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.     

Microstructure and glycosaminoglycan ratio of canine cornea after reconstructive transplantation with glycerin-preserved porcine amniotic membranes

Objective  Although amniotic membranes of canine, feline, and equine species have some advantages as corneal transplantation material in many canine ocular diseases, their softness, thinness, and low availability can pose problems. As an alternative, the more abundant porcine amniotic membranes may be used. This paper describes the use of glycerin-preserved porcine amniotic membranes in corneal transplantation in eight normal dogs.
Method  A 0.4-mm deep recipient bed in the axial cornea of the OS of all dogs was created using an 8-mm Barron radial vacuum trephine. The recipient bed was then filled with amnion, and the entire cornea was covered with another piece of the glycerin-preserved membrane. The ocular signs evaluated were corneal opacity and corneal vascularization. The dogs were euthanized on days 5, 10, 20, or 40 after surgery, and samples were collected to evaluate corneal thickness, parenchymal cell number, mean collagen fibril diameter, collagen fibril content and the glycosaminoglycan (GAG) ratio.
Results  Corneal opacity was observed immediately after surgery. Restoration of corneal transparency, regression of corneal vascularization, and visualization of the pupil and iris were noted on day 40.
Conclusions  The clinical observations were supported histologically by regained corneal thickness, parenchymal cell number, mean collagen fibril diameter, collagen fibril content, and GAG ratio, suggesting that this technique may be a novel method for the treatment of ocular surface disorders.     

An unusual case of feline acute corneal hydrops: atypical disease presentation and possible in vivo detection of Descemet's membrane detachment in the cat's unaffected eye

A 1‐year‐old, female spayed, domestic shorthair cat presented for blepharospasm of the right eye. Slit‐lamp biomicroscopic examination showed focal corneal ulceration and presumptive keratomalacia of the right eye. Examination of the left eye was normal apart from a focal endothelial opacity. Within the first 24 h of medical management, the right eye developed marked corneal edema and globular anterior protrusion of the corneal surface consistent with feline acute corneal hydrops (FACH). Surgical management consisted of a bridge conjunctival graft, nictitating membrane flap, and temporary tarsorrhaphy. Resolution of corneal edema and pain occurred in the right eye within 24 days. Spectral domain optical coherence tomography (SD‐OCT) of the anterior segment was performed in both eyes. Conjunctival tissue from the bridge graft precluded examination of deeper corneal structures in the right eye. The left eye displayed a focal separation of the corneal endothelium and Descemet's membrane from the overlying stroma. These SD‐OCT findings are similar to the analogous syndrome found in humans and represent a potential etiology for FACH of the right eye in the case presented here. Unfortunately, the cat was lost to follow‐up and the progression of this lesion to FACH in the left eye could not be determined.     

Canine amniotic membrane transplantation for corneal reconstruction after the excision of dermoids in dogs

Transplantation of canine amniotic membrane (AM) in conjunction with a third eyelid flap was performed after the removal of large dermoids by keratectomy and conjunctivectomy on 7 eyes of 7 dogs. Corneal epithelialization was completed within 2 weeks after the transplantation. Five eyes attained normal transparency of the cornea within 5 weeks. Slight pigmentation of the bulbar conjunctiva at the limbus was observed in 1 dog that had pre-existing pigmentary keratitis. Neovascularization and scarring of the cornea and impaired vision were not found in any dogs at 8 weeks after the transplantation. In conclusion, transplantation of canine AM can promote corneal healing after the excision of large dermoids in dogs.     

Amniotic membrane transplantation for corneal surface reconstruction after excision of corneolimbal squamous cell carcinomas in nine horses

