A comparison of anesthetic complications between diabetic and nondiabetic dogs undergoing phacoemulsification cataract surgery: a retrospective study

Objective To compare the incidence of anesthetic complications in diabetic and nondiabetic dogs undergoing general anesthesia and phacoemulsification cataract surgery. Procedure The medical and anesthetic records of all dogs undergoing phacoemulsification cataract surgery at Davies Veterinary Specialists between 2005 and 2008 were reviewed. Anesthetic records were evaluated by an ECVAA Diplomate. Dogs for which records were incomplete were excluded. The anesthetic technique, including all drugs administered in the perioperative period, was recorded. The anesthetic complications investigated included hypotension (MAP (mmHg): ≥55 none/mild; ≤54 moderate/severe), bradycardia (<60 bpm associated with hypotension) and hypothermia (esophageal temperature <36.7 °C). Where hypotension was present, the method of and response to treatment was recorded. The incidence of severe hyperglycemia (blood glucose >13.75 mmol/L (250 mg/dL)) in the diabetic group was also assessed. Results 66 diabetic and 64 nondiabetic dogs were included in the study. Diabetic dogs were more likely to develop moderate and severe intraoperative hypotension than nondiabetic dogs. Forty‐four percent of diabetic dogs had at least one episode of severe hyperglycemia whilst anesthetized. Conclusions Diabetic dogs undergoing phacoemulsification are more likely to suffer the anesthetic complications of moderate and severe hypotension than nondiabetic dogs. The increased incidence and severity of hypotension in diabetic dogs may be explained by hypovolemia secondary to hyperglycemia and resultant osmotic diuresis.     

Vascular endothelial growth factor in diabetic and nondiabetic canine cataract patients

Objective To measure vascular endothelial growth factor (VEGF) levels in aqueous humor, serum, and plasma in diabetic and nondiabetic cataractous dogs. Methods Canine VEGF was assayed in the plasma and serum of 32 dogs (20 diabetics; 12 nondiabetics) and aqueous humor in 57 eyes of those dogs (39 diabetic; 18 nondiabetic) undergoing phacoemulsification, using a commercial canine VEGF assay. Statistical analysis was performed using Fisher’s PLSD, t‐test, and regression analysis to compare values by diabetic status, duration of diabetes, age, weight, gender, left vs. right eye, and blood clarity. Results Plasma, but not serum or aqueous humor VEGF values of diabetics were significantly greater than nondiabetics (P = 0.019). Older nondiabetics (10–15 years) had higher plasma VEGF values than younger (0–5 and 5–10 years) dogs (P = 0.0002 and 0.0001, respectively). There was no significant difference in aqueous humor VEGF between left and right eyes in all patients. Serum and plasma, but not aqueous humor, VEGF values in females were significantly higher than males in both groups. Conclusion Similar to human diabetic patients, VEGF aqueous humor values in all dogs are significantly higher than blood values. Aqueous humor VEGF values in human diabetics are elevated and correlate with the severity of diabetic retinopathy. However, aqueous humor values of VEGF in diabetic dogs are not greater than nondiabetics and may serve to protect the dog against development of diabetic retinopathy.     

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.     

Posterior capsular opacification in diabetic and nondiabetic canine patients following cataract surgery

Posterior capsular opacification (PCO) is the most common postoperative complication of contemporary cataract surgery. Limited information is available regarding PCO formation and factors that influence PCO development in the dog. Two hundred sixty-five eyes (144 from diabetic dogs and 121 from dogs with breed-related cataracts) were prospectively evaluated for PCO formation for up to 12 months postoperatively. The mean age of all dogs in the study was 7.77 years and diabetic dogs were significantly older than dogs with breed-related cataracts. There were 73 males (61 neutered, 12 intact) and 74 females (70 neutered, 4 intact) in the study. Statistical analysis was performed based on age, breed/size, gender, stage of cataract at the time of surgery, PCO score at each time point, breed-related vs. diabetic cataract, right eyes compared to left eyes, and presence/absence of uveitis. Age and gender did not significantly influence PCO formation. Small and medium-sized breeds developed significantly more PCO in comparison to the large/giant breeds at 2 weeks and 2-4 months postoperatively, but the differences were not significant at later time points. There was an overall significant increase in PCO formation in eyes with early immature cataracts when compared to other stages of cataract up to 4 months postoperatively but not at later time points. There were no statistical differences in PCO score at 6 months or at 1 year postoperatively in eyes with breed-related and diabetic cataracts. Right eyes did not differ from left eyes in PCO score. PCO score significantly increased over time in breed-related and diabetic groups and in the overall population. No difference was found in the degree of PCO formation in eyes with inflammation prior to or after surgery compared with those without inflammation. In summary, age, gender, presence of inflammation, and cause of cataract (breed-related vs. diabetes mellitus) do not influence the development of PCO in canine cataract dogs. Small and medium-sized breeds develop significant PCO earlier than larger breeds. It is important to note that all eyes from all dogs in this study developed PCO in a time dependent manner.     

