A modified supraorbital surgical approach for enucleation- exenteration in dromedary camels (camelus dromedarius): Clinical study.

Enucleation and exenteration are widely utilized ophthalmic procedures in veterinary field. Enucleation in camels is like other large animals, typically performed under the influence of heavy sedation and loco-regional analgesia. The aim of the current study was to introduce a new surgical approach to enucleate the eye of camels through supraorbital fossa approach. for that purpose, the technique was applied to seven camels referred to the King-fisal teaching veterinary hospital for unilateral enucleation. Assessment of applicability, safety and feasibility of this technique was done. All procedures were performed in the kush (sitting) position under the influence of heavy sedation with Xylazine HCl in combination with retrobulbar nerve block. A "C" shaped skin incision was made in the skin and fascia of the supraorbital fossa to enter the orbital cavity, after which the periorbital fat was gripped, dissected and removed. Bleeding controlled by electrocautery and visible large blood vessels were ligated. After ligation the optic nerve and ophthalmic blood vessels, the eyeball was dissected sharply and freed from the orbital bony attachment. Finally, the orbital fascia and skin were sutured with simple interrupted pattern separately. The approach proved successful in all camels, with the enucleation procedure being both feasible and easily performed. The mean surgical time was approximately 46.6±12.4 minutes. The minimal occurrence of short and long-term complications was encouraging, and the cosmetic outcomes were notably improved. The supraorbital approach is a safe and effective technique for camel ophthalmic surgery, showing advantages in exposure and minimal complications. Further research is needed for validation and broader clinical applications.

Comparison of preoperative retrobulbar bupivacaine and postoperative subcutaneous liposome-encapsulated bupivacaine on postoperative analgesia in dogs undergoing enucleation.

OBJECTIVE: To compare the effectiveness of preoperative bupivacaine inferotemporal retrobulbar blocks to postoperative liposome-encapsulated bupivacaine (Nocita) line blocks for analgesia following enucleation. ANIMALS: 39 client-owned dogs (40 eyes) presenting to the Ophthalmology Service for enucleation. METHODS: Dogs were randomly assigned to receive either a preoperative inferotemporal retrobulbar block with 0.5% bupivacaine or a peri-incisional line block with liposome-encapsulated bupivacaine (Nocita) at closure. Patients underwent unilateral enucleation and were hospitalized for 24 hours after surgery. Pain scores were performed by a masked observer with the Glasgow Composite Measure Pain Scale and the University of Wisconsin Ocular Pain Scale at 0.25, 0.5, 1, 2, 4, 6, 8, and 24 hours following surgery. Intraoperative use of blood pressure and anesthetic support mediations as well as need for rescue pain control were recorded and compared between groups. RESULTS: There was no significant difference in rescue rates between treatment groups. When comparing the use of medical intraoperative heart rate, blood pressure, or anesthetic plane support, there were no significant differences in use between groups. CLINICAL RELEVANCE: Use of preoperative bupivacaine retrobulbar blocks and postoperative Nocita line blocks were equally effective at postoperative pain control with similarly low complication rates.

Effect of dexmedetomidine added to retrobulbar blockade with lignocaine and bupivacaine in dogs undergoing enucleation surgery.

OBJECTIVE: To investigate the effect of the addition of dexmedetomidine (BLD) to retrobulbar blockade with combined lignocaine and bupivacaine on nociception. ANIMALS: A total of 17 eyes from 15 dogs. METHODS: Prospective, randomized, masked clinical comparison study. Dogs undergoing unilateral enucleation were randomly assigned into two groups; a retrobulbar administration of lignocaine and bupivacaine in a 1:2 volume ratio combined with either BLD or 0.9% saline (BLS). The total volume of the intraconal injection was calculated at 0.1 mL/cm cranial length. Intraoperative parameters were recorded: heart rate (HR), respiratory rate (RR), end-tidal CO2 (EtCO2 ) arterial blood pressure (BP), and inspired isoflurane concentration (ISOinsp). Pain scores, heart rate and RR were recorded postoperatively. RESULTS: Dogs receiving BLD (n = 8) had significantly lower intraoperative RR (p = 0.007), and significantly lower ISOinsp (p = 0.037) than dogs in the BLS group (n = 9). Postoperatively heart rate was significantly lower in the BLD group at 1 min (p = 0.025) and 1 h (p = 0.022). There were no other significant differences in intraoperative or postoperative parameters, or in postoperative pain scores (p = 0.354). Dogs receiving BLD had a higher rate of anesthetic events of bradycardia and hypertension (p = 0.027). Analgesic rescue was not needed in either group. CONCLUSIONS: The addition of BLD to retrobulbar anesthesia did not result in a detectable difference in pain scores relative to blockade with lignocaine and bupivacaine alone. Dogs receiving retrobulbar BLD had a significantly lower intraoperative RR and isoflurane requirement and an increased incidence of intraoperative bradycardia and hypertension.

