Comparison of capsular opacification and refractive status after placement of three different intraocular lens implants following phacoemulsification and aspiration of cataracts in dogs

Objective  To evaluate the effect of lens design and biomaterial on formation of posterior capsular opacification (PCO) and refractive correction.
Animals studied  Sixty dogs undergoing bilateral phacoemulsification for mature or diabetic cataracts.
Procedures  One randomly selected eye received a rounded edge 41D polymethyl-methacrylate (PMMA) intraocular replacement lens (IOL) and the contralateral eye received either a squared edge 41D hydrophilic acrylic IOL ( n  = 35) or a squared edge 40D hydrophobic acrylic IOL ( n  = 25). At the (mean = 79 day) reexamination period, PCO was graded using direct slit-lamp observation and by masked observer evaluation of digital images of the IOLs. Streak retinoscopy and B-mode ultrasound were performed at this period.
Results  The PCO score via direct slit-lamp was significantly lower for the hydrophilic acrylic IOL when compared to the PMMA IOL. Masked observer evaluation of digital images revealed that the acrylic IOLs had lower but generally not statistically significant PCO scores than the PMMA IOLs. Streak retinoscopy showed that the PMMA IOL was significantly closer to emmetropia (+0.44 D) when compared to either the hydrophilic acrylic (+0.96 D) or the hydrophobic acrylic (+1.2 D) IOLs. B-mode ultrasonography revealed the center of the hydrophilic acrylic IOL is 0.31 mm closer to the retina and the center of the hydrophobic acrylic IOL is 0.63 mm further from the retina when compared to the center of the PMMA to retina distance.
Conclusions  Square edged foldable acrylic IOLs show a predisposition towards generating slightly less PCO than round edged PMMA IOLs in the early postoperative period, however, both acrylic IOLs had greater persistent hyperopia than the PMMA IOLs.     

Postoperative complications and visual outcomes of phacoemulsification in 103 dogs (179 eyes): 2006-2008

Objective To describe the postoperative complications and visual outcome after phacoemulsification in dogs and identify risk factors for complications. Animals studied One hundred and three dogs (179 eyes) that had phacoemulsification with or without intraocular lens (IOL) placement including foldable acrylic IOLs between March 2006 and March 2008 at Purdue University Veterinary Teaching Hospital. Procedure Medical records were reviewed and occurrence and dates of postoperative complications were tabulated. Visual status at the final recheck during the study period was recorded. Additional information including signalment, diabetes mellitus status, operative complications and factors, presence of prior lens induced uveitis, preoperative retinopexy, and cataract stage was collected. Results The majority of eyes were functionally visual (148 eyes, 82.7%) at the end of the study period. Blindness was seen in 18 eyes (10.0%) with reduced vision in 13 eyes (7.3%) at the final recheck. Postoperative ocular hypertension (22.9%), corneal lipid opacity (19.0%), uveitis (16.2%), intraocular hemorrhage (12.3%), retinal detachment (8.4%), and glaucoma (6.7%) were the most common postoperative complications seen in eyes. The odds of blindness were significantly greater (OR = 290.44) in the eyes of Boston terriers compared with mixed breed dogs and with each year of increasing age (OR = 2.00). Conclusion The prognosis for vision after phacoemulsification with injectable IOL placement is good. Boston terriers were at much higher risk for certain complications.     

The incidence of posterior capsule disruption during phacoemulsification and associated postoperative complication rates in dogs: 244 eyes (1995-2002)

OBJECTIVE: The objective of this retrospective study was to report the incidence of posterior capsule disruption during routine phacoemulsification and to document the postoperative outcomes and complications in eyes with posterior capsule disruption compared with eyes with intact posterior capsules. PROCEDURES: Records of 143 dogs (244 eyes) were reviewed. Data collected included whether the posterior capsule was disrupted, whether the disruption was planned or accidental, whether an intraocular lens was implanted, and visual outcome. Records were reviewed for postoperative complications. Intraocular lens implantation rates, complication rates, and visual outcomes were compared between intact and disrupted posterior capsule groups using Chi-square analyses. RESULTS: The posterior capsule was disrupted in 33/244 eyes (14%). Planned capsulotomies accounted for 36% of the disruptions. Intraocular lenses were implanted in 76% of eyes without a disruption of the posterior capsule and in 31% of eyes with a posterior capsule disruption. Intraocular lenses were more likely to be implanted in eyes with a planned disruption of the posterior capsule (7/12; 58%) than in eyes with an accidental disruption (3/20; 15%). There were no significant differences in postoperative complications or visual outcome between eyes with posterior capsule disruption and those without. CONCLUSIONS: The most significant complication of posterior capsule disruption during phacoemulsification is the inability to implant an intraocular lens. Intraocular lenses are more likely to be placed in eyes with intentional disruptions of the posterior capsule than those with accidental ruptures.     

