Modified lamellar keratoplasties for the treatment of deep stromal abscesses in horses

Fonte: Richard J. McMullen Jr., Brian C. Gilger and Tammy M. Michau

Diagram of the partial thickness anterior stromal keratectomy, with the superficial flap reflected, started with biopsy punch 2 mm wider than biopsy punch used to remove the lesion during DLEK.
   Diagram of the partial thickness anterior stromal keratectomy, with the superficial flap reflected, started with biopsy punch 2 mm wider than biopsy punch used to remove the lesion during DLEK.

Objective: To describe a surgical modification of deep lamellar endothelial keratoplasty(DLEK) and posterior lamellar keratoplasty (PLK) procedures, to facilitate surgery on standing horses under-sedation.Animals studied Four client-owned horses, for which the owners declined surgery under general anesthesia, underwent standing corneal lamellar keratoplasty procedures for the treatment of deep corneal stromal abscesses.Procedures All four horses were place d in stocks and sedated with detomidine. Local eyelid and retrobulbar blocks were performed to provide local analgesia and akinesia,and each horse’s head was stabilized and supported by soft pads placed on a mobilecart. Deep lamellar endothelial keratoplasties (DLEKs) and posterior lamellar kerato-plasties (PLKs) were performed on two horses each, for the treatment of deep stromal abscesses (DSA). Following the first DLEK, a mid-stromal two-step anterior lamellar keratectomy modification was used to facilitate rapid closure of