Cirurgia de enucleação em decorrência de proptose do globo ocular em cadela: relato de caso / Enucleation surgery due to proptosis of the eyeball in a female dog: case report / Cirugía de enucleación por proptosis del globo ocular en una perra: informe de un caso

A proptose do globo ocular é uma das consequências comuns do trauma e a enucleação é um procedimento de escolha em caso de impossibilidade de reversão do quadro. Nota-se a infrequência de relatos de enucleação do globo ocular resultante de proptose traumática, o que torna importante a descrição deste caso, a qual objetiva fornecer relevantes informações e contribuições para o desenvolvimento da oftalmologia e clínica cirúrgica veterinária. Uma cadela filhote foi atendida no HVU - UFPI/CPCE, apresentando o globo ocular direito prolapsado. A enucleação foi selecionada em decorrência do intervalo prolongado entre a detecção da lesão e a busca por assistência médica, da presença de uma alta carga de corpos estranhos observados e da ausência de reflexos pupilares. A cirurgia iniciou-se com a cantotomia seguida da dissecação da musculatura do globo ocular. Foi realizado o pinçamento dos vasos sanguíneos e do nervo óptico, e fez-se a ressecção do globo ocular. Depois de uma ligadura invaginante e redução do espaço morto, removeu-se as bordas palpebrais e realizou-se a blefarorrafia. Cerca de 40 dias após a enucleação, a cadela apresentou-se estável e com uma evolução cicatricial satisfatória do ferimento cirúrgico. Esse procedimento, foi realizado de forma semelhante ao que é visto na literatura, embora, majoritariamente, seja recomendada a enucleação em decorrência de afecções diferentes da proptose traumática.(AU)

Proptosis of the eyeball is one of the common consequences of trauma and enucleation is the procedure of choice if it is impossible to reverse the condition. There are few reports of enucleation of the eyeball resulting from traumatic proptosis, which makes it important to describe this case, which aims to provide relevant information and contributions to the development of ophthalmology and veterinary surgical practice. A female puppy was seen at the HVU - UFPI/CPCE, presenting with a prolapsed right eyeball. Enucleation was selected due to the prolonged interval between detecting the lesion and seeking medical assistance, the presence of a high foreign body burden and the absence of pupillary reflexes. Surgery began with canthotomy followed by dissection of the eyeball muscles. The blood vessels and optic nerve were clamped and the eyeball was resected. After an invaginating ligature and reduction of the dead space, the eyelid edges were removed and blepharorrhaphy was performed. Around 40 days after enucleation, the dog was stable and had satisfactory healing of the surgical wound. This procedure was carried out in a similar way to that seen in the literature, although enucleation is mostly recommended for conditions other than traumatic proptosis.(AU)

La proptosis del globo ocular es una de las consecuencias comunes de los traumatismos y la enucleación es el procedimiento de elección si es imposible revertir la condición. Existen pocos relatos de enucleación del globo ocular resultante de proptosis traumática, lo que torna importante la descripción de este caso, que pretende proporcionar informaciones relevantes y contribuciones para el desarrollo de la oftalmología y de la práctica quirúrgica veterinaria. Una cachorra fue atendida en el HVU - UFPI/CPCE con prolapso del globo ocular derecho. Se optó por la enucleación debido al prolongado intervalo entre la detección de la lesión y la búsqueda de asistencia médica, la presencia de una elevada carga de cuerpo extraño y la ausencia de reflejos pupilares. La cirugía comenzó con una cantotomía seguida de la disección de los músculos del globo ocular. Se pinzaron los vasos sanguíneos y el nervio óptico y se resecó el globo ocular. Tras una ligadura invaginante y la reducción del espacio muerto, se retiraron los bordes de los párpados y se realizó una blefarorrafia. Unos 40 días después de la enucleación, el perro estaba estable y la herida quirúrgica había cicatrizado satisfactoriamente. Este procedimiento se llevó a cabo de forma similar a lo visto en la bibliografía, aunque la enucleación se recomienda sobre todo para afecciones distintas de la proptosis traumática.(AU)

Persistent socket pain in a dog after the enucleation of the eye and its clinical management.