Canine cataracts, diabetes mellitus and spontaneous lens capsule rupture: a retrospective study of 18 dogs

OBJECTIVE: To describe the clinical presentation and surgical outcome of diabetic canine patients with cataracts and preoperative spontaneous lens capsule rupture. ANIMALS STUDIED: A total of 20 dogs and 40 eyes were included in the retrospective evaluation. The patients' ages ranged from 5 to 14 years (mean 8.5 years). RESULTS: All dogs had clinical diabetes mellitus, with the duration since diagnosis ranging from 30 to 240 days (mean 123 days). Cataracts were bilateral and noted to have been present for 14-112 days (mean 39 days). Of the 40 eyes affected with cataracts, 30 had a spontaneous rupture of the lens capsule prior to surgery. The capsular rupture was diagnosed on clinical examination in 28/30 eyes and was noted intraoperatively in 2/30. The location of the capsular rupture was equatorial in 29/30 and posterior in 1/30 eyes. Surgery was performed in 38/40 eyes, with one case lost to follow-up without surgical intervention. Prior to surgery, routine diagnostic ophthalmic examination, ocular ultrasound, electroretinography, and systemic evaluation were performed in all dogs. Surgical procedures included phacoemulsification in 28/40 eyes, with IOL placement performed in 20/28 eyes. Intrascleral prosthesis placement or enucleation was performed in 8/40 and 2/40 eyes, respectively, due to a significantly reduced ERG or secondary glaucoma. CONCLUSIONS: The duration of clinical follow-up (19/20 dogs) ranged from 1 to 36 months (mean 12.9 months). All eyes that had cataract surgery with or without IOL placement were sighted at the time of the last follow-up examination. Spontaneous lens capsule rupture associated with diabetes mellitus, cataract and rapid lens intumescence occurs in the dog. Early surgical intervention, prior to secondary complications of glaucoma and loss of retinal function, is associated with a favorable outcome.     

Evaluation of client perceptions concerning outcome of cataract surgery in dogs

OBJECTIVE: To compare client perception of outcome of phacoemulsification in dogs with information obtained from medical records. DESIGN: Retrospective cohort study. ANIMALS: 108 dogs (203 eyes) undergoing phacoemulsification from May 1999 through April 2004. PROCEDURE: Data obtained from medical records included signalment, presence of diabetes mellitus, cataract stage, whether surgery was unilateral or bilateral, intraocular lens (IOL) placement, and postoperative complications. Owners completed a survey concerning outcome of phacoemulsification in their dog. Survey responses from owners classified as satisfied or dissatisfied with the outcome of phacoemulsification on the basis of their willingness, in retrospect, to have the surgery performed again were compared. RESULTS: Data from medical records and survey responses were available for 108 dogs (203 eyes). Median follow-up was 3 months via medical record review and 12 months via owner survey responses. Most (81%) owners were satisfied with outcome. The most common reason for dissatisfaction was loss of vision after surgery; however, most dissatisfied owners did not return their dog for examinations. Owner perception of success was not associated with patient age, sex, presence of diabetes mellitus, cataract stage, or IOL placement in at least 1 eye but was associated with perceived improvement of their pet's vision and activity level. Dissatisfied owners were significantly more likely to report that explanation of risks and complications before surgery was inadequate. CONCLUSIONS AND CLINICAL RELEVANCE: Owner perception of outcome after phacoemulsification in dogs was highly favorable. However, surgical risks and the importance of postoperative examinations, particularly in dogs undergoing visual deterioration, must be conveyed to clients.     