OBJECTIVE: The purpose of this study was to evaluate the usefulness and effectiveness of permanent amniotic membrane transplantation as an adjunctive treatment to superficial keratectomy alone or combined with strontium-90 irradiation for treatment of equine corneolimbal squamous cell carcinoma (SCC) to decrease corneal scarring and recurrence rate. STUDY: The retrospective case study included 11 horses (n = 12 eyes) diagnosed and treated for ocular SCC that involved the limbus and cornea. Nine of those horses (n = 9 eyes) were treated between 2002 and 2006, with superficial lamellar keratectomy alone or combined with strontium-90 irradiation and followed by placement of a permanent amniotic membrane graft in the surgical defect. The level of scarring (i.e. the clarity of the cornea) resulting with the use of amniotic membrane was subjectively compared to cases where a permanent bulbar conjunctival graft was performed following keratectomy combined with strontium-90 irradiation or cryotherapy (n = 3 eyes). Recurrence was defined as the postoperative and postirradiation regrowth of SCC in the same site and globe. RESULTS: The nine horses that received an amniotic membrane graft after keratectomy alone or combined with irradiation showed a minimal level of scarring in a cornea that regained a greater transparency in comparison to the horses that were treated with a bulbar conjunctival graft. All of the horses that received an amniotic membrane graft had 226 +/- 218 days of follow-up without tumor recurrence (mean +/- SD), ranging from 21 days to 778 days. CONCLUSIONS: The combination of superficial keratectomy alone or associated with beta-irradiation and permanent amniotic membrane transplantation is an effective treatment of corneal or corneolimbal SCC in horses. The placement of an amniotic membrane material represents an alternative surgical procedure to bulbar conjunctival grafts, especially if there is a lack of bulbar conjunctiva tissue available after tumor resection or if a particularly large corneal resection is necessary. The amniotic membrane is incorporated into the corneal defect and seems to create noticeably much less scarring than a corneal defect covered by bulbar conjunctiva.     

Aspergillus flavus keratomycosis in a cat treated with topical 1% voriconazole solution

An 8-year-old male castrated Domestic Short-haired cat was examined for a 1-week history of blepharospasm and mucoid ocular discharge OS. Examination revealed ulcerative keratitis with stromal loss, stromal infiltrate, corneal edema, perilimbal vascularization and miosis. Cytology of the cornea revealed multiple dichotomously branching, septate fungal hyphae and severe, predominantly neutrophilic inflammation. PCR of the cytology samples confirmed the presence of Aspergillus flavus while fungal and bacterial cultures were negative. Treatment with topical 1% voriconazole solution was successful in resolving the keratomycosis.     

Superficial keratectomy and topical mitomycin C as therapy for a corneal squamous cell carcinoma in a dog

A 10-year-old female West Highland white terrier was presented with refractory hyperplastic keratitis of the left cornea of one month's duration. At this time, a vascularised and rough lesion 5 mm in diameter was observed on the left cornea. No other abnormality was recognised on the affected eye. The corneal neoplasm was surgically removed and histologically diagnosed as a squamous cell carcinoma. For two months after the surgery, 0.04 percent mitomycin C (MMC) eye drops were applied as adjuvant chemotherapy. Primary corneal squamous cell carcinoma with no history of keratoconjunctivitis sicca is rare in dogs. In the present report, surgical removal of the neoplasm was combined with the topical administration of the anticancer drug mitomycin C and a good prognosis was obtained. The result indicates that the combination treatment used in this case may be an appropriate therapeutic choice for corneal squamous cell carcinoma in dogs.     

The use of xenologous amniotic membrane to repair canine corneal perforation created by penetrating keratectomy

This study was performed to evaluate the use of glycerol-preserved equine amniotic membrane as replacement for full-thickness corneal defects in dogs. Eighteen mixed-breed dogs were used. A perilimbal, full-thickness, 5 mm square corneal defect was created surgically, and a donor implant of equine amniotic membrane of the same size and shape sutured in place with 10–0 nylon simple interrupted sutures. Corneal edema was observed near the implant 24 h after surgery, but was absent after 1 week. Granulation tissue and corneal vascularization superficial to the implant were noticed on postoperative day 7, but were absent on day 30. Corneal vascularization persisted until the end of the experiment. There was no fluorescein retention by postoperative day 30. There was slight clearing of the corneal implant by postoperative 30, and slight pigmentation of the donor implant observed at postoperative day 180. An acute inflammatory process as well as fibroblasts were present at early postoperative stages. At postoperative day 60 there was no inflammatory cellular infiltrate, but fibroblasts and fibrosis were present. Corneal architecture was restored at the end of the experiment, with a layering of the epithelium–stroma–debris of amniotic membrane–stroma–endothelium present, and pigmentation and vascularization present in the deep layers of the cornea. Although vascularization indicated some degree of graft rejection, the clinical and histological evidence indicates that the xenologous amniotic membrane can be useful as a tectonic graft in the repair of full-thickness lesions of the cornea of dogs.     