Persistent socket pain is a condition described in humans after enucleation of the eye. This report aims at describing this condition in dogs. A 10-year-old male-neutered crossbreed was presented to the referral veterinary surgeon for enucleation of the right ocular globe. Anaesthesia and surgery were uneventful although during the postoperative period the dog was reluctant to open the mouth and to be explored by the referral veteterinary surgeon. Despite treatment with meloxicam, paracetamol and tramadol, no improvements were observed. Ten weeks after surgery, the dog was referred to the Dick White referrals for further investigations. Ophthalmic examination was normal, though palpation of the wound triggered an avoidance response. Magnetic resonance imaging showed changes compatible with orbital cellulitis. The area of interest was evaluated with the use of the mechanical Von Frey filaments. A response, characterised by sudden turning of the head and attempts to withdraw it, was evoked with filament 4.93 (8.0 g) during stimulation of the periorbital area. After induction of anaesthesia, an ultrasound-guided injection containing levobupivacaine 0.5% and methylprednisolone was performed within the retrobulbar area. Three hours after recovery from anaesthesia, no discomfort was observed during palpation of the area. Re-evaluation was performed with the Von Frey filaments; no response could be evoked during testing with all 20 filaments (from 2.36 to 6.65) applied on either side of the face. The patient was discharged with a course of gabapentin and, 3 weeks after the intervention, the dog showed no clinical signs of pain. Persistent socket pain is an unpleasant sensation at the level of the enucleated orbit, and it should be regarded as a challenging condition to diagnose and treat. The MRI findings appeared to be essential to select the most appropriate interventional treatment. The injection of local anaesthetic and steroid into the retrobulbar space was useful for both confirming the diagnosis and treating pain by reducing the peripheral signalling and decreasing the residual inflammation.

Subconjunctival enucleation with or without third eyelid removal may present a viable enucleation technique in rabbits: 18 cases (2014-2022).

OBJECTIVE: To evaluate intraoperative and postoperative complications and outcomes following subconjunctival enucleations with and without third eyelid removal in domestic rabbits. ANIMALS: 18 client-owned rabbits with ocular disease confined to the globe that underwent 20 subconjunctival enucleation procedures at a veterinary teaching hospital. METHODS: Records were retrospectively reviewed for all enucleations performed at a veterinary teaching hospital from 2014 to 2022. A standard subconjunctival enucleation procedure was performed in all cases, with third eyelid removal in 2 surgeries and without third eyelid removal in the remaining 18 surgeries. Outcomes were assessed on the basis of observations in medical records and owner follow-up. RESULTS: 20 total enucleations were included. Reported reasons for enucleation included suspected or confirmed ocular Encephalitozoon cuniculi infection in 9 rabbits, refractory glaucoma in 4 rabbits, and various intraocular diseases in 5 rabbits. The only intraoperative complication reported was hemorrhage during the third eyelid removal in 1 surgery. Postoperative complications included serous to mucoid discharge from the surgical site in 8 of 20 surgeries and swelling at the surgery site in 2 of the 8 cases that had discharge. Postoperative swelling spontaneously resolved within 3 months of surgery; postoperative discharge spontaneously resolved within 10 months of surgery. CLINICAL RELEVANCE: Subconjunctival enucleation with or without third eyelid removal in rabbits may be a viable enucleation technique to reduce the risk for intraoperative hemorrhage, but it can result in postoperative complications, including transient discharge and swelling at the surgical site.

Eye enucleation and exenteration in -cattle: a retrospective study of 38 cases (2013-2020).

INTRODUCTION: The study aimed to describe clinical indications for eye enucleation and exenteration, the occurrence of complications and long-term outcome in cattle, and examine owners' attitude towards enucleation and exenteration and their satisfaction with the surgical outcome. Medical records from the two veterinary teaching hospitals in Switzerland were reviewed to identify cattle that underwent unilateral enucleation or exenteration between January 2013 and December 2020. Data extracted included medical history, ocular examination, clinical diagnosis, surgical procedure including anesthesia, suture material and pattern used, complications, and treatment thereof. Long-term follow-up was evaluated via national animal database inquiries to determine survival time and via owners' interviews with the use of a standardized questionnaire that included questions regarding the occurrence of complications and reason for culling, production performances and perceived quality of life after surgery, concerns, factors affecting the decision to proceed with surgery, and general satisfaction with the outcome. Descriptive statistics, Fisher's exact tests and unpaired t-test were used to summarize the data and assess association between variables. Association was considered significant if p < 0,05. Thirty-eight cases were identified, with a median age of 5 years. More than half of the cases (55,3 %) were diagnosed with non-neoplastic ocular lesions represented by severe trauma with loss of globe content, globe rupture with history of infectious keratoconjunctivitis or hypopyon, or congenital malformations. The remaining cases were diagnosed with neoplastic lesions, including ocular squamous cell carcinoma (OSCC), melanoma, or sarcoma. Complications following surgery were reported in 29 % of cases and included postoperative infection and recurrence of OSCC. There was no significant association between ocular diagnosis and the occurrence of postoperative complications or survival time. Surgery did not seem to influence the animals' postoperative production performance or the perceived quality of life. Most owners (92 %) were satisfied with the surgical outcome. The occurrence of postoperative complications leading to increased overall costs and culling was the main reason for lower owner satisfaction.