Development of glaucoma after cataract surgery in dogs: 220 cases (1987-1998)

OBJECTIVE: To examine postoperative ocular hypertension (POH) and other variables as predictors of the risk of developing glaucoma after cataract surgery in dogs. DESIGN: Retrospective study. ANIMALS: 220 dogs that had cataract surgery. PROCEDURE: Medical records of 220 dogs (346 eyes) that had extracapsular cataract removal or phacoemulsification of cataracts were reviewed. With respect to glaucoma development, 8 variables were analyzed, which included development of POH, breed, sex, age at time of surgery, eye (right vs left), phacoemulsification time, intraocular lens (IOL) placement (yes or no), and stage of cataract development. Eyes developed glaucoma within 6 or 12 months of surgery or did not have signs of glaucoma at least 6 or 12 months after cataract surgery. RESULTS: Of 346 eyes, 58 (16.8%) developed glaucoma after surgery. At 6 months, 32 of 206 (15.5%) eyes examined had glaucoma; at 12 months, 44 of 153 (28.8%) eyes examined had glaucoma. Median follow-up time was 5.8 months (range, 0.1 to 48 months). Mixed-breed dogs were at a significantly lower risk for glaucoma, compared with other breeds. Eyes with IOL placement were at a significantly lower risk for glaucoma, compared with eyes without IOL placement. Eyes with hypermature cataracts were at a significantly higher risk for glaucoma, compared with eyes with mature or immature cataracts. CONCLUSIONS AND CLINICAL RELEVANCE: Multiple factors appear to contribute to the onset of glaucoma in dogs after cataract surgery. Complications prohibiting IOL placement during cataract surgery may lead to a high risk of glaucoma development.     

Implantation of a foldable intraocular lens in dogs

A 1-piece, tripod-shaped, acrylic intraocular lens was implanted in the posterior chamber after phacoemulsification to remove cataracts in 20 eyes of 16 dogs. Biomicroscopy and intraocular pressure measurements were performed at 1, 8, 30, and 90 days after surgery; retinoscopy was performed at day 30. Complications were not encountered during implantation of the lens. All dogs had mild ocular inflammation characterized predominantly by aqueous flare and mild corneal edema at day 1, which resolved completely by day 8; 3 eyes had mild hyphema at day 1, which resolved by day 8. Three eyes developed fibrin in the anterior chamber, which resolved by day 30. Two eyes developed distorted pupils caused by adherence of vitreous humor or fibrin to the incision site. Postoperative intraocular pressure ranged from 7 to 21 mm Hg. Implantation resulted in 9 emmotropic eyes, 5 myopic eyes, and 6 hyperopic eyes. Maintenance of central lens position was excellent in 19 eyes; in 1 eyes, a disclocated superior haptic at day 2 was easily repositioned.     

Effect of ophthalmic Nd:YAG laser energy on intraocular lenses after posterior capsulotomy in normal dog eyes

OBJECTIVE: To determine Nd:YAG laser energy requirements for posterior capsulotomy and intraocular lens (IOL) damage threshold for foldable acrylic IOLs as compared to traditional polymethylmethacrylate (PMMA). MATERIALS AND PROCEDURES: Four groups of five-six fresh canine cadaver eyes were used in this study. The groups included (1) unaltered eyes (2) aphakic eyes (3) eyes implanted with PMMA IOLs, and (4) eyes implanted with acrylic IOLs. Laser energy was delivered to the posterior capsule in grid fashion for 10 sites each of five levels of laser energy ranging from 0.5 mJ to 9 mJ. Number of successful capsulotomy sites was recorded based on slit-lamp observation. Sites of IOL damage were evaluated using scanning electron microscopy (SEM). Statistical analysis of number of capsulotomies and IOL defects per laser energy level was conducted among and between groups using anova with Tukey's HSD test. RESULTS: When comparing groups (a) including all energy levels (n = 25) and (b) by specific energy levels (n = 5), there was no significant difference (P < 0.05) in number of successful capsulotomy sites between IOL types. The 50% incidence threshold for successful capsulotomy was 2.74 mJ for acrylic IOLs and 2.64 mJ for PMMA IOLs. Energy-dependent damage to both types of IOL was detected for medium, high-medium, and high laser energy. Calculated 50% damage threshold was 4.9 mJ for acrylic IOL and 5.7 mJ for PMMA IOL. Damage to the IOL varied subjectively between IOL type, but there was no significant difference in number of defects caused, with the exception of high-medium energy. CONCLUSIONS: Both posterior lens capsules and IOLs were disrupted in an energy-dependent manner with minimal difference in number of capsulotomy sites or damage to the IOL between acrylic and PMMA IOLs. A therapeutic margin between capsulotomy threshold (2.6-2.7 mJ) and IOL damage threshold (4.9-5.7 mJ) was determined to reliably achieve capsulotomies with minimal IOL damage for both acrylic and PMMA IOLs in normal canine cadaver eyes.     

