Disseminated idiopathic lipid keratopathy in a normolipemic cat.

OBJECTIVE: To report a case of idiopathic lipid keratopathy in a normolipemic cat. ANIMAL STUDIED: A 10-year-old neutered female European domestic cat. RESULTS: A cat was evaluated for bilateral white corneal deposits. Slit-lamp examination revealed multiple, well-defined, round, stromal, cream-colored deposits of different sizes associated with generalized superficial corneal vascularization. Blood lipids were normal, and no history of travel to tropical locations or ocular trauma was present. Topical betamethasone/gentamicin 0.1% suspension q 12 hours did not result in any improvement of clinical appearance after one week. Tomography following the initial therapy revealed dense, hyperreflective deposits with posterior shadowing in the anterior and mid stroma of both corneas. A four-week course of itraconazole 0.01% ophthalmic cream was prescribed q 12 hours with no improvement. Four months after the initial examination, a diagnostic superficial keratectomy and amniotic membrane implantation were performed. Histopathological analysis showed membrane bound vacuoles with infiltration of foamy macrophages suggesting a diagnosis of primary lipidosis. The post-surgical period was unremarkable, and ten days later, the patient was re-examined. Opacification from a corneal leukoma was observed in the excision site with mild fibrotic tissue. Two months post-keratectomy, no further changes were detected in the cornea, and the patient was managed only with topical lubricant. CONCLUSIONS: To our knowledge, this is the first report of idiopathic corneal lipidosis in a cat and may be considered as a differential diagnosis of corneal disease in felines.

Application of superficial keratectomy and soft contact lens for the treatment of symblepharon in a cat: a case report.

A 7-month-old intact female Persian cat was diagnosed with symblepharon accompanied by epiphora, brownish ocular discharge, and ocular discomfort in the left eye. Superficial keratectomy (SK) was performed to remove adhesions between the conjunctiva and cornea. To prevent re-adhesion after SK, the detached conjunctival tissue was sutured to the corneal limbus, and a soft contact lens (SCL) was inserted and a partial temporary tarsorrhaphy was performed. The SCL and tarsorrhaphy sutures were maintained for 22 days, and symblepharon did not recur 347 days postoperatively. SK combined with SCL is a relatively easy and cost-effective surgical option for feline symblepharon.

A modified technique of keratoleptynsis ("letter-box") for treatment of canine corneal edema associated with endothelial dysfunction.

PURPOSE: To describe a modified keratoleptynsis procedure, as a method of preserving central corneal function, and evaluate the outcome in vision, reduction of corneal thickness and treatment of epithelial corneal ulcers in cases with endothelial cell dysfunction. METHODS: Forty-four dogs (72 eyes) were affected by progressive corneal edema, with or without ulcerative keratitis. All patients were treated with a dorsal and ventral superficial keratectomy followed by conjunctival flaps, maintaining a clear central cornea. Corneal thickness measurements were obtained via ultrasound biomicroscopy. RESULTS: All eyes showed resolution of ocular discomfort postoperatively, with a median time to resolution of 35 days. Two years post-surgery, vision had been lost in 2 of 29 eyes (7%). From the initial population, 23 dogs (39 eyes) had follow-up evaluations of corneal thickness. The mean central corneal thickness was 1359 ± 251 µm prior to surgery. Thickening of the central cornea was observed one week after surgery to 1559 ± 263 µm. Decreased corneal thickness was reported, at 1 month, 4 months, 10 months and 2 years postoperatively (1285 ± 267 µm, 1102 ± 150 µm, 1121 ± 288 µm, 1193 ± 283 µm, respectively). All eyes showed a similar trend of increasing and then decreasing corneal thickness. CONCLUSIONS: This surgical technique provided statistically significant reduction in central corneal thickness and sustained relief of ocular pain. Reduction in corneal thickness appeared to be maintained 2 years post-surgery, and all patients remained comfortable. Superficial corneal pigmentation and fibrosis resulted in vision loss in two eyes.

Microsporidial keratopathy in two dogs.

A microsporidial keratopathy is described in two dogs. Both dogs presented with a unilateral stromal keratopathy characterized by multifocal coalescing opacities, and the diagnosis was made on histopathologic examination of keratectomy specimens. Transmission electron microscopy (TEM) on formalin-fixed, paraffin-embedded corneal tissue was performed in one dog, and the morphologic features were consistent with Nosema species infection. Both dogs were initially diagnosed and treated by superficial keratectomy. One dog received additional antifungal medication and underwent a penetrating keratoplasty following local recurrence two years later. No other systemic lesions attributable to the microsporidial infection were identified clinically. The clinical and diagnostic pathology findings, treatment, and follow-up are discussed.

Use of cyanoacrylate adhesive in the surgical management of feline corneal sequestrum: 16 cases (2011-2018).