INTRODUCTION: La présente étude vise à décrire les indications cliniques de l'énucléation et de l'exentération de l'œil, la survenue de complications et le résultat à long terme chez les bovins et à examiner l'attitude des propriétaires vis-à-vis de l'énucléation et de l'exentération et leur satisfaction quant au résultat chirurgical. Les dossiers médicaux des deux hôpitaux universitaires vétérinaires de Suisse ont été examinés pour identifier les bovins qui ont subi une énucléation ou une exentération unilatérale entre janvier 2013 et décembre 2020. Les données extraites comprenaient les antécédents médicaux, l'examen oculaire, le diagnostic clinique, la procédure chirurgicale y compris l'anesthésie, le matériel et le patron de suture utilisés, les complications et leur traitement. Le suivi à long terme a été évalué en utilisant la base de données nationale sur les animaux afin de déterminer la durée de survie, et par d'entretiens avec les propriétaires à l'aide d'un questionnaire standardisé qui comprenait des questions concernant l'apparition de complications et la raison de la réforme, les performances de production et la qualité de vie perçue après la chirurgie, les réserves, les facteurs affectant la décision de procéder à la chirurgie et la satisfaction générale du résultat. Les données ont été résumées à l'aide de statistiques descriptives et les différences éventuelles entre les variables ont été analysées à l'aide de tests exacts de Fisher et de tests t non appariés. L'association a été considérée comme significative si p < 0,05. Trente-huit cas ont été identifiés, avec un âge médian de 5 ans. Plus de la moitié des cas (55,3 %) ont été diagnostiqués avec des lésions oculaires non néoplasiques causées par un traumatisme grave avec perte du contenu du globe, une rupture du globe avec des antécédents de kératoconjonctivite infectieuse ou d'hypopion ou des malformations congénitales. Les autres cas ont été diagnostiqués comme des lésions néoplasiques, notamment carcinome épidermoïde oculaire, mélanome ou sarcome. Des complications après l'opération ont été signalées dans 29 % des cas, notamment infection postopératoire et récidive du carcinome épidermoïde oculaire. Il n'y avait pas d'association significative entre le diagnostic et l'apparition de complications postopératoires ou la durée de survie. L'intervention chirurgicale n'a pas semblé influencer les performances de production postopératoires des animaux ni la qualité de vie perçue. La plupart des propriétaires (92 %) étaient satisfaits du résultat de la chirurgie. L'apparition de complications postopératoires entraînant une augmentation des coûts globaux et l'abattage des animaux était la principale raison de la baisse de satisfaction des propriétaires.

Causes, outcomes, and owner satisfaction of dogs undergoing enucleation with orbital implant placement.

OBJECTIVE: To describe clinical and histopathologic pre-operative diagnoses as well as associated post-operative complications following orbital silicone implantation in dogs undergoing enucleation and evaluate owner satisfaction. ANIMALS STUDIED: One hundred and eighty-six dogs who underwent enucleation with orbital implant. PROCEDURES: Medical records from dogs that underwent enucleation with orbital implant performed at Virginia-Maryland Veterinary Teaching Hospital between 2007 and 2019 were reviewed. Owners were surveyed via telephone regarding client satisfaction. RESULTS: Enucleation followed by orbital implant placement occurred in 215 eyes of 186 dogs. The most common pre-operative diagnoses were glaucoma (68.8%), uveitis (17.7%), cataracts (15.8%), intraocular neoplasia (13.0%), and lens luxation (10.7%). The most common histopathologic diagnoses were retinal degeneration (46.5%), uveitis (39.5%), cataract (29.8%), retinal detachment (27.4%), and secondary glaucoma (26.5%). Fourteen eyes (6.5%) from ten dogs had post-operative complications reported including orbit cellulitis (n = 11), implant migration (n = 1), and implant extrusion (n = 1). Five of these dogs (50%) had concurrent diabetes mellitus. Median complication time from surgery was 41 days (range: 11-541 days). Ninety-five owner survey responses were completed with a median time of 6.3 years following surgery. Most owners, 85.3% (n = 81), were satisfied with the post-operative outcome. CONCLUSION: Enucleation with implantation of an orbital implant is a viable and safe method for irreversibly blind eyes. Diabetes mellitus may be a risk factor for the development of post-operative complications. Intraocular neoplasia was not associated with development of post-operative complications. Results of this study indicated high owner satisfaction rates for improving cosmetic appearance after enucleation in dogs.