Solid intraocular xanthogranuloma in three Miniature Schnauzer dogs

OBJECTIVE: Macrophages that contain abundant intracytoplasmic lipid are called 'foam cells'. In four canine globes submitted to the Comparative Ocular Pathology Laboratory of Wisconsin (COPLOW), foam cells formed a solid intraocular mass. The purpose of this study was to describe the histopathologic findings in these cases. PROCEDURE: The electronic COPLOW database (1993-2006) was searched for the diagnosis of 'foam cell tumor'. Clinical history, gross pathology and histopathology (5-micron sections, hematoxylin and eosin and Alcian blue periodic acid Schiff) were reviewed in all cases. Cases were included if the globe was grossly filled by a solid mass and if all intraocular structures were effaced by lipid-laden foam cell macrophages admixed with birefringent, Alcian blue-positive crystals oriented in stellate patterns. RESULTS: All three patients (four globes) satisfying the selection criteria were Miniature Schnauzers. In all cases the clinical history included diabetes mellitus, hyperlipidemia and chronic bilateral uveitis that was interpreted to be lens-induced. All globes were enucleated because of glaucoma. CONCLUSIONS: The term solid intraocular xanthogranuloma was used to describe these cases because the intraocular contents were effaced by a solid mass of foam cells and birefringent crystals. The cases in this report suggest that diabetic Miniature Schnauzers with hyperlipidemia are at risk for lipid and macrophage-rich uveitis, which may in some cases form a solid inflammatory intraocular mass, precipitate glaucoma, and lead to enucleation.     

Retrospective investigation of perioperative risk factors for immediate postoperative corneal erosions in dogs undergoing phacoemulsification

Objective

To characterize the incidence, contributing risk factors, and healing characteristics of immediate postoperative corneal erosions (IPCE) in dogs undergoing routine phacoemulsification.

Animals Studied

Medical records of 313 canine eyes (159 dogs) undergoing routine phacoemulsification surgery.

Procedures

Medical records of dogs undergoing planned cataract surgery at UW Veterinary Care were retrospectively reviewed. Patient-related variables including age, skull conformation, diabetes status, and cataract stage at the time of surgery were recorded. Intraoperative variables per eye were also recorded including surgical technique, surgeon expertise level, average phacoemulsification power, and phacoemulsification time. Diagnosis of IPCE ≤ 24 h after completion of surgery and time to IPCE healing were recorded where follow-up data were available.

Results

Immediate postoperative corneal erosions were observed in 48/313 (15.3%) operated eyes. The presence of diabetes mellitus or brachycephalic skull conformation, preoperative Schirmer tear test (STT) value, surgical technique and surgeon experience level, phacoemulsification time, and absolute phacoemulsification time were not statistically significant risk factors for IPCE. Average phacoemulsification power was associated with IPCE (RR 1.52, p = .001). Time to IPCE healing was similar in diabetic and non-diabetic dogs (median [IQR] 8 [6–11] days and 8 [6–15] days, respectively). Diabetes mellitus, brachycephaly, and phacoemulsification parameters were not associated with IPCE healing at 7 or 14 days postoperatively.

Conclusions

Higher average phacoemulsification power may be associated with the development of IPCE in canine eyes. The presence of diabetes mellitus or brachycephaly are not risk factors for the development of IPCE, nor are they factors that influence IPCE healing.     

