Surgical Treatment of Canine Glaucoma: Cyclodestructive Techniques.

Medical and surgical management of canine glaucoma can be challenging. The goal of surgical treatment is to manipulate the inflow and/or outflow of aqueous humor. This article describes the inflow-reducing, cyclodestructive techniques. Diode cyclophotocoagulation is the most common cyclodestructive procedure performed in humans and animals. Diode laser energy can be applied via a transscleral (transscleral cyclophotocoagulation [TSCP]) or an endoscopic (endoscopic cyclophotocoagulation [ECP]) approach. ECP provides direct visualization of the targeted ciliary body, allowing safer and more titratable treatment than TSCP techniques, offering a better long-term prognosis for vision and intraocular pressure control. Advancements in diode laser therapy seem promising.

Diode laser endoscopic cyclophotocoagulation in the normal equine eye.

OBJECTIVE: To determine the clinical and histologic effects of diode endoscopic cyclophotocoagulation (ECP) in the phakic equine eye. ANIMALS STUDIED: Phase I: 10 equine cadaver eyes. Phase II: four normal adult horses. PROCEDURES: Phase I: ECP probe angle of reach (AR) was determined. Multiple ECP energy levels: 0.75, 0.90, 1.05, 1.20, 1.35, 1.50 J, and the resulting visible and histologic ciliary process changes were evaluated. Phase II: Ocular quadrants were treated with ECP at 0.90, 1.14, 1.38 J, and a control. The contralateral eye underwent a sham operation. Tissue changes (clinical and histologic) were evaluated. RESULTS: Phase I: Mean combined AR was 162 ± 29 degrees. Mean visible tissue scores: 2.60 ± 0.58 (0.75 J) to 5.04 ± 0.30 (1.50 J) from possible total of 6. Tissue 'popping' was observed at 1.50 J. Histologic ciliary tissue damage was present at all settings. Phase II: Mean visible tissue scores: 2.90 ± 0.48 (0.90 J), 3.61 ± 0.57 (1.14 J), and 4.52 ± 0.56 (1.38 J). Tissue 'popping' was observed at 1.38 J. Histologic ciliary tissue damage was present at all settings. Clinical effects included acute inflammation, intraocular pressure reduction, cataract formation, corneal edema, corneal ulceration, and postoperative ocular hypertension. CONCLUSIONS: Diode ECP between 0.90 and 1.14 J is a potential treatment option for glaucoma in horses based on visible tissue effects and target ciliary epithelium damage. Iatrogenic cataract development may limit the use of an anterior chamber approach in phakic horses. Supported in part by an ACVO VAF grant.

Semiconductor diode laser transscleral cyclophotocoagulation for the treatment of glaucoma in horses: a retrospective study of 42 eyes.

OBJECTIVE: To evaluate the outcome of diode laser transscleral cyclophotocoagulation (TSCP) for the treatment of glaucoma in horses. PROCEDURE: Medical records at The Ohio State University were reviewed. All horses that underwent diode laser TSCP between the years of 1995 and 2007 were included. Preoperative, procedural and clinical follow-up data were collected, and telephone follow-up was performed. RESULTS: Forty-two eyes of 36 horses were included. Twenty-four hours prior to surgery mean intraocular pressure (IOP) was 37.17 + or - 13.48 mmHg (42 eyes). Forty-one of 42 eyes (98%) were sighted and 39 of 39 (100%) of eyes were receiving topical glaucoma medication. At 3-5 weeks postoperatively the average IOP was 19.36 + or - 12.04 mmHg (22 eyes). IOP remained significantly lower than pretreatment values at all periods of clinical follow-up (P < 0.05). There was no significant difference in vision outcome, or the requirement for topical glaucoma medication relative to pretreatment values at any follow-up period. Hyphema in 5 of 42 eyes was the only complication noted. Of the 27 eyes seen for clinical follow-up, 2 were enucleated because of refractory elevation of IOP. Mean telephone follow-up was 49 months. Twenty-one of 22 owners contacted (95%) reported that the treatment had been of value, 14 of 22 eyes (64%) were receiving topical glaucoma medication, and 13 of 22 eyes (59%) were considered sighted. CONCLUSIONS: Diode laser TSCP aided in the control of IOP and maintenance of vision but did not eliminate the need for topical glaucoma medication during the period of clinical follow-up.