Comparing the behaviour of dogs before and after enucleation due to glaucoma.

PURPOSE: There is limited literature on owner's attitudes towards enucleation and behavioural changes after enucleation in dogs. The aim of this study is to investigate the owner's perception of canine enucleation as well as gain insight into the behavioural changes of dogs before and after enucleation due to glaucoma. METHODS: This retrospective study involved a questionnaire sent to the owners whose dogs were diagnosed with glaucoma and underwent enucleation at the Queen Mother Hospital for Animals between June 2015 and January 2018. Owners were asked about their attitude towards enucleation, and to assess factors that affect their dogs' behaviours (appetite, general activity, playfulness and lethargy) at three time points: before enucleation, immediately after and 2 months after (TMA) enucleation. RESULTS: Twenty-six of 45 questionnaires were completed and returned by the owners. TMA enucleation showed the most strongly positive responses indicating that owners perceived an improvement in the behaviours of their pets. 96% of participants were happy with their decision to go ahead with the surgery; and no participants regretted opting for enucleation. CONCLUSION: The present study found expression of "normal" behaviour to increase after enucleation.

Ocular porcupine quilling in dogs: Gross, clinical and histopathologic findings in 17 cases (1986-2018).

The objectives of this retrospective study were to evaluate the histopathologic changes associated with porcupine ocular quill injuries in dogs, to discuss the various methods of quill detection when quills are not grossly visible, and to discuss the pathogenesis of delayed ocular quill injuries in dogs. Seventeen globes sustaining ocular quilling injuries from 17 dogs (1986-2018) were identified in the COPLOW archives and the gross and histologic changes tabulated and compared. All cases were dogs, with one whole globe submitted from each patient. Sixteen of 17 cases had known or suspected porcupine encounters in the weeks or years preceding enucleation. Histopathologic findings included retinal detachment, hyphema, cataract, granulomatous to pyogranulomatous inflammation (uveitis, endophthalmitis, panophthalmitis), lens capsule rupture, suppurative phakitis, scleral perforation, stromal keratitis, breaks in Descemet's membrane, preiridal fibrovascular membrane, anterior and posterior synechia, Schnabel's cavernous atrophy, and periorbital fibrosis. Quill-associated ocular trauma can have a significant deleterious effect on vision and result in enucleation. The time from initial quilling to the manifestation of ocular signs may be prolonged (weeks to years). Any dog presenting for ocular signs with a history of a previous porcupine encounter should be carefully checked for quill migration into the globe as the source of ocular disease. Quills may not be visible grossly, and ancillary imaging techniques can be utilized with various rates of success.

Glaucoma-associated pain results in mechanical sensitivity changes in dogs: A pilot study.

PURPOSE: To explore the effects of chronic, uncontrolled glaucoma on pressure sensitivity in dogs before and after enucleation of the painful globe. METHODS: Client-owned dogs undergoing enucleation for chronic glaucoma with no other sources of pain were enrolled. Normal dogs of similar breeds and skull morphology were enrolled as controls. Craniofacial ratio (CFR) and relative palpebral fissure width (RPFW) were assessed in all patients. Serial mechanical quantitative sensory testing (QST) was performed the day before surgery, and 14, 30, 60, and 120 days after surgery. QST consisted of electronic Von Frey (eVF), and blunt algometry (BA) performed above and below the nonglaucomatous eye, the metacarpus, and metatarsus. Cochet-Bonnet esthesiometry (CB) was also performed on the remaining eye. RESULTS: Twelve dogs (6 per group) were included. Compared to baseline values, sensitivity tended to decrease over time (increased thresholds) in treatment dogs while it stayed constant or increased slightly in control dogs. The difference in change from baseline sensitivity between control and treatment groups was significant at day 120 using BA at supraorbital (P = .0153), infraorbital (P = .0209), and metacarpal sites (P = .007) and overall (P = .0470). This divergence was also significant using CB (P = .0470) on the opposite cornea. As patient CFR and RPFWV increased, both eVF (P = .005-.023) and BA (P = .004-.041) increased. CONCLUSIONS: Sensitivity to mechanical stimuli decreased both locally and at remote sites in dogs following enucleation for painful chronic glaucoma. Cranial conformation is associated with differences in sensitivity.