Corneal diagnostic procedures

The cornea is the anterior, transparent portion of the fibrous tunic of the eye. It is continuous with the sclera at a transition called the limbus. In healthy conditions, the transparency of the cornea is maintained by the smooth, nonkeratinized, squamous epithelium, which is further enhanced by the precorneal tear film, the lack of corneal vascularization or pigmentation, the size and regular arrangement of the collagen fibrils that make up the corneal stroma, and the relative dehydration of the cornea (which is maintained by the endothelium and epithelium). The cornea can respond to adverse stimuli through vascularization, pigmentation, fibrosis, accumulation of cellular or noncellular infiltrate, and/or edema. Because of these limited responses, routine diagnostic procedures are critical in the diagnosis and treatment of corneal disorders. This article discusses tests of the precorneal tear film, corneal staining procedures, culture and sensitivity, cytology, and a few other procedures that are performed less commonly or require specialized instrumentation.     

A retrospective study of 30 cases of frozen lamellar corneal graft in dogs and cats

Frozen lamellar corneal grafts and nictitating membrane flaps were used in 18 dogs and 12 cats to repair deep corneal defects. In all dogs either melting corneal ulcers or descemetoceles were present. In the 12 cats, nine had either a melting corneal ulcer or descemetocele, two animals had acute bullous keratopathy, and one cat had corneal sequestrum. Initial vascularization with gradual clearing of the graft occurred during the first 45 days postoperatively. At 60 days postoperatively, all eyes were visual. Frequent postoperative complications included: focal dehiscence of the wound ( n  = 9); melting of part of the graft ( n  = 7); and pigmentation of the graft ( n  = 4). The frozen lamellar corneal graft was a very safe technique, and restored the tectonic and the optical function of the cornea. It provided the best results in corneas with nonperforating corneal defects. This technique provides poorer results when the cornea was perforated prior to surgery or during the surgical procedure.     

Mineralized corneal sequestrum in a cat.

An 8-month-old 3-kg (6.6-lb) sexually intact male cat was evaluated for chronic refractory keratitis and a corneal plaque that developed after treatment with a corticosteroid-containing ophthalmic preparation. Pertinent ophthalmic findings included blepharospasm, conjunctivitis, corneal vascularization, and a tan raised corneal plaque with a dense and gritty composition. Lamellar keratectomy was performed to excise the plaque. The cornea healed with mild scarring. Histologic examination revealed extensive coagulation necrosis and mineralization of the corneal stroma with increased inflammatory cells, blood vessels, and fibrosis, which is compatible with a diagnosis of mineralized corneal sequestrum. The history suggested chronic feline herpesvirus-1 (FHV-1)-induced keratoconjunctivitis as the underlying cause. Topical corticosteroid administration may have potentiated the preexisting corneal necrosis and initiated mineralization. To our knowledge, mineralization of a corneal sequestrum in a cat has not been reported in a clinical case but has been reported in cats experimentally infected with FHV-1.     

Co-existing squamous cell carcinoma and hemangioma on the ocular surface of a cat

A 14-year-old spayed female domestic short-haired cat was presented for evaluation of a mass in the right eye. Ophthalmic examination revealed a blind right eye and presence of two distinct masses: a pink and a red-to-brown mass, the latter occupying most of the cornea and part of the conjunctiva. Exenteration was performed under general anesthesia, and the ocular tissues were processed routinely for histopathology. Upon microscopic examination, a malignant epithelial neoplasm and a benign vascular neoplasm were present in the cornea. The conjunctiva and the third eyelid were also affected. Upon immunohistochemistry, the epithelial tumor was positive for cytokeratin and negative for vimentin and the endothelial tumor was negative for cytokeratin and positive for vimentin. A diagnosis of squamous cell carcinoma (SCC) and hemangioma was made. The SCC was affecting the cornea, bulbar conjunctiva (lateral and inferior) and the base of the third eyelid, whereas the hemangioma was affecting the cornea and medial limbus. To the authors' knowledge, this is the first report of concomitant SCC and hemangioma affecting the ocular surface in a cat.     

Inherited eye disease in the dog and cat

This paper describes the more common inherited eye conditions in the dog and cat, paying particular attention to the newer conditions, not all of which have previously been reported in the literature. These newer conditions include entropion in the shar pei, microphthalmos in the dobermann and miniature schnauzer, cataract in the German shepherd dog and Norwegian buhund, progressive retinal atrophy in the Tibetan terrier, Tibetan spaniel, miniature longhaired dachshund and two forms in the Abyssinian cat, multifocal retinal dysplasia in the English springer spaniel and other breeds, persistent hyperplastic primary vitreous in the Staffordshire bull terrier and dobermann and optic nerve hypoplasia in the toy poodle. Anatomical classification presents a convenient means of describing these conditions which may affect the whole globe, the eyelids, the nictitating membrane, the nasolacrimal duct system, the conjunctiva, the cornea, the aqueous, the iris, the lens and zonule, the vitreous, the retina, the choroid and sclera and the optic nerve.     