OBJECTIVE: To evaluate the use of cyanoacrylate adhesive as an adjunct to lamellar keratectomy in cats with corneal sequestrum. METHODS: Medical records were reviewed to identify cats with naturally occurring midstromal corneal sequestra treated with lamellar keratectomy and cyanoacrylate adhesive. All cats also had a bandage contact lens placed for postoperative comfort. Data collected included breed, age, sex, and reproductive status of the cat, eye involved, presence or absence of neovascularization at the time of surgery, history of prior sequestra, additional ocular procedures performed, use of neuromuscular blocking agents, procedure time, time to cessation of topical medications, time to recurrence or last follow-up, and complications aside from recurrence. RESULTS: Sixteen cats met study criteria, with a median follow-up time of 17.5 months in those without recurrence. Median time to cessation of topical medications was 4 weeks. Fourteen cats (87%) have not experienced recurrence. Other than recurrence in two cats, no significant complications were noted. Aside from purebred status, no commonalities were found between the two cats with recurrence. Neuromuscular blocking agents were not used during surgery in most cases. Median procedure time was 10 minutes. CONCLUSIONS: Cyanoacrylate adhesive is an effective and safe alternative to grafting procedures in cats undergoing lamellar keratectomy for treatment of corneal sequestrum. Recurrence rates are comparable to those seen with grafting techniques. Benefits of this approach include decreased anesthesia time, lower procedure costs, and short duration of postoperative treatment.

Corneal collagen cross-linking following superficial keratectomy as treatment for corneal endothelial cell dystrophy in dogs: Preliminary clinical study.

OBJECTIVE: To describe the outcome of corneal collagen cross-linking (CXL) combined with superficial keratectomy (SK) as treatment for corneal edema due to corneal endothelial dystrophy (CED) in dogs. ANIMALS STUDIED: Four eyes of four dogs (3 Shih Tzus and 1 English Cocker Spaniel) with corneal edema due to CED were treated with SK and CXL. Two were males, and two were females. PROCEDURE: Depending on corneal thickness, 500-700 µm of edematous cornea was removed by SK. Next, CXL was performed by irradiating the cornea with UVA (365 nm) at 3 mW/cm² irradiance for 30 min after soaking with 0.1% riboflavin in 20% dextran every three minutes for 30 minutes. One drop of riboflavin was instilled every three minutes during irradiation. Slit lamp biomicroscopy and optical coherence tomography were used to examine the cornea during the follow-up period. RESULTS: The corneas had focal to diffuse edema, and the average corneal thickness was 1553 (1282-1900) µm. All corneas showed a significantly reduced corneal thickness and regained marked transparency immediately after treatment; however, the opacity increased as the corneal thickness increased during the follow-up period. Corneal vascularization (n = 4) disappeared within a month. Corneal pigmentation (n = 1) and bullae (n = 1) were observed. All cases showed marked reduction in corneal thickness; however, transparency was improved in only one case. CONCLUSION: Collagen cross-linking with SK has the potential to reduce the corneal thickness in CED cases; however, a lasting clinically significant improvement of corneal transparency seems unlikely. As the added benefit of CXL to the SK procedure is unclear based on the results of this study, combined treatment of CXL and SK for the treatment of corneal edema caused by CED is currently not recommended in dogs.

Superficial keratectomy as a treatment for non-healing corneal ulceration associated with primary corneal endothelial degeneration.

OBJECTIVE: To analyze a study population of dogs with primary corneal endothelial degeneration (PCED) for information on the patterns of disease and to report the efficacy of superficial keratectomy (SK) for resolution of non-healing corneal ulcers associated with PCED. ANIMALS STUDIED: Primary corneal endothelial degeneration was diagnosed in 238 dogs between 1998 and 2017. Corneal ulceration associated with PCED was present in 89 dogs (109 eyes), of which 47 eyes were treated with SK. PROCEDURES: A retrospective assessment of medical records was performed to determine the signalment patterns of PCED, and the success rate of the SK procedure for resolving PCED-associated corneal ulceration. Descriptive statistics were reported on the signalment of PCED cases, with odd ratios and confidence intervals calculated to detect breed predispositions. RESULTS: Primary corneal endothelial degeneration was diagnosed in 238 dogs, 40.8% were female and 59.2% were male, with a mean age at diagnosis of 11.4 years. Dachshunds, Dalmatians, English Springer Spaniels, Welsh Springer Spaniels, Chihuahuas, Cocker Spaniels, and Golden Retrievers were significantly over-represented. All PCED-affected Dalmatians developed associated corneal ulceration. Follow-up information was available for 41/47 eyes treated with SK. At the first reassessment, 87.8% were healed which increased to 97.6% with subsequent monitoring. Four eyes (9.8%) had late corneal ulcer occurrence following SK, at a median time following SK of 182 weeks post-surgery. CONCLUSIONS: Superficial keratectomy was an effective option for resolving painful non-healing corneal ulcers associated with PCED. Dalmatians may be at increased risk of developing PCED-associated corneal ulceration.

Limbal xanthogranuloma in a dog.