Self-limiting Orbital Emphysema Following Ocular Evisceration and Demonstration of Nasolacrimal-Oropharyngeal Communication in a South African Ostrich (Struthio camelus australis).

A 25-year-old, male, sanctuary-owned, South African ostrich (Struthio camelus australis) was evaluated for orbital emphysema after evisceration of a nonvisual and chronically irritated eye. On initial ophthalmic examination, the ostrich's left eye displayed severe corneal fibrosis, broad anterior synechia, and a shallow anterior chamber, all suggestive of a previous corneal perforation. Conjunctival hyperemia and eyelid crusts were also present, reportedly associated with chronic rubbing. Evisceration of the left eye was performed by excising the eyelid margins, conjunctiva, nictitans, cornea, and intraocular contents. Four weeks postoperatively, a nonpainful, fluctuant swelling of the surgical site was noted. Trocarization of the surgical site verified orbital emphysema and served to temporarily decompress the orbit. Orbital emphysema reoccurred within 48 hours but gradually regressed without intervention over the subsequent 9 months. A Jones test was performed in the healthy, right eye and demonstrated clear communication to the oropharynx. To our knowledge, this is the first reported case of an evisceration performed on an ostrich and the first reported case of orbital emphysema in any avian species. It is probable that the emphysema noted in this case was secondary to nasolacrimal duct-oropharynx communication.

Custom-made artificial eyes using 3D printing for dogs: A preliminary study.

Various incurable eye diseases in companion animals often result in phthisis bulbi and eye removal surgery. Currently, the evisceration method using silicone balls is useful in animals; however, it is not available to those with impaired cornea or severe ocular atrophy. Moreover, ocular implant and prostheses are not widely used because of the diversity in animal size and eye shape, and high manufacturing cost. Here, we produced low-cost and customized artificial eyes, including implant and prosthesis, using computer-aided design and three-dimensional (3D) printing technique. For 3D modeling, the size of the artificial eyes was optimized using B-mode ultrasonography. The design was exported to STL files, and then printed using polycaprolactone (PCL) for prosthesis and mixture of PCL and hydroxyapatite (HA) for ocular implant. The 3D printed artificial eyes could be produced in less than one and half hour. The prosthesis was painted using oil colors and biocompatible resin. Two types of eye removal surgery, including evisceration and enucleation, were performed using two beagle dogs, as a preliminary study. After the surgery, the dogs were clinically evaluated for 6 months and then histopathological evaluation of the implant was done. Ocular implant was biocompatible and host tissue ingrowth was induced after in vivo application. The custom-made prosthesis was cosmetically excellent. Although long-term clinical follow-up might be required, the use of 3D printed-customized artificial eyes may be beneficial for animals that need personalized artificial eye surgery.

Retrospective analysis of complications associated with retrobulbar bupivacaine in dogs undergoing enucleation surgery.

OBJECTIVE: To investigate complications associated with, and without, bupivacaine retrobulbar local anesthesia in dogs undergoing unilateral enucleation surgery. STUDY DESIGN: Retrospective, observational study. ANIMALS: A total of 167 dogs underwent unilateral enucleation surgery via a transpalpebral approach. METHODS: Records from 167 dogs that underwent unilateral enucleation surgery that did (RB) or did not (NB) include retrobulbar bupivacaine anesthesia were reviewed, including anesthetic record, daily physical examination records, surgery report, patient discharge report and patient notes within 14 days of the surgery. Specific complications and severity were compared between RB and NB using the Wilcoxon rank-sum test. A 'complication burden' (0-5) comprising five prespecified complications was assigned and tested using rank-sum procedures. Statistical significance was set to 0.05. RESULTS: Group RB included 97 dogs and group NB 70 dogs. Dogs in NB had a 17.0 percentage points (points) greater risk for a postoperative recovery complication (38.6% versus 21.6%; 95% confidence interval: 3.0-30.6 points; p = 0.017). There was inconclusive evidence that dogs in group RB had a lower risk of requiring perioperative anticholinergic administration (12.4% versus 22.9%; 10.5 points; p = 0.073). Other complications were similar between groups RB and NB with risks that differed by <10 points. The risk of hemorrhage was similar between groups RB (22.7%) and NB (20.0%) with no significant difference in the level of severity (p = 0.664). CONCLUSIONS AND CLINICAL RELEVANCE: In this retrospective study, the use of retrobulbar bupivacaine for enucleation surgery in dogs was not associated with an increased risk of major or minor complications.

