Ahmed valve implantation to control intractable glaucoma after phacoemulsification and intraocular lens implantation in a dog

An 11-year-old spayed female Miniature Poodle presented with bilateral senile cataracts. Treatment was cataract removal by phacoemulsification and intraocular lens implantation. Five hours after surgery the operated right eye was partially closed and painful. The right pupil was fully dilated, there was generalized corneal edema, and intraocular pressure (IOP) was increased. After 12 h of medication IOP was controlled. Ten weeks after surgery the owners reported cloudiness of right eye, and the dog was again evaluated. The IOP was again increased and an Ahmed valve was implanted. This case describes describe the progression of this case and benefits of controlling postcataract surgery glaucoma by the implantation of an Ahmed valve.     

Combined transscleral diode laser cyclophotocoagulation and Ahmed gonioimplantation in dogs with primary glaucoma: 51 cases (1996-2004)

OBJECTIVE: To evaluate the combined diode laser cycloablation procedure and adjunctive Ahmed gonioimplant use in dogs with primary glaucoma. DESIGN: Retrospective study. ANIMALS: 48 dogs, 51 eyes with primary glaucoma. PROCEDURE: Medical records from two large private clinical ophthalmology services were reviewed. Signalment, duration of glaucoma, gonioscopic evaluation, laser power and duration settings, immediate postoperative and final intraocular pressure and visual results, short and long-term visual outcome, and surgical complications were recorded. RESULTS: The age range of affected dogs was 3.0-14.0 years, with a mean age of 7.5 +/- 2.6 years. Eleven pure breeds were represented, with the most common being the American Cocker Spaniel. The sex distribution was 22 neutered males, 1 intact male, 23 spayed females, and 2 intact female dogs. The right eye was affected in 33 cases, and the left eye in 18 cases. The average total joules, which was administered with the diode laser, was 109.6 +/- 23.6 J. Immediate surgical complications included fibrin formation in the anterior chamber (15), corneal ulcers (4), hyphema (7), and focal retinal detachment (1). Long-term complications included cataract formation (8 total, 2 of which were significant, vision-threatening), elevated intraocular pressure (IOP) (6), unstable gonioimplant (1), and glaucoma recurrence (14). Additional surgeries performed on the eyes over the course of study included: intrascleral prosthesis (4), enucleation (1), resection of fibrotic scar tissue (5), and repeat laser cycloablation (8). The dogs were examined for a mean follow-up time of 17.6 months (range: 2-83 months postoperatively). Twenty-nine cases were followed greater than one year. Vision was maintained in 42/51 eyes (82%) in the immediate short-term of this study. In all cases included in the study, good control of IOP was achieved in 39/51 (76%) of eyes, and IOP was poor or uncontrolled in 12/51 (24%) of eyes. Twenty out of 41 eyes (49%) maintained fair to excellent vision six months after surgery. Twelve months postoperative observations demonstrated that 12/29 (41%) of the eyes were still visual. CONCLUSIONS: In primary glaucoma, the combined procedure of laser diode cyclophotocoagulation and Ahmed valve implant was associated with return or maintenance of vision in 42/51 eyes (82%) in the immediate short-term of this study, and a long-term IOP control in 39/51 (76%) of the cases, with 12/29 eyes (41%) visual after 12 months.     

Anterior chamber to frontal sinus shunt for the diversion of aqueous humor: a pilot study in four normal dogs

Silicone tubing was used to divert aqueous humor from the anterior chamber of the right eye to the rostral compartment of the right frontal sinus in four clinically normal mixed-breed dogs. Biomicroscopic examination, and pneumoapplanation tonometry and tonography, completed for up to 18 weeks postoperatively, confirmed gonioimplant function in all four cases. The dogs were euthanized at 6, 8, 16 and 18 weeks postoperatively. Gonioimplant patency was further confirmed by postmortem examination of the globes, implants and frontal sinuses. Gross and light microscopic examinations revealed iridal attachments to the implant ( n  = 4), mild anterior uveitis ( n  = 3), anterior subcapsular cataracts ( n  = 4), and focal corneal ( n  = 3) and scleral ( n  = 3) scarring in the operated globes. Light microscopic examination of frontal sinus specimens revealed mild lymphocytic proliferation and fibrosis immediately adjacent to the implant entrance site. There were no bacteria detected on aerobic or anaerobic cultures of the frontal sinuses or light microscopic examination of the globes or frontal sinuses. Results indicate that the frontal sinus shunting of aqueous humor is a safe and effective means of extraorbital aqueous diversion with potential applicability in the management of glaucoma.     