Cataracts in 44 dogs (77 eyes): A comparison of outcomes for no treatment, topical medical management, or phacoemulsification with intraocular lens implantation

Outcomes for 77 cataractous eyes were compared after each eye underwent no treatment, topical medical treatment only, or phacoemulsification with intraocular lens implantation. Median follow-up time for all dogs was 2.3 y. Failure occurred in all untreated eyes and the rate of failure was 65 and 255 times higher than in medically and surgically treated eyes, respectively. The failure rate was 4 times higher in dogs receiving only medical treatment compared with dogs that received surgery. Across all groups, the success rate for mature and hypermature cataracts was lower than for immature cataracts. Regardless of cataract stage, the chance of success was higher for eyes undergoing phacoemulsification than for eyes that received medical management only. Results of this study support prompt referral for phacoemulsification when cataracts are diagnosed in dogs or, if referral is not possible, topical anti-inflammatory therapy.     

Penile amputation and scrotal urethrostomy in 18 dogs

The objective of this study was to report the signalment, indications for surgery, postoperative complications and outcome in dogs undergoing penile amputation and scrotal urethrostomy. Medical records of three surgical referral facilities were reviewed for dogs undergoing penile amputation and scrotal urethrostomy between January 2003 and July 2010. Data collected included signalment, presenting signs, indication for penile amputation, surgical technique, postoperative complications and long-term outcome. Eighteen dogs were included in the study. Indications for surgery were treatment of neoplasia (n=6), external or unknown penile trauma (n=4), penile trauma or necrosis associated with urethral obstruction with calculi (n=3), priapism (n=4) and balanoposthitis (n=1). All dogs suffered mild postoperative haemorrhage (posturination and/or spontaneous) from the urethrostomy stoma for up to 21 days (mean 5.5 days). Four dogs had minor complications recorded at suture removal (minor dehiscence (n=1), mild bruising and swelling around the urethrostomy site and mild haemorrhage at suture removal (n=2), and granulation at the edge of stoma (n=1)). One dog had a major complication (wound dehiscence and subsequent stricture of the stoma). Long-term outcome was excellent in all dogs with non-neoplastic disease. Local tumour recurrence and/or metastatic disease occurred within five to 12 months of surgery in two dogs undergoing penile amputation for the treatment of neoplasia. Both dogs were euthanased.     

Keratometry, biometry and prediction of intraocular lens power in the equine eye

OBJECTIVE: To determine ocular dimensions (A- and B-scan ultrasound) and corneal curvature (radius of corneal diameter determined in B-scan ultrasound) in the equine eye and to calculate the appropriate dioptric power for a posterior chamber intraocular lens (IOL) necessary to achieve emmetropia in the eyes of horses undergoing lens extraction. ANIMALS: Fourteen clinically normal adult horses of various breeds. Additionally, for comparison, one American Miniature colt foal, and one 2.5-year-old Shire gelding were examined. PROCEDURE: B-scan ultrasound was performed on one eye from each horse. One eye from both the Shire and the American Miniature were examined for comparison. Data from ultrasound (globe measurements and corneal curvature), and the estimated postoperative IOL positions were entered into theoretical IOL formulas (Binkhorst and Retzlaff theoretical formulas) in order to calculate the predicted IOL strength required to achieve emmetropia after lens extraction in horses. Results: Mean axial length of globes was 39.23 mm +/- 1.26 mm, mean preoperative anterior chamber depth (ACD) was 5.63 +/- 0.86 mm, and mean lens thickness was 11.75 +/- 0.80 mm. Predicted postoperative ACD (PACD) was calculated as the ACD plus 50% of the lens thickness. Additionally, PACD 2 mm anterior and 2 mm posterior to the center of the lens were calculated in order to evaluate the effect of IOL position on its required refractive power. Required IOL strength calculated, using the three values for the predicted postoperative ACD, was 29.91 D +/- 2.50, 29 D +/- 2.52 (center of lens); 27.13 D +/- 2.27, 26.33 D +/- 2.20 (2 mm anterior to center of lens); and 33.18 D +/- 2.78, 32.24 D +/- 2.68 (2 mm posterior to center of lens) with the Binkhorst and Retzlaff theoretical formulas, respectively. CONCLUSIONS: An IOL of substantially lower diopter strength than that needed in either dogs or cats is required to achieve emmetropia after lens extraction in adult horses. IOL strength of approximately 30 D, depending on where the IOL ultimately comes to rest, will probably be required.     