Corneal plaque containing levofloxacin in a dog

A 13‐year‐old castrated male Yorkshire terrier developed a corneal ulcer 2 weeks after intracapsular lens extraction (ICLE) in the right eye. The corneal ulcer was treated with levofloxacin eye drops. A plaque with a white luster developed in the central cornea 2 weeks after treatment with levofloxacin eye drops. The corneal plaque was surgically removed under inhalant anesthesia. The corneal plaque displayed antimicrobial activity against Escherichia coli. Furthermore, levofloxacin content in the plaque was confirmed by matrix‐assisted laser desorption/ionization time‐of‐flight/time‐of‐flight (MALDI‐TOF/TOF) mass spectrometry (MS). The corneal ulcer completely resolved 2 weeks after the surgical removal of the corneal lesion and replacement of levofloxacin eye drops with tobramycin eye drops. Although the topical use of levofloxacin is unlikely to lead to corneal chemical deposits due to the high water solubility of the drug compared to other topical fluoroquinolones, this patient developed corneal plaque of the antibiotic drop.     

Clinical experience with butyl-2-cyanoacrylate adhesive in the management of canine and feline corneal disease

PURPOSE: To examine and evaluate clinical indications and postoperative outcome in a series of small animal patients in which corneal disease was managed by the application of butyl 2-cyanoacrylate adhesive. MATERIALS AND METHODS: In this retrospective study all small animal patients were identified that presented to the Royal Veterinary College, University of London over a 2-year period, in which corneal disease was managed by the application of butyl 2-cyanoacrylate. Indications for application, complicating factors prior to gluing, glue retention time, postoperative comfort, and extent of subsequent corneal reaction and scarring were noted for each case. Long-term follow-up data concerning visual and cosmetic outcome were obtained from owners and referring veterinarians. RESULTS: Thirty-seven patients (28 dogs and 9 cats), in which 39 eyes were treated, were identified. Indications for corneal gluing in this series included stromal ulceration (26/39 eyes); descemetocele (4/39 eyes); corneal laceration/foreign body (5/39 eyes); lamellar keratectomy (3/39 eyes) and superficial ulceration (1/39 eyes). At least one factor responsible for initiation, persistence or progression of the ulcer was identified in 66.7% of eyes prior to corneal gluing. These included keratomalacia; confirmed bacterial keratitis; corneal edema related to endothelial disease and keratoconjunctivitis sicca. Cyanoacrylate was generally well tolerated by patients with only 8/34 eyes demonstrating transient blepharospasm and increased lacrimation postoperatively. Retention time of cyanoacrylate varied widely from < 1 week to approximately 6 months, but was < 2 months in the majority (89%) of eyes. Exaggerated corneal vascularization was an infrequent postoperative complication, noted in only six canine eyes, and did not appear to be related to initial corneal disease, glue retention time or breed. CONCLUSIONS: Butyl 2-cyanoacrylate offers a convenient, economical and effective alternative to other treatment modalities, such as conjunctival grafts, in the management of corneal defects in canine and feline patients.     

Orbitotomy for retrobulbar malignant fibrous histiocytoma in a dog

A retrobulbar malignant fibrous histiocytoma was diagnosed in a 12-year-old castrated male Keeshond dog. The mass was excised with a lateral orbitotomy and zygomatic arch resection. Vision was preserved in the affected eye, and no recurrence was noted up to 10 months postoperatively. Malignant fibrous histiocytoma originates from primitive mesenchymal stem cells. The malignant fibrous histiocytoma seen in our patient was most consistent with the storiform-pleomorphic variant, given the storiform arrangement of spindle cells, the presence of histiocytoid cells, and a mixed inflammatory infiltrate, without giant cells. The metastatic potential of malignant fibrous histiocytoma in general, and the storiform variant in particular, is unknown. Seventeen months later the dog was presented to the referring veterinarian with anorexia, diarrhea, weight loss and bilateral purulent nasal exudates. The dog was euthanized without necropsy.     

Acute bullous keratopathy in a domestic shorthair

A 14-year-old cat was presented for corneal rupture of the right eye and bulla formation of the left cornea. It was diagnosed with acute bullous keratopathy, based on clinical and histopathologic examination. This is a rare condition of unknown origin in cats; it was treated successfully with bilateral conjunctival pedicle grafts.