A 10-year-old female spayed American Pitt Bull Terrier was presented with a slow growing mass on the temporal limbus area of the right eye. Canine nodular granulomatous episclerokeratitis was suspected, and the affected eye was treated with 1% prednisolone acetate ophthalmic suspension and 0.03% Tacrolimus ophthalmic solution. As the lesion did not respond to the medical treatments and continued to grow, the mass was excised by lamellar sclerokeratectomy. Microscopically, the mass was composed of granulomatous inflammation with intrahistiocytic lipids and lakes of acicular cholesterol clefts, histopathology findings consistent with xanthogranuloma. To the authors' knowledge, this is the first canine report of limbal xanthogranuloma.

Corneal edema in four horses treated with a superficial keratectomy and Gundersen inlay flap.

OBJECTIVE: To describe the clinical presentation, treatment, and outcome of four horses with severe corneal edema caused by suspected endothelial disease treated with a superficial keratectomy and Gundersen inlay flap and to determine whether this procedure (i) reduces corneal edema, (ii) reduces ocular pain, (iii) eliminates recurrent corneal ulceration, and (iv) improves vision in these horses. ANIMALS STUDIED: Four horses met inclusion criterion of (i) diagnosis with endothelial disease by a board-certified veterinary ophthalmologist and (ii) surgical treatment with a superficial keratectomy and Gundersen inlay flap. PROCEDURE: Retrospective medical record review of included horses was used to determine breed, age and sex of included horses, as well as details of medical and surgical therapy, and visual outcome. RESULTS: Four horses were presented with a complaint of focal corneal edema that progressed to diffuse corneal edema. Epithelial bullae and ulceration were present in all cases. The disease process was unresponsive to standard medical treatment with a hyperosmotic agent and topical and systemic anti-inflammatories. However, treatment with a superficial keratectomy and Gundersen inlay flap performed under general anesthesia was associated with (i) a significant decrease in corneal edema, (ii) increased comfort, (iii) elimination of corneal ulceration, and (iv) retention of vision postoperatively with little to no need for medical therapy. Follow-up time was 15, 12, 6, and 3 months. CONCLUSIONS: The superficial keratectomy and Gundersen inlay flap may provide a surgical alternative to chronic medical treatment of severe corneal edema in horses.

Hemangiossarcoma corneal em cão / Corneal hemangiosarcoma in a dog

O hemangiossarcoma é uma neoplasia maligna e sua apresentação corneal é rara em cães. Relata-se um caso de hemangiossarcoma corneal primário, em uma fêmea canina, sem raça definida, de 20kg, nove anos de idade e com histórico de crescimento progressivo de massa em bulbo ocular direito há dois meses. Ao exame oftálmico do olho direito, foram observados blefarospasmo, hiperemia conjuntival moderada e presença de nódulo avermelhado, irregular em região dorsal de córnea direita, ocupando cerca de 60% dela. A ultrassonografia ocular foi realizada, e constatou-se que a neoplasia acometia apenas a córnea. Por meio do exame citológico, foi diagnosticada neoplasia mesenquimal maligna. O paciente foi submetido à ceratectomia seguida de flap de terceira pálpebra. Encaminhou-se o material excisado para análise histopatológica, e foi diagnosticado hemangiossarcoma. Após 15 dias, o flap de terceira pálpebra foi retirado, e, ao exame oftálmico, notou-se a recidiva da neoplasia, que recobria toda a córnea e parte da conjuntiva bulbar, procedendo-se à enucleação. O paciente foi submetido à ultrassonografia abdominal e à radiografia torácica sem nenhuma alteração evidente, o que caracterizou o caráter primário da afecção. Após dois anos do procedimento cirúrgico, o paciente encontra-se bem clinicamente, sem qualquer sinal de recidiva ou metástase. Apesar da exérese cirúrgica da neoplasia com margens limpas, em casos de hemangiossarcoma com comportamento agressivo, a enucleação deve ser considerada uma opção viável para um protocolo terapêutico de sucesso e melhor prognóstico do paciente.(AU)

Hemangiosarcoma is a malignant neoplasm and its corneal presentation is uncommon in the dog. The present work reports a case of primary corneal hemangiosarcoma on a mongrel female dog, 20kg, nine years old with a 2 month history of a mass with progressive growth in the right eye. The ophthalmic examination of the right eye showed blepharospasm, moderated conjunctival hyperemia and the presence of a reddish irregular nodule on the dorsal region of the cornea, occupying approximately 60% of the cornea. The ocular ultrasound revealed that the neoplasm affected only the cornea and the cytological examination diagnosed a malignant mesenchymal neoplasm. The patient was submitted to keratectomy followed by a third eyelid flap. The excised material was sent for histopathological analysis that diagnosed hemangiosarcoma. Fifteen days after surgery the third eyelid flap was removed and the ophthalmic examination revealed recurrence of the tumor, with the mass occupying the entire cornea and part of the bulbar conjunctiva. The patient was submitted to enucleation. No alterations were observed on the abdominal ultrasound and thoracic radiography, showing the primary characteristics of the disease. Two years after surgery the patient is clinically healthy, without any signs of recurrence or metastasis. Despite the surgical excision of the tumor with free margins, in cases of hemangiosarcoma with aggressive behavior, the enucleation should be considered as a viable option for a successfull therapeutic protocol and better prognosis of the patient.(AU)