Applications, complications, and outcomes of transvenous pacemaker implantation in 105 dogs (1997-2002)

We reviewed the indications for age and breeds of dogs who received transvenous endocardial artificial pacemaker (AP) implantation (n = 105) and complications and survival thereafter at a single institution over a 6-year period. A third-degree atrioventricular (AV) block (59%) and sick sinus syndrome (SSS; 27%) were the most common indications, along with a high-grade second-degree AV block (9%) and atrial standstill (5%). The most common breeds identified were Labrador Retriever (n = 16; 11 with a third-degree AV block), American Cocker Spaniel (n = 14; 10 with SSS), and Miniature Schnauzer (n = 13; all with SSS). Common presenting complaints were syncope (n = 66) and exercise intolerance or lethargy (n = 25). Half of the dogs (n = 52) had a history of acute onset of clinical signs (<2 weeks). Mean survival time for the 60 dogs who died during the study period was 2.2 years (range, 0.1-5.8 years). Major complications occurred in 13% of dogs and included lead displacement (n = 7), sensing problems that led to syncope (n = 3), infection at the pacemaker site (n = 1), bleeding (n = 1), and ventricular fibrillation during implantation (n = 1; successfully defibrillated). Minor complications occurred in 11 dogs (11%). The success rate of transvenous AP implantation was comparatively high (all dogs survived the first 48 hours), and the complication rate was comparatively low when compared with a previous multicenter study, most likely because of how commonly the procedure was performed and supervisory experience.     

Keratoprosthesis with retrocorneal fixation: preliminary results in dogs with corneal blindness

Objective To evaluate the use and complications of a penetrating keratoprosthesis implantation in the management of corneal opacification in dogs. Methods A retrospective clinical study describes the indications for the surgical technique utilized and the outcomes of this procedure in 20 eyes of 19 dogs with blindness of corneal origin. A successful surgical outcome was defined as a clear keratoprosthesis optic and improvement or restoration of functional vision over a follow‐up period ranging from at least 8 months to a maximum of 7 years. Results Eyes with total corneal opacification resulting from chronic superficial keratitis (n = 11), keratoconjunctivitis sicca (n = 5), endothelial dystrophy (n = 3) and chemical burn (n = 1) were treated by unilateral (n = 18) or bilateral (n = 1) full‐thickness implantation of a keratoprosthesis. Keratoprostheses were retained in 15 eyes (75%) which regained vision to the date of reporting. Among these eyes, six had uncomplicated postoperative course, five developed retroprosthetic membranes and four developed granulation tissue over the optic of the keratoprostheses. These complications were successfully removed surgically in the nine eyes. The five remaining eyes (25%) developed serious early postoperative complications, for which enucleation had to be performed. Conclusion In keratopathies in which the corneal opacification could not be treated by standard medical or surgical procedures, this keratoprosthesis appears to be promising to restore vision in chronic superficial keratitis and deep corneal dystrophy. It appears to have a poor prognosis in keratoconjunctivitis sicca in brachycephalic dogs. The post operative complications retro‐prosthetic membranes and granulomatous overgrowth could be treated well.     

Cataracts are not associated with retinal detachment in the Bichon Frise in the UK--a retrospective study of preoperative findings and outcomes in 40 eyes

Objective The aim of this study was to evaluate whether the Bichon Frise population in the UK is at the same risk of developing retinal detachment in association with cataract formation and following phacoemulsification as described in reports from the USA. Procedures The medical records of Bichon Frises which were presented for cataract assessment and of those which were treated with phacoemulsification at Willows Referral Service between 1997 and 2009 were reviewed. Results Forty eyes (26 dogs) with unilateral or bilateral cataracts were included in the study. There was no evidence of retinal detachment associated with the cataracts at initial presentation. Phacoemulsification was performed on 34 eyes (20 dogs). Clinically evident lens‐induced uveitis was treated preoperatively in 17/34 eyes. Artificial lens implantation was carried out in 30/34 eyes; automated anterior vitrectomy was performed in 7/34 eyes. The mean follow‐up time was 16.6 months (range 1.5–73 months). At the last re‐examination, 31/34 eyes (91.2%) were visual. Three eyes (8.8%) were blind – two (in the same dog) because of presumptive bilateral optic nerve disease and one because of uveitis and secondary glaucoma. There was no evidence of retinal detachment following phacoemulsification in any of the 34 eyes. Conclusion This study suggests that the Bichon Frise population in the UK does not appear to have a predisposition for retinal detachment in association with cataract formation or following cataract surgery. Prophylactic random transscleral laser retinopexy or transscleral cryopexy cannot therefore be routinely recommended for Bichon Frises with cataracts in the UK.     

