Use of free oral mucosal graft for treatment of feline eyelid agenesis in seven patients.

OBJECTIVE: To describe a simple and effective surgery for feline eyelid agenesis. PROCEDURE: Free oral mucosal grafts were harvested from the upper lips of the surgical patients. A recipient bed was created by incising the conjunctiva at the conjunctival-skin border and opening a space in the tissue with blunt dissection without removal of tissue. The free oral mucosal graft was sutured into the space with simple continuous suture pattern of 7-0 Vicryl. RESULTS: Eyelids were cosmetically acceptable at final examination, and areas of coloboma appeared less prominent. Patient comfort was improved in all subjects as subjectively noted by decreased blepharospasm. All grafts were successfully incorporated. All patients developed brown-colored crusting over the grafts within days of the surgery, which gradually resolved over a 4- to 6-week period. Three of seven patients developed few trichiatic hairs at the donor-recipient junction, and two of these patients had follow-up cryoepilation. CONCLUSION: For feline eyelid agenesis, free oral mucosal graft implantation was successful in creating space between fur and cornea with insertion of smooth-surfaced, hairless tissue, alleviating the discomfort of hair contacting the cornea. The extra tissue can also create a small overhang or fold of tissue (pseudo-lid) which may also be protective. For two cases, cryoepilation of few trichiatic hairs at the donor-recipient border was performed at a later date. As illustrated by case 3, use of a long and wide rectangular graft with squared edges is recommended to lessen the chance of trichiasis at lateral or medial edges of recipient-donor junctions.

Phaco chop technique for cataract surgery in the dog.

Phaco chop is a bimanual phacoemulsification technique to remove cataracts. The technique was first presented at the 1993 3rd American-International Congress on Cataract, IOL, and Refractive Surgery in Seattle by Dr Kunihiro Nagahara. He compared the lens with a block of wood and by applying chopping forces parallel to the natural planes of the lens lamellae, as one does in splitting wood, a nucleus can be cleaved with surprisingly little force and time. Dr Nagahara used the phaco tip to impale and high vacuum to hold the nucleus while a second instrument, or chopper, hooked the equator and was pulled centrally, splitting the nucleus along its natural cleavage planes. This was a breakthrough for surgeons who had been utilizing several minutes of phaco energy sculpting grooves and bowls in a lens. Studies have shown that compared with four-quadrant 'divide and conquer', the phaco chop technique uses less phaco time and energy, significantly reducing endothelial cell damage. Other advantages of phaco chop include reduction of zonular and capsular stress because forces are directed toward an opposing instrument and the phaco tip is kept in a central 'safe zone' in the middle of the pupil. This technique has also been successfully adapted to the canine phacoemulsification procedure. The larger canine lens requires some modifications, and lenses with hard nuclear and cortical material may not be amenable to this procedure.