Corneal surgery: instrumentation, patient considerations, and surgical principles

Surgical management of corneal disease can be a challenging undertaking. Some corneal surgical procedures require specialized microsurgical training, whereas individuals with general surgical training, written guidance, and proper instrumentation can successfully perform others. A prerequisite to success is familiarity with several unique features of corneal microsurgery. The purpose of this article is to provide an overview of applicable microsurgical instruments and their proper use, to provide guidelines for appropriate suture choice and application, and to present pre- and postoperative surgical considerations particular to corneal surgical procedures. Specific surgical procedures are beyond the scope of this article, but the fundamentals of corneal surgical manipulations applicable to the specific surgeries covered in other articles in this issue are described. Finally, because an understanding of corneal function, anatomy, and physiology is essential to the corneal surgeon, a brief review of these topics with an emphasis on surgical application is provided.     

Indications, surgical technique, and long-term experience with laparoscopic closure of the nephrosplenic space in standing horses

OBJECTIVE: To describe surgical technique and outcome after laparoscopic closure of the nephrosplenic space for treatment of recurrent left dorsal displacement of the left colon (LDDLC) in standing horses. STUDY DESIGN: Retrospective study. ANIMALS: Forty-four horses with LDDLC. METHODS: Laparoscopic portals were located in the left flank region. After administration of etilefrin intravenously to contract the spleen, the dorsal splenic margin was sutured to the nephrosplenic ligament to obliterate the nephrosplenic space. Horses were re-examined (< or = 3 years) for history of recurrence. In addition, medical records of 4,852 horses treated for colic over 16 years were evaluated to establish incidence of LDDLC and recurrence after treatment. RESULTS: Splenic contraction facilitated suture placement and closure of the nephrosplenic space was achieved without complications. LDDLC recurrence did not occur although 5 horses had subsequent episodes of colic; 4 horses had displacement of the ascending colon between the spleen and body wall. Review of medical records revealed an incidence of LDDLC of 6% and recurrence of 21% in a population of horses with signs of colic. CONCLUSION: Laparoscopic closure of the nephrosplenic space, facilitated by etilefrin-induced splenic contraction can be efficiently performed in standing horses. CLINICAL RELEVANCE: Laparoscopic ablation of the nephrosplenic space should be considered in horses that are predisposed to recurrent LDDLC.     

Clinical, ultrasonographic, and surgical findings in foals with umbilical remnant infections

Infection of umbilical arteries, umbilical vein, and/or urachus was diagnosed ultrasonographically in 33 foals 1 to 90 days old (mean, 17.7 +/- 17.3 days). In these foals, the most common initial problems were umbilical abnormalities, septic arthritis, and/or neonatal septicemia. In 16 foals, abnormalities of the external umbilical stalk were noticed on admission. Abnormalities of the internal umbilical structures were identified when enlargement and echogenic material (fluid and/or gas) were imaged ultrasonographically within these structures. Multiple structures were affected in 23 foals, with the urachus the most commonly affected structure. Surgical findings confirmed ultrasonographic identification of infected umbilical structures in 23 foals. Twenty-two samples from affected umbilical remnants submitted for culture at surgery were positive for bacterial growth. Multiple organisms were isolated in 15 cultures. Escherichia coli and beta-hemolytic streptococci were the most common isolates. Two foals died of late complications associated with surgical resection, 1 foal treated surgically and 3 foals treated medically died or were euthanatized because of other complications, and the remaining 27 foals lived.     

Medical and surgical management of the glaucoma patient

Glaucoma usually causes rapid blindness in small animals and should be treated as a true ophthalmic emergency. Current treatment is directed toward decreasing intraocular pressure to protect the optic nerve and preserve vision. These treatment methods include various medical and surgical methods that are often combined for a particular patient. No magic drugs or surgeries exist to permanently control glaucoma; the clinician often has to switch to assorted methods of treatment after the previous treatments fail to control the intraocular pressure. Newer theories on the cause of glaucoma involve various vascular and toxic effects on the optic nerve rather than simple mechanical damage to the nerve from increased ocular pressure. Therefore, treatments designed to protect the optic nerve from biochemical alterations are probably the future of treating this challenging disease.     

Non-neoplastic surgical diseases of the lung and pleura

Non-neoplastic diseases of the bronchi, pulmonary parenchyma, mediastinum, and pleura that are amenable to surgical management represent a wide range of unrelated etiopathogenic conditions that usually have a focal distribution. The author discusses the presurgical clinical, radiographic, and laboratory assessment and prognoses, and addresses therapeutic recommendations.     

From the practice, for the practice: Swiss veterinarians invent surgical instruments

Sometimes the name of instruments in veterinary text books and catalogs of medical suppliers points to their origin. Between 1850 and 1950 quite a number of veterinarians in Switzerland invented various instruments. They passed their ideas on or produced and distributed their inventions. The ideas originated from their daily work, such as surgery and treatments in the field of diseases in obstetrics and reproduction, udder diseases and digestive system.     

Fractures of the carpus in racing thoroughbreds of the Japan Racing Association: Prevalence, location, and current modes of surgical therapy

From 1985 through 1994 approximately 39,800 Thoroughbred horses competed in over 3,400 races each year conducted by the Japan Racing Association (JRA). During this time the prevalence of fractures incurred during racing was 1.99, and 0.09% during training. Of these, 0.32% of the horses during racing died or were humanely destroyed as a direct result of their injuries. During 1994, 1,837 fractures occurred. The cuboidal bones of the carpus and the distal end of the radius accounted for 33.5% of all recorded fractures, with 47.4% of these occurring during racing and 24.2% occurring during training. The most common sites of fracture within the carpus were the distal end of the radius, the third carpal bone, and the radial carpal bone accounting for 35.3, 35.2, and 29.5% of fractures, respectively. Of these, 86/7% of osteochondral fractures occurred on the dorsal aspect of the cuboidal bones. At racing speed, characteristic fractures of the carpus are relatively common in race horses.Since 1991 in Japan, arthroscopic surgery has been the treatment of choice for the removal of carpal joint osteochondral fragments. Of all horses having arthroscopic surgery (n=155), 68.4% of these horses returned to race 9 months after surgery. Of all horses having osteochondral fractures of the distal end of the radius, radial carpal, and third carpal bones treated with arthroscopic surgery in 1993 (n=97) 52.6%, 60.0%, and 55.6% respectively, returned to race and competed at the same level of competition or higher compared with pre-operative racing performance. Arthroscopic surgery, as adapted by the JRA, is a useful technique for the treatment of carpal bone fractures in race horses; however, following surgery some horses had chronic arthritic changes associated with the surgical site. This suggests that the surgical methods and post-operative training program have to be re-evaluated.The objectives of this paper are to describe the prevalence, location, post-operative complication and racing performance for horses having cuboidal carpal bone fractures in racing Throughbreds of JRA.     

Use of a rigid-type polyethylene T-cannula,silicone tubing,and adhesion netting for surgical cannulation of ileum of the horse

A rigid-type of polyethylene T-cannula was fitted into the anterior ileum of six horses in order to improve the cannulation techniques. A piece of polyethylene net was fastened onto the intestinal wall around the cannula to prevent dislodgment of the cannula by promoting a secure adhesion between the ileum and the abdominal wall. The cannula barrel sheathed with silicone tubing was exteriorized through a stab incision at the lateral ventral wall on the transverse line of the second lumber vertebra, and a flange was screwed onto the barrel. The feeding regime gradually increased concentrate without roughage prevented any colic signs. The use of these techniques succeeded in the ileal cannulation with no leakage of digesta.