Investigation of hypertriglyceridemia in healthy Miniature Schnauzers

BACKGROUND: Idiopathic hypertriglyceridemia has been reported in Miniature Schnauzers (MS). However, studies investigating the prevalence of this disorder in a large population of MS are lacking. HYPOTHESIS: Hypertriglyceridemia is prevalent in healthy MS. ANIMALS: This study used 192 healthy MS and 38 healthy dogs of other breeds (control dogs). METHODS: Serum triglyceride and cholesterol concentrations were measured and statistically compared in both the MS and control group. Dogs were categorized based on their age, and median serum triglyceride concentrations were compared among different age groups. RESULTS: A total of 63 (32.8%) of the 192 MS had serum triglyceride concentrations above the reference range. In contrast, of the 38 control dogs, only 2 (5.3%) had serum triglyceride concentrations above the reference range. The median serum triglyceride concentration in MS was 73.5 mg/dL, which was significantly higher as compared to that of the control group (median, 55 mg/dL; P = .0005). Serum cholesterol concentration was above the reference range in 9 (9.0%) of 100 MS and in 2 (5.3%) of the control dogs. Mean serum cholesterol concentrations were not significantly different between the 2 groups (P = .1374). Median serum triglyceride concentrations in MS increased significantly with age (P < .0001), and there was a significant positive correlation between serum triglyceride concentrations and age (Spearman r = 0.47; P < .0001). There was no difference in serum triglyceride concentrations between male and female MS (P = .48). CONCLUSION: Healthy MS have a high prevalence of hypertriglyceridemia as compared to healthy dogs of other breeds. Both the prevalence and severity of hypertriglyceridemia increase with age.     

Intraocular pressure development after cataract surgery: a prospective study in 50 dogs (1998-2000)

Objective To study the course of intraocular pressure (IOP) after cataract surgery in 50 dogs. Design Prospective study. Animals Fifty dogs without preoperative ocular hypertension were selected for cataract surgery. Methods All dogs underwent cataract surgery: 25 by manual extracapsular extraction and 25 by phacoemulsification. For each dog, intraocular pressure was measured before surgery, and 1, 3, 5, 18 h, 1 week and 1 month post surgery. Results No significant difference of mean intraocular pressure between the two surgical methods was observed for each time measurement. Nine dogs had postoperative hypertension (IOP > 25 mmHg) during the first 5 hours post surgery. Incidence of postoperative hypertension was not significantly different with manual extracapsular extraction (16%) vs. phacoemulsification (20%). A decrease of mean IOP was observed 1 h after surgery (8.49 mmHg vs. 10.91 mmHg), then an increase 3 and 5 h post surgery (12.3 and 13.32 mmHg, respectively). At 18 h, 1 week and 1 month post surgery, mean IOP decreased. Mean IOP was 10.38, 10.38 and 8.84 mmHg, respectively. Conclusion In this study incidence of POH is not high. However, a follow‐up of IOP in the first hours after cataract surgery is required to avoid complications of the retina and optic nerve and to administer hypotensive treatment if necessary.     

Microbial contamination of the anterior chamber during cataract phacoemulsification and intraocular lens implantation in dogs

The objective of this study was to determine the frequency of intraoperative contamination of the anterior chamber with viable microorganisms during cataract phacoemulsification and intraocular lens implantation, and to evaluate the relationship of contaminant microorganisms to patients' extraocular and nasal cavity floras. Also, the impact of various aspects of the patient history and phacoemulsification procedure on the incidence of positive postoperative anterior chamber cultures was investigated. Twenty-two eyes from 13 dogs presented for elective cataract phacoemulsification and intraocular lens implantation were studied. Preoperatively, microbiologic samples of the conjunctiva, eyelid margins, nares, and rostral nasal cavity were collected. Postoperatively, anterior chamber fluid was aspirated. Samples were submitted for aerobic/anaerobic bacteriologic culture and antimicrobial susceptibility, Mycoplasma culture, and fungal culture. Anterior chamber aspirates collected at the conclusion of surgery were culture positive for at least one organism in 22.7% of eyes. Three aerobic bacteria and three fungi were isolated from the anterior chamber aspirates. Two fungi and one bacterium isolated from the anterior chamber were typed identically, and the bacterium had a similar antibiogram to organisms recovered from the patient's conjunctiva and eyelid margin. No statistically significant difference in contamination frequency was found for the investigated patient and surgical variables. We conclude that intraoperative contamination of the anterior chamber with viable bacterial and fungal organisms is a common occurrence in canine patients undergoing cataract phacoemulsification and intraocular lens implantation, and the external ocular flora is a likely source of some of these contaminating microorganisms. This contamination is independent of the patient and surgical variables investigated.     

Retrospective study of prophylactic random transscleral retinopexy in the Bichon Frise with cataract

The objective of this study was to determine the efficacy of prophylactic random transscleral retinopexy (PRTR) in preventing rhegmatogenous retinal detachment (RRD) in the Bichon Frise with juvenile cataract. The medical records were reviewed from a private veterinary ophthalmology practice of nondiabetic Bichon Frise dogs younger than 11 years that had inherited cortical cataracts in one or both eyes and that had a follow-up examination after at least 9 months. Eyes were included in the study if the fundus could be visualized by indirect ophthalmoscopy at the last examination either because of phacoemulsification or resorption of the cataract. Four groups of eyes were identified. In group 1, no PRTR was performed and there was resorption of the cataract; in group 2, eyes had no PRTR performed and phacoemulsification of the cataract. Group 3 had PRTR performed and resorption of the cataract. In group 4, PRTR was performed as was phacoemulsification of the cataract. In group 1, 20 eyes had resorbed cataracts, and 12 (60%) of these had RRD. In group 2, 18 eyes had phacoemusification of the cataract, and 10 (55%) of these had RRD. In group 3, 19 eyes had PRTR and resorbed cataracts, and 2 (10%) of them had RRD. In group 4, 39 eyes had PRTR and phacoemulsification of the cataract; of these 5 (12%) had RRD. The Bichon Frise dog with inherited cataract is at high risk of RRD. PRTR reduces this risk.     

Cataracts in Labrador Retriever and Jack Russell Terrier From the United Kingdom: A Two-Year Retrospective Study

Cataracts are among the most common ocular diseases, and are a leading cause of vision loss in humans and dogs. Jack Russell Terriers (JRT) and Labrador Retrievers (LR) are among the most popular canine breeds in the United Kingdom, and also among the most affected by cataracts.This study aimed to analyze the clinical features and the surgical outcome of cataracts in JRT and LR in an ophthalmologic reference Veterinary Hospital in the United Kingdom. For that purpose, medical records from JRT and LR diagnosed with cataracts between January 2015 and December 2016 were retrospectively evaluated. Data related to identification, clinical history, preoperative features, and surgical outcomes were analyzed.Forty-four dogs (81 eyes), including 26 JRT and 18 LR, were enrolled in the study. Mean ages were 10.2 ± 3.2 years in JRT and 8.5 ± 3.7 years in LR. Twenty-eight (63.6%) were females and 16 (36.4%) were males. Most dogs (84.1%) presented with bilateral cataracts. Nuclear and cortical cataracts were the most prevalent type in both breeds (JRT: n?=?30, 61.2%; LR: n?=?16, 50.0%), although subcapsular cataracts were also frequent in LR (n?=?10, 31.3%). Significant differences in cataract location within the lens were detected between the two breeds (P?=?.002).Senile in JRT (n?=?7) and genetic in LR (n?=?7) were the most common etiologies. Concomitant ocular lesions were more frequent in dogs presented with cataracts in advanced stages, and included lens (n?=?18; JRT: n?=?15; LR: n?=?3) and retinal alterations (n?=?8; JRT: n?=?2; LR: n?=?6), and glaucoma (n?=?6; JRT: n?=?5; LR: n?=?1). Thirty-three animals (75.0%, 51 eyes) were submitted to phacoemulsification with intraocular lens placement. Of these, 28 eyes (54.9%; JRT: n?=?21; LR: n?=?7) were visual, 19 eyes (37.3%; JRT: n?=?11; LR: n?=?8) presented impaired vision and four eyes (7.8%; JRT: n?=?0; LR: n?=?4) were blind at last clinical record. Postoperative complications were detected in 11 eyes (21.6%), and were more frequent in dogs presented with cataracts in advanced stages.These results and the multifactorial nature of cataracts call for further studies to identify and characterize the variables in a broader assessment, including other breeds and influencing factors.