cases. In the immediate postoperative period, uveitis was mild-to-moderate in most operated eyes, ocular hypertension was not detected, and clinically significant corneal edema did not occur in any eyes. The mean (± standard deviation) duration of clinical follow-up after surgery was 32 months (±25 months). A peri-incisional corneal stromal ulcer associated with fibrinous uveitis was identified in a single eye during recheck examination 4 weeks postoperative that resolved with medical therapy. Long-term complications included unilateral glaucoma in two alpacas that resulted in vision loss. On the final recheck ophthalmic examination, 78% (7 of 9) of operated eyes were visual and all operated alpacas had vision in at least one operated eye. CONCLUSIONS AND CLINICAL RELEVANCE: In this series, the visual outcomes associated with elective phacoemulsification surgery in alpacas were good. Glaucoma was the most common vision-threatening long-term postoperative complication.

Transnasal, Endoscopically Guided Skull-Based Surgery by Pharyngotomy for Mass Removal from the Sphenopalatine Sinus in a Horse.

OBJECTIVE: To report a transnasal, endoscopically guided ventral surgical approach for accessing the cranial and caudal segments of the sphenopalatine sinus for mass removal in a horse. STUDY DESIGN: Case report. ANIMAL: Adult horse with acute onset blindness referable to a soft tissue mass within the sphenopalatine sinus. CLINICAL REPORT: A 7-year-old Warmblood gelding presented with a history of running into a fence and falling. No neurologic signs were identified at initial examination but acute blindness was noted 3 weeks later. On computed tomography (CT) the sphenopalatine sinus was filled with a large homogeneous mass with poor contrast enhancement that extended dorsally with thinning to the dorsal cortex of the sphenoid bone, just rostral to the entrance of the optic canals into the cranial cavity. Surgical access to the sphenopalatine sinus was achieved using a transnasal, endoscopically guided ventral pharyngotomy approach and the mass lesion was removed. A presumptive diagnosis of chondroma was made based on histopathology. The horse recovered well from surgery, and although it has not regained vision as of 6.5 years postoperatively, the disease has not progressed. CONCLUSION: Transnasal, endoscopically-guided ventral surgical access to the sphenopalatine sinus is possible in horses and may improve access in horses with disease extending caudally beyond the palatine portion of the sinus. Use of smaller diameter or specialized instruments, such as various endoscopic bone cutting instruments, and CT image guidance may improve sinus access by this route.

Use of a formal assessment instrument for evaluation of veterinary student surgical skills.

OBJECTIVES: To (1) evaluate the design and use of a global rating scale assessment instrument in veterinary medical education and; (2) examine the effectiveness of 2 surgical techniques courses for improving the surgical skills of veterinary students. STUDY DESIGN: Instrument development; observational; survey-based. SAMPLE POPULATION: Students (n = 16) registered for 2 elective surgical techniques courses were enrolled on a volunteer basis. METHODS: A 5-point global rating scale instrument was designed for the evaluation of 12 basic surgical skills by faculty evaluators and used to obtain student start and end scores during the courses. Upon conclusion of the courses, students completed a survey from which their opinions on their improvement as well as their desire for feedback were obtained. RESULTS: All authors agreed the instrument was easy to use. As groups, 3rd year students, 4th year students, and all students combined had significantly higher total skill scores at the end of the courses compared to the start of the courses. Individually, 10 students (63%) had significant improvement in surgical skills as a result of their participation in the courses: 4 (100%) 3rd year and 6 (50%) 4th year students. Student survey responses revealed a strong desire for feedback as well as support of formal assessment methods. Only weak agreement was found between student opinions on their improvement and the authors' assessment scores. CONCLUSIONS: Assessment instruments are useful for (1) student evaluation and (2) for providing students with feedback on their surgical skills.