Uveal amelanotic melanoma in a ragdoll cat.

A 13-year-old castrated male ragdoll cat's left eye was evaluated for dyscoria, iridal thickening and color change of 2 years duration, as well as elevated intraocular pressure. The primary lesion seen on ophthalmic examination was a pale pink-white mass observed in the dorsomedial aspect of a diffusely thickened iris. Metastatic workup revealed hepatic and splenic nodules, but cytology was inconclusive. The left eye was enucleated, and histopathology was consistent with uveal amelanotic melanoma.

Mélanome uvéal amélanotique chez un chat ragdoll. L'oeil gauche d'un chat mâle ragdoll castré âgé de 13 ans fut évalué pour dyscorie, épaississement iridien et changement de couleur présent depuis deux ans, de même que pour une pression intra-oculaire élevée. La lésion primaire vue lors de l'examen ophtalmique était une masse blanc-rosée pâle observée à l'aspect dorso-médial d'un iris épaissi de manière diffuse. Une vérification pour métastases révéla des nodules hépatiques et spléniques, mais la cytologie était non-concluante. L'oeil gauche fut énucléé et l'histopathologie était compatible avec un mélanome uvéal amélanotique.(Traduit par Dr Serge Messier).

Unfolding the diagnosis of subspectacular fluid opacity in a corn snake (Pantherophis guttatus).

OBJECTIVE: To present the results of clinical, surgical, and histopathologic procedures and how these were compared with the initial presumptive clinical diagnosis in a corn snake (Pantherophis guttatus) presenting with subspectacular fluid opacity; and to improve upon currently established surgical enucleation techniques in the snake. ANIMAL STUDIED: An 8-month-old corn snake was presented for enlarged globe OD. PROCEDURES: The following diagnostics were performed: systemic and ophthalmic examinations, complete blood count, cytology and culture of subspectacular fluid, and histopathology of enucleated globe and spectacle. Enucleation was performed in a routine fashion with the addition of a porcine small intestinal submucosa bioscaffold graft (SISplus™; Avalon Medical, Stillwater, MN), sutured over the orbit. RESULTS: Systemic examination revealed signs of maxillary stomatitis. Ophthalmic examination revealed semitransparent fluid in the subspectacular space. Complete blood count was unremarkable. Cytology of fluid obtained via subspectacular centesis was acellular, and culture grew Clostridium perfringens, which was consistent with the clinical suspicion of right maxillary stomatitis. Histopathology of the enucleated globe revealed spectaculitis, characterized by regional heterophilic inflammation, and no evidence of lymph dissection in the (peri)ocular tissues. The final diagnosis was a subspectacular abscess. Follow-up revealed that the SIS graft provided excellent healing and cosmesis of the surgical site. CONCLUSIONS: While there are reports of lymphatic fluid dissection between skin layers during ecdysis, which can result in an opaque spectacle, the fluid opacity in this case was attributed to a subspectacular abscess secondary to an ascending oral infection. Addition of biological wound dressing may contribute to positive post-enucleation outcome in the snake.

A novel surgical technique for enucleation in rabbits to reduce the risk of intra- and post-operative orbital hemorrhage.

A 10-year-old male castrated Holland Lop rabbit (Oryctolagus cuniculus) was presented for severe ulcerative stromal keratitis of the right eye and a luxated hypermature cataract and glaucoma of the left eye. Staged bilateral enucleation was elected. A LigaSure™ electrosurgical bipolar vessel-sealing device was used as a means to minimize intraoperative and post-operative hemorrhage, especially that associated with the orbital venous plexus. The LigaSure™ was used to ligate and transect all extraocular muscles, the optic nerve bundle, and the base of the third eyelid with no complications encountered. Overall, the LigaSure™ was easy to use, resulted in minimal hemorrhage, and reduced surgery time. This is the first report of the use of a LigaSure™ to aid in the enucleation of a rabbit. Although only positive results were achieved as an alternative to conventional methodologies, its use in clinical practice should be that of caution until a larger study evaluating the long-term results is performed.

A preoperative bupivacaine retrobulbar block offers superior antinociception compared with an intraoperative splash block in dogs undergoing enucleation.