Effects of transcorneal iridal photocoagulation on the canine corneal endothelium using a diode laser.

OBJECTIVE: To investigate the potential damage to the canine corneal endothelium following transcorneal iridal laser photocoagulation using a semiconductor diode laser. ANIMALS STUDIED: Sixteen young mongrel dogs. PROCEDURES: Baseline corneal endothelial cell counts and corneal thickness were measured in the central and temporal quadrants using a noncontact specular microscope under general anesthesia. Transcorneal iridal photocoagulation was applied using a semiconductor diode laser in a continuous mode with the use of an operating microscope. Fifteen dogs were treated, and the sixteenth dog served as a control. Fifteen different treatment combinations were randomly assigned to the 30 eyes; the fellow eye was treated differently. Three treatment factors were investigated: (1) laser energy intensity, (2) target tissue to endothelial distance, and (3) laser application duration. After 3 weeks the dogs were euthanized, specular microscopy was repeated, and the cornea was examined by scanning electron microscopy. RESULTS: Dyscoria and focal iris darkening were noted in all eyes immediately following laser treatment. Focal corneal edema (n = 2) and an incipient anterior capsular cataract (n = 1) were also noted. Baseline mean corneal endothelial cell densities were 2530 cells/mm2 centrally and 2607 cells/mm2 temporally. Postlaser corneal endothelial cell densities were 2499 cells/mm2 centrally and 2523 cells/mm2 temporally. Mean prelaser corneal thickness measurements were 0.555 mm centrally and 0.549 mm temporally. Postlaser corneal thickness measurements were 0.580 mm centrally and 0.554 mm temporally. Statistical analyzes revealed no significant changes in endothelial cell densities (P > 0.05) or corneal thickness (P > 0.05) induced by any treatment combination. Aside from tissue handling and processing artifacts, scanning electron microscopy revealed no endothelial cell damage. CONCLUSIONS: Our study demonstrated by specular and scanning electron microscopy that diode laser iridal photocoagulation had no significant effect on the canine corneal endothelium within the parameters described. However, one must take into consideration the young age of the dogs and the potential for corneal endothelial cell regeneration in young dogs, and the relatively short period of postoperative study.

Combined cycloablation and gonioimplantation for treatment of glaucoma in dogs: 18 cases (1992-1998).

OBJECTIVE: To evaluate a combined cycloablative and gonioimplantation technique for treatment of glaucoma in dogs. DESIGN: Retrospective study. ANIMALS: 18 adult dogs with glaucoma. PROCEDURE: Medical records of dogs that received a valved gonioimplant and a cyclodestructive procedure (cyclocryoablation or diode laser cyclophotocoagulation) during a 6-year period were reviewed. Retention of vision and intraocular pressure control were assessed, as well as number and nature of complications. RESULTS: 19 eyes of 18 dogs received a valved gonioimplant and either cyclocryoablation (n = 12) or diode laser cyclophotocoagulation (7). At > or = 1 year after surgery, 11 of 19 eyes had vision and 14 of 19 eyes had intraocular pressure < 25 mm Hg. Two dogs (2 eyes) were lost to follow-up 3 and 6 months after surgery. Despite the alternative route for aqueous humor flow created by the gonioimplant, 7 eyes had increased intraocular pressure (27 to 61 mm Hg) < 24 hours after surgery. Other complications included excessive intraocular fibrin, focal retinal detachment, corneal ulcer, retinal hemorrhage, cataract, and implant migration. CONCLUSIONS AND CLINICAL RELEVANCE: Combined cycloablation and gonioimplantation appears to be a promising technique for retention of vision and control of intraocular pressure in dogs with glaucoma.

Management of giant retinal tears in dogs.

Sixteen dogs with giant retinal tears resulting in total retinal detachment (360 degrees) underwent unilateral retinal reattachment surgery. In all dogs, complete vitrectomy was performed, and in most, perfluorooctane liquid was used to unroll and flatten the detached retina. Stainless steel tacks were used to anchor the retina to the choroid and sclera. Silicone oil was injected into the vitreous cavity to provide for permanent retinal tamponade. Endophotocoagulation or cryosurgery was used in several dogs to induce formation of permanent chorioretinal adhesions. Retinal attachment was successful in 14 of 16 dogs, and 13 of 14 dogs in which reattachment was successful retained some degree of vision. Complications included formation of cataracts and corneal erosions, development of glaucoma, and dislodgement of tacks.