Coccygeal epidural with local anesthetic for catheterization and pain management in the treatment of feline urethral obstruction

Objective – To describe the technique for performing a coccygeal epidural injection of local anesthetic to facilitate catheterization in male cats with urethral obstructions using low‐dose sedation. Significance – Prompt diagnosis and relief of urethral obstructions is important as many cats may have developed marked metabolic abnormalities at the time of presentation. General anesthesia in these patients may be associated with significant risk for complications. Pain management is also an essential treatment goal, and this technique relieves urethral and penile pain during the unblocking process. Conclusion – Coccygeal epidurals can be used safely to provide analgesia to the penis and urethra and to the authors' knowledge, is a novel treatment modality to aid in the relief of urethral obstructions in male cats.     

Topical tacrolimus (FK506) for the treatment of feline idiopathic facial dermatitis

A 3-year-old, neutered male Persian cat with chronic ulcerative facial dermatitis was diagnosed with feline idiopathic facial dermatitis based on signalment, clinical history and diagnostic test results, including dermatohistopathological evaluation. Initial treatment started with 4 weeks of oral antifungal/antibiotic medication for severe secondary infectious dermatitis of Malassezia and bacteria. As the lesions gradually improved, the oral medication was withdrawn, leaving only 0.1% topical FK506 (tacrolimus) ointment for the remaining lesions. Topical treatment was administered just in case any new lesions developed. The patient has been managed effectively with topical tacrolimus and no side-effects were observed during treatment. Feline idiopathic facial dermatitis is known as a difficult dermatosis to manage successfully, but our experience suggests that it may respond to topical tacrolimus.     

Amniotic membrane transplantation for the treatment of feline corneal sequestrum: pilot study

Objectives To describe and evaluate the use of equine amniotic membrane trans‐plantation after lamellar keratectomy for the treatment of corneal sequestrum in cats. Methods Six cats (seven eyes) of various breed and ages with corneal sequestra were treated surgically with lamellar keratectomy and amniotic membrane transplantation. All the sequestra and a small piece of the amniotic membranes used for each surgery were submitted for histopathologic examination. Results Five of the seven eyes showed minimal level of scarring in the cornea and good transparency. No recurrences of the sequestra have been noted during the follow‐up period (3–9 months). One eye had necrosis of the amniotic membrane 2 weeks after the surgery. The sequestrum of this eye showed a high level of bacterial contamination on histopathology. Three months later the same cat developed a descemetocele in the area where the necrotic amniotic membrane was rejected. A second eye developed a perforation under the amniotic membrane two weeks after the surgery. The sequestrum of this eye was deep and without vascularization. Conclusion Amniotic membrane transplantation after lamellar keratectomy was a valid procedure for surgical treatment of corneal sequestrum in cats. The procedure resulted in excellent cosmesis and functional vision in five of seven eyes; although case selection is important, particularly to exclude the very deep and non‐vascularized sequestra.     

The outcome of surgical mitral valve repair with loop-in-loop technique in dogs with different stage myxomatous mitral valve disease

ObjectivesSurgical mitral valve repair is a possible option for dogs with myxomatous mitral valve disease. However, information on surgical results and postoperative echocardiography is limited. This study aimed to verify the stage-specific surgical results of mitral valve repair and postoperative echocardiographic changes for two years following surgery.AnimalsAdult dogs (n = 55) treated with surgical mitral valve repair using the loop-in-loop technique were included in this study. Medical records were retrospectively reviewed.ResultsNinety percent of cases (50/55) survived to discharge, which survival was significantly decreased in myxomatous mitral valve disease advanced-stage dogs, Stage B2 (n = 14): 100%, Stage C (n = 27): 96.2%, and Stage D (n = 14): 71.4%. Significant reductions of overall heart size (vertebral heart score: preoperative 11.4 vs. post one month 10.2, P < 0.001), left atrium (left atrium to aortic root ratio: preoperative 2.3 vs. post one month 1.5, P < 0.001) and left ventricle (left ventricular end-diastolic diameter [normalized for bodyweight]: preoperative 2.2 vs. post one month 1.5, P < 0.001) were documented one month after surgery, showing successful management of mitral regurgitation. All medications for mitral valve disease were discontinued three months after surgery. The recurrence of mitral regurgitation was not evident during the two-year follow-up period.ConclusionsSurgical mitral valve repair with the loop-in-loop technique is associated with significant decreases in indices of cardiac size at one-month post-repair. Disease stage influences operative survival after surgical mitral valve repair.     