PURPOSE: Investigate nociception differences in dogs undergoing enucleation administered bupivacaine either via preoperative retrobulbar block (pRB) or intraoperative splash block (iSB). METHODS: Prospective, randomized, double-masked, clinical comparison study. Dogs undergoing unilateral enucleation were randomized to two groups: one received bupivacaine pRB and saline iSB of the same volume, and the other received saline pRB and bupivacaine iSB. The following intraoperative parameters were recorded: heart rate (HR), respiratory rate (RR), end-tidal CO2 (EtCO2 ); systolic, mean, and diastolic arterial blood pressure (SAP, MAP, and DAP respectively); inspired end-tidal isoflurane concentration (EtISOIns), and expired end-tidal isoflurane concentration (EtISOExp). Pain scores were recorded pre- and postoperatively. Analgesic rescue was documented. Surgical hemorrhage and postoperative bruising and swelling were graded subjectively by the surgeon (HDW) and study coordinator (AEZ). RESULTS: A significant (P = .0399) increase from baseline in overall mean heart rate was recorded in iSB bupivacaine patients (n = 11) compared with pRB bupivacaine patients (n = 11), with no significant differences in other intraoperative physiologic parameters, or pain scores. More analgesic rescue events occurred in iSB bupivacaine patients compared to pRB bupivacaine patients. A near-significant increase in intraoperative bleeding (P = .0519), and a significant increase in bruising (P = .0382) and swelling (P = .0223) was noted in the iSB bupivacaine group. CONCLUSIONS: Preoperative retrobulbar block bupivacaine is more effective than an iSB bupivacaine at controlling both intraoperative and postoperative nociception in dogs undergoing enucleation. Additionally, iSB causes more postoperative bruising and swelling and may be associated with increased intraoperative hemorrhage.

Clinical and pathological findings in three dogs with a corneocentric presentation of nodular granulomatous episcleritis.

PURPOSE: To describe the clinical signs, management, histopathologic findings, and outcome of three dogs with a corneocentric presentation of nodular granulomatous episcleritis (NGE). METHODS: Three dogs of varying breeds were presented for a unilateral, nonpainful, and infiltrative corneal lesion in the dorsal aspect of the eye. Clinical response to symptomatic topical treatment directed at a presumed inflammatory or immune-mediated cause was poor. Due to this, and concerns of neoplasia, ultrasonography (n = 1), incisional biopsy (n = 2), and/or enucleation (n = 2) were performed. RESULTS: The inflammatory infiltrate observed on histopathology was identical to that seen in nodular granulomatous episcleritis in all three cases. However, atypically the inflammation was confined to the cornea and limbus, without episcleral or conjunctival involvement. Inflammation of the cornea was full thickness to Descemet's membrane. Following enucleation (n = 2), there were no postoperative complications, and no reported ophthalmic disease in the remaining eye. Currently, the single non-enucleated case remains controlled with systemic and topical immunosuppression. CONCLUSION: To the best of the authors' knowledge, this is the first report of an NGE condition purely affecting the full thickness of the cornea, without episcleral or conjunctival involvement. The authors propose this to represent an atypical corneocentric variant of NGE. This clinical presentation can resemble neoplasia; incisional biopsy is recommended for a definitive diagnosis. Further research into the optimal treatment strategies for this variant of NGE is required.

Bilateral enucleation in dogs: A review of owner perceptions and satisfaction.

PURPOSE: To evaluate owner perceptions of the quality of life of their dogs before and after bilateral enucleation and to assess owner satisfaction with the procedure. METHODS: Medical records of 72 dogs from the Willows Veterinary Centre and Referral Service (49 dogs) and the Royal Veterinary College (RVC, 23 dogs) that had undergone bilateral enucleation, either in one procedure or at different times, between April 2008 (Willows) or 2012 (RVC) and April 2017, were reviewed. Owners were initially telephoned to determine owner satisfaction, followed by a postal visual analogue scale (VAS) questionnaire evaluating perceptions of their dog's quality of life before and after the bilateral enucleation. Statistical evaluation included Wilcoxon signed-rank tests and Chi-squared analysis. RESULTS: Of the 72 cases identified, 63 owners (88%) were contacted by telephone and 60 owners (83%) also completed the VAS questionnaire. The mean age at the time of the second or bilateral enucleation was 8.47 years (range 7.1 months-14.5 years). Cross-breeds (n = 12, 17%) and Jack Russell Terriers (n = 7, 10%) were the two most represented breeds. Glaucoma was the most common reason for enucleation (139/144 eyes, 97%). Most owners (57/63, 90%) were satisfied with the surgery and would consent to the procedure again. Statistically significant improvements in owner perceptions of their dog's pain level, reaction to facial/ocular palpation, activity levels, and quality of life were identified post-enucleation. CONCLUSIONS: Following bilateral enucleation, owners were satisfied with the procedure and perceived their dogs to have a good quality of life.