Treatment of glaucoma by use of transscleral neodymium:yttrium aluminum garnet laser cyclocoagulation in dogs.

Neodymium:yttrium aluminum garnet (Nd:YAG) laser energy was transsclerally applied to the ciliary body of 56 eyes of 37 dogs for treatment of glaucoma. Forty-four eyes were glucomatous at the time of treatment, and 12 normotensive eyes with ciliary cleft closure were treated prophylactically. Glaucoma was primary in 35 dogs and secondary in 2 dogs (1 eye in each dog). Energy was delivered by a general surgical Nd:YAG laser via a hand-held, 600-muc-diameter flexible quartz fiber. The mean (+/- SD) number of spots treated per eye was 35 (+/- 9.7), with mean energy per burst of 7.1 (+/- 2.6) J; mean total energy delivered to the eyes was 228 (+/- 81) J. Follow-up evaluation was available for 42 eyes from 2 to 4 weeks after treatment, and for 32 eyes from 12 to 24 weeks after treatment. Treatment success, defined as maintenance of intraocular pressure less than 25 mm of Hg, was achieved in 83% (20/24) of glaucomatous eyes evaluated between 12 and 24 weeks of treatment. Of 4 treatment failures, 3 were eyes devoid of uveal pigment. The consistent acute effects of treatment were conjunctival vascular congestion and blood-aqueous barrier disruption, recognized clinically by the presence of aqueous flare. Hyphema developed in 16% (9/56) of eyes; hyphema resolved without complication in all but 2 eyes. A common long-term complication of treatment was cataract formation, recognized in 37% (12/32) of eyes evaluated at 12 to 24 weeks. Cataracts were sufficiently dense to obstruct vision in 4 eyes. Phthisis bulbi was observed in 1 eye.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of serous retinal detachments associated with optic disk pits in dogs.

Serous retinal detachment, associated with optic disk pit, was diagnosed in 28 eyes of 24 dogs. Xenon arc photocoagulation was used in treatment of the detachment. Of 24 dogs, 21 were Collies. In 23 eyes, retinal detachments affected temporal and/or inferior portions of the retina. In 5 eyes, detachments were predominantly superior and/or nasal. A single photocoagulation treatment resulted in reattachments in 25 eyes. Of the 3 remaining detachments, 2 eyes improved with additional photocoagulation, and 1 eye, which was not treated further, had a complete retinal detachment.

Neodymium:yttrium, aluminum, and garnet laser energy delivered transsclerally to the ciliary body of dogs.

Using a hand-held optical fiber, a surgical neodymium:yttrium, aluminum, and garnet laser was used transsclerally on the left ciliary body of 25 dogs. Dogs were assigned to groups and were given low (100 J) and high (238 J) energy levels. In 12 dogs given 100-J energy, the intraocular pressure decreased a mean value of 6 mm of Hg below that in the untreated right eye. However, intraocular pressure returned to the pretreatment value 1 week after treatment. Intraocular lesions were not found by histologic examination 28 days later. In the second group of 13 dogs treated with 238-J energy, 6 were euthanatized 7 days after treatment and 7 were euthanatized 28 days after treatment. A mean decrease in intraocular pressure of 10 mm of Hg in the treated left eye, relative to the untreated right eye, persisted throughout the evaluation period. In eyes examined histologically 7 days after treatment, ciliary hemorrhage and necrosis were prominent. Other histologic changes were minimal and consisted principally of iris stromal hemorrhage. Of 7 dogs examined for 28 days after treatment, 6 remained sighted; in 1 dog, extensive intraocular hemorrhage occurred, eventually resulting in phthisis bulbi. Ciliary atrophy and fibrosis were the important histologic lesions observed 28 days after treatment. Laser energy delivered transsclerally by this optical system effectively induced ciliary necrosis and may be an effective treatment for canine glaucoma.