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 ± 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 ± 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 unilateral topical administration of 0.5% tropicamide on anterior segment morphology and intraocular pressure in normal cats and cats with primary congenital glaucoma

Objective To determine the effects of topical 0.5% tropicamide on anterior segment morphology (ASM) and intraocular pressure (IOP) in normal and glaucomatous cats. Animals used Normal cats and cats with inherited primary congenital glaucoma (PCG). Procedures Control IOP curves were performed in untreated normal and PCG cats. In the first experiment, tropicamide was applied OD in eight normal and nine PCG cats. IOP and pupillary diameter (PD) were measured at 0, 30, and 60 min, then hourly until 8 h post‐treatment. In a second experiment, six normal and seven PCG cats received tropicamide OD. High‐resolution ultrasound images were obtained at 0, 1, 5, and 10 h post‐treatment to measure ASM changes. IOP and PD were measured OD at 0, 1, 2, 3, 5, 7, and 9 h. Results In untreated normal cats IOP OU decreased throughout the day. In PCG cats IOP OU had wide fluctuations over time. In normal cats IOP response varied in the treated eye but did not change significantly in untreated eyes. IOP significantly increased from baseline in both eyes of all treated PCG cats. Increases in IOP were associated with some ASM changes. Cats with PCG had a significantly smaller angle recess areas, diminished ciliary clefts and decreased iris‐lens contact. ASM changes were not strongly correlated with IOP in all cats. Conclusions The ASM of PCG cats is markedly different from normal cats, and clinically significant increases in IOP OU occur in cats with PCG after tropicamide treatment. The mechanism for this increase remains unclear.     

Analytical validation of the Sysmex XT‐2000iV for cell counts in canine and feline effusions and concordance with cytologic diagnosis

Background: The Sysmex XT‐2000iV is a hematology analyzer that combines laser and impedance technology. Its usefulness for determining cell counts in canine and feline intracavitary effusions has not yet been studied. Objectives: The objectives of this study were to evaluate the analytical performance of the Sysmex XT‐2000iV for cell counts in effusions from dogs and cats, and to assess correlation with an impedance counter and concordance with diagnoses based on cytologic findings. Methods: Effusions (43 pleural, 23 peritoneal, 6 pericardial) were analyzed from 32 dogs and 34 cats. Total nucleated cell count (TNCC), HCT, and RBC count were determined on the Sysmex and compared with those obtained on an impedance counter (Hemat 8, SEAC). Imprecision, linearity, and limit of detection were determined for the Sysmex. An algorithm was designed using quantitative and qualitative data from the Sysmex to classify the effusions and the results were compared with diagnoses based on cytologic findings. Results: Intra‐assay and interassay coefficients of variation on the Sysmex were variable. Linearity of TNCC was ≥0.993 for dogs and cats, with the exception of effusions from cats with feline infectious peritonitis, which had delta (Δ) TNC values >3.0. In comparison with the Hemat 8, a proportional error was found for TNCC on the Sysmex. Effusion classification based on the algorithm was concordant with that obtained by cytologic examination in 43/72 (60%) samples. Discordant results usually were due to the misclassification of cells with similar morphology (such as mesothelial and carcinoma cells) in Sysmex scattergrams. Conclusion: The Sysmex XT‐2000iV provides a precise and accurate TNCC and has moderate concordance with cytologic findings for classifying canine and feline effusions. Although microscopic examination of effusions is necessary to achieve an accurate diagnosis, the Sysmex can provide preliminary information that may be helpful to cytopathologists.     

Assessment of the measurement of canine and feline serum fibroblast growth factor-23 concentrations by automated chemiluminescence immunoassay

This study compared canine and feline fibroblast growth factor (FGF)-23 concentration measurements between automated chemiluminescence assay (CLEIA) and enzyme-linked immunosorbent assay (ELISA). Seventy serum samples each from dogs and cats were evaluated. FGF-23 measurements by CLEIA significantly correlated with those of ELISA in both dogs and cats. The Bland–Altman test showed that FGF-23 between CLEIA and ELISA had fixed and proportional biases, respectively, in both dogs and cats. Measurements by CLEIA were lower than those of ELISA, especially in higher serum FGF-23 concentrations. This study showed that FGF-23 concentrations in dogs and cats can be evaluated by automated CLEIA. However, FGF-23 cannot be directly compared between CLEIA and ELISA.