Practices and outcome of artificial cardiac pacing in 154 dogs

Artificial pacing (AP) is a treatment for symptomatic bradyarrhythmias unresponsive to medical therapy. This retrospective study was designed to define the practices and outcome of AP in dogs at 7 referral institutions participating in the Companion Animal Pacemaker Registry and Repository (CANPACERS). The indications, implantation techniques, complications, long-term outcome, and owner satisfaction were examined. One hundred fifty-four dogs were identified as undergoing AP from January 1, 1991, to January 1, 1996. Third-degree atrioventricular (AV) block (n = 91; 59%) and sinus node dysfunction (n = 45; 29%) were the most common indications for AP Transvenous endocardial AP systems were implanted in 136 dogs (88%), and epicardial systems were implanted in 18 (12%). Complications associated with AP were reported in 84 dogs (55%). Major complications occurred in 51 dogs (33%), including dislodgement of the pacing lead (n = 15; 10%), generator failure (n = 10; 6%), cardiac arrest during implantation (n = 9; 6%), and infection (n = 7; 5%). Minor complications occurred in 47 dogs (31%), including seroma formation (n = 18; 12%), muscle twitch (n = 17; 11%), and inconsequential arrhythmias (n = 15; 10%). Fourteen dogs (9%) experienced both major and minor complications. Survival analysis revealed 1-, 2-, and 3-year survival rates of 70, 57, and 45%, respectively. Age and presence of preexisting congestive heart failure (CHF) had a negative effect on survival (P = .001). Sixty percent of dogs with preexisting CHF died within 1 year of implantation, whereas 25% of dogs without heart failure died during the same period. Owners rated their satisfaction with the procedure as high in 80% of the dogs.     

Development of glaucoma after phacoemulsification for removal of cataracts in dogs: 22 cases (1987-1997)

OBJECTIVE: To determine factors contributing to glaucoma after lens extraction via phacoemulsification in dogs. DESIGN: Retrospective study. ANIMALS: 22 dogs (29 eyes) with glaucoma and 21 dogs (30 eyes) without glaucoma after phacoemulsification. PROCEDURE: Medical record review. RESULTS: Eyes at increased risk for glaucoma included those of Boston Terriers, those with uveal or retinal abnormalities before surgery, and those with intraoperative intraocular hemorrhage. Significant differences between groups were not detected for incidence of preoperative lens-induced uveitis, presence of an intraocular lens, or frequency of an acute postoperative increase in intraocular pressure. Glaucoma developed (mean +/- SD) 12.8+/-14.1 months (median, 10 months; range, 0.25 to 55 months) after surgery. Eighteen of 29 (62%) eyes with potential for vision after onset of glaucoma retained vision for a mean of 16.5+/-12.8 months (median, 10.8 months; range, 1.5 to 37 months) after glaucoma was diagnosed. Most of these eyes still had vision at the conclusion of the study period. CONCLUSIONS AND CLINICAL RELEVANCE: Risk factors identified by this study will aid in preoperative counseling of clients and refining selection criteria for candidates for phacoemulsification. Careful follow-up for the remainder of the dog's life after surgery may improve long-term success rates by permitting early intervention before intraocular pressure increases substantially and vision is irreversibly lost. Surgery for cataracts may still be worthwhile in dogs with increased risk of glaucoma, especially if elderly, because of the lengthy period to onset of glaucoma after surgery and the beneficial effects of treatment after glaucoma develops.     

Clinical features and outcomes of phacoemulsification in 39 horses: a retrospective study (1993-2003)

OBJECTIVE: To identify visual outcome and postoperative complications following phacoemulsification of equine cataracts. ANIMALS: Records of 39 horses (55 eyes) with cataracts were reviewed. METHODS: Eyes with cataracts removed by phacoemulsification were included in the study. Data collected included age, breed, sex, stage and etiology of cataract, unilateral vs. bilateral involvement, and ultrasound findings. Horses were grouped by etiology of the cataract. Visual outcome and complications were evaluated for each group and the overall population. RESULTS: Immediately postoperatively 46 out of 47 eyes (98%) were sighted. Four weeks postoperatively 23 of 29 operated eyes (79%) were sighted [13/18 (72%) eyes with congenital/juvenile onset, 6/6 (100%) eyes with traumatic and 4/5 (90%) eyes with uveitis-induced cataracts], with 18 eyes lost to follow-up. The most common postoperative complications included corneal edema (19 eyes/40%), fibrin in the anterior chamber (11 eyes/23%), postoperative ocular hypertension (9 eyes/19%), synechia/dyscoria (9 eyes/19%), and hyphema (7 eyes/15%). CONCLUSIONS: Prognosis for vision is favorable for horses following phacoemulsification and planned posterior continuous tear circular capsulorrhexis. Success rates depend on age of patient, cause of cataract and pre-existing intraocular disease. The highest success rate occurred in eyes with traumatic cataracts.     

Phacoemulsification and implantation of foldable +14 diopter intraocular lenses in five mature horses

Presently, intraocular lenses (IOLs) are not routinely implanted after equine cataract surgery. Subsequently, horses are visual but markedly farsighted (hyperopic). This report describes the surgical results and visual status after phacoemulsification and implantation of IOLs in mature horses with spontaneous cataracts. Six eyes of 5 mature horses underwent phacoemulsification and implantation of a +14 diopter (D) foldable IOL. Recheck ocular examinations were performed at 1, 4 and 24 weeks post operatively. Refractive error was recorded at 4 weeks post operatively. Visual status, refractive error and anterior chamber depth were recorded 24 weeks post operatively: 5 of 6 operated eyes remained visual and the average refractive error was +0.4 ± 1.1D. There was a significant difference between the 24 week post operative refractive error and the population mean of +10D (P<0.0001) for aphakic horses. The average post operative anterior chamber depth was 7.89 ± 1.55 mm. One globe was enucleated 2 months post operatively. Phacoemulsification with IOL implantation resulted in a significant reduction in post operative refractive error and restored vision to within 0.4D of emmetropia in 5 of 6 operated eyes. Implantation of a +14D IOL ameliorated the hyperopia documented in aphakic horses and improved the post operative visual acuity.     

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.     

Cullen frontal sinus valved glaucoma shunt: preliminary findings in dogs with primary glaucoma

PURPOSE: To evaluate the efficacy of a novel, professionally manufactured, frontal sinus valved glaucoma shunt in maintaining normal intraocular pressure (IOP) and vision in dogs with primary glaucoma. METHODS: Three eyes of three dogs diagnosed with primary glaucoma were included in this prospective clinical study. A Cullen frontal sinus valved glaucoma shunt was implanted into each glaucomatous globe. Dogs were treated postoperatively with topical neomycin/polymyxin B/0.1% dexamethasone and 0.03% flurbiprofen every 6 h tapered over 8-12 weeks, and meloxicam at 0.1 mg/kg orally every 24 h for 7-10 days. IOP, intracameral shunt position and apparent patency, and vision were assessed twice daily for up to 4 (n= 3 eyes) and 10 (n= 2 eyes) days postoperatively, and then at re-examination periods of up to 36 weeks (n= 1 eye). Postoperative complications were recorded and documented photographically. RESULTS: Normal IOP was maintained in all shunted globes (range 10-29 mmHg; mean = 16.7 mmHg at 24 h; IOP = 23 mmHg at 36 weeks) postoperatively for 2 days (3/3 eyes), 8 weeks (2/2 eyes), and 36 weeks (1/1 eye) without additional antiglaucoma therapies. Photopic vision and shunt position and patency were maintained in all shunted globes for all follow-up periods. Postoperative complications included mild aqueous flare and fibrin (n= 3 eyes for 3-10 days postoperatively); intracameral shunt occlusion with fibrin (n= 1 eye at days 2 and 4); partial anterior chamber tube extrusion (n= 1 eye at day 4), and focal corneal edema (n= 1 eye at 18 weeks). Tissue plasminogen activator injected intracamerally through the silicone tube near the frontal sinus effectively resolved the fibrinous shunt occlusion. CONCLUSIONS: The Cullen frontal sinus valved glaucoma shunt shows promise for the management of canine primary glaucoma.