Long-term outcome of autologous fascia lata grafting with conjunctival flap overlay in horses with ulcerative keratitis and keratomalacia.

OBJECTIVES: To describe the technique, postoperative complications, and outcome after autologous fascia lata grafting with conjunctival flap overlay in horses with ulcerative keratitis and keratomalacia. STUDY DESIGN: Retrospective case series. ANIMALS: Eleven horses with ulcerative keratitis and keratomalacia. METHODS: Horses included had undergone fascia lata grafting with conjunctival flap overlay due to impending or recent corneal perforation. Preceding therapy, lesion characteristics, postoperative complications, and short- and long-term outcomes were recorded. RESULTS: Postoperative complications included complete (1/11) or partial (2/11) dehiscence of the conjunctival flap and fascia lata graft, postoperative pneumonia (1/11), intermittent hypercreatinemia (2/11) and mild uveitis after trimming of the conjunctival flap (9/10). The donor sites healed without complications (11/11). A satisfactory short-term outcome (at cessation of medical therapy) was achieved in all horses (11/11). Long-term follow-up (median 29 months, range 7-127 months) was available for 10/11 horses. A comfortable eye with functional vision was achieved in 9/10 horses with long-term follow-up, including 3/4 horses with prior corneal perforation and 1/11 horses in which the fascia lata graft completely dehisced 15 days after surgery. Enucleation was required in a single horse (1/10) after phthisis bulbi developed 7 months postoperatively. CONCLUSION: Fascia lata grafting with conjunctival flap overlay appears to be a viable solution for globe preservation in horses with ulcerative keratitis and keratomalacia. Long-term ocular comfort with functional visual outcomes can be achieved in most cases with limited concerns for donor site morbidity while bypassing acquisition, storage or lesion-size limitations related to other biomaterials.

Corneoconjunctival transposition for the treatment of deep stromal to full-thickness corneal defects in dogs: A multicentric retrospective study of 100 cases (2012-2018).

OBJECTIVE: To describe and evaluate the use of corneoconjunctival transposition (CTT) as a surgical treatment for canine deep stromal ulcers, descemetoceles, and full-thickness corneal defects and to determine its efficacy in preserving corneal graft transparency and vision. ANIMALS STUDIED: One hundred client-owned dogs with deep stromal ulcers, descemetoceles, or full-thickness corneal defects. METHODS: Medical records of canine patients that underwent CCT, from 2012 to 2018, were reviewed. Only, patients with preoperative positive consensual pupillary light and dazzle reflexes were included. RESULTS: There were 59 males and 41 females, from 0.3 to 17 years. Brachycephalic breeds were overrepresented (65%). All patients were unilaterally affected, with 16 deep stromal ulcers, 33 descemetoceles, and 51 corneal perforations, of a median (range) size of 4 (2-8) mm. The central cornea was affected in the majority of cases (57%), and euryblepharon and keratoconjunctivitis sicca were the most common concurrent ocular diseases (42% and 40%, respectively). The graft was most frequently harvested from dorsal (67%), and 9/0 absorbable suture material was used. Intraoperative and postoperative complications were seen in 7 and 21 cases, respectively. Mean follow-up time was 107.8 days. Vision was preserved in 96% patients, with 62% showing faint to mild opacification. Among the statistically analyzed variables, euryblepharon and pigmentary keratitis were found to be significantly associated with greater corneal graft opacification (P = .040 and P = .028, respectively). CONCLUSIONS: Corneoconjunctival transposition is an effective surgical treatment for deep stromal, descemetocele, and full-thickness corneal defects in dogs, achieving a highly satisfactory degree of corneal graft transparency and preserving vision.

Corneal grafting for the treatment of full-thickness corneal defects in dogs: a review of 50 cases.

OBJECTIVE: To describe corneal grafting for the treatment of full-thickness corneal defects in dogs and to determine its effectiveness in preserving vision. METHODS: A review of the medical records of dogs that underwent corneal grafting following corneal perforations (≥3 mm) at the VTH-UAB from 2002 to 2012 was carried out. RESULTS: Fifty dogs of different breed, age and gender were included. Brachycephalic breeds were overrepresented (37/50;74%). All cases were unilateral, with euryblepharon being the most common concurrent ocular abnormality (20/50;40%). Full-thickness penetrating keratoplasties (FTPK) were performed in 21/50 eyes (42%) and lamellar keratoplasties (LK) in 29/50 eyes (58%). Frozen grafts (FroG) were used in 43/50 eyes (86%) and fresh homologous grafts (FreHoG) in 7/50 (14%). Of the former group, 26 were homologous (FroHoG:60%) and 17 heterologous (FroHeG:40%). A combination of topical medication (antibiotics, corticosteroids, cycloplegics, and 0.2% cyclosporine A) and systemic mycophenolate mofetil was administered. Median follow-up time was 200 days. Postsurgical complications included wound dehiscence (6/50;12%) and glaucoma (4/50;8%). Clinical signs of graft rejection were diagnosed as follows: FroHoG (13/26;50%), FroHeG (11/17;65%), FreHoG (4/7;57%), FTPK (12/21;57%), and LK (16/29;55%). Medical treatment successfully controlled graft rejection in 11/28 eyes (39%). Good anatomical outcome was achieved in 86% (43/50), of which 95% (41/43) were visual at last examination, with moderate opacification to complete transparency of the graft present in 48.2%. CONCLUSIONS: Corneal grafting is an effective surgical treatment for full-thickness corneal defects in dogs. If graft rejection is present, additional medical or surgical therapy may be necessary, achieving a highly satisfactory visual outcome.

Corneal Emergencies.

Corneal emergencies can be due to a number of different causes and may be vision threatening if left untreated. In an attempt to stabilize the cornea, it is of benefit to place an Elizabethan collar on the patient to prevent further corneal damage. This article discusses the diagnosis, prognosis, and management of corneal emergencies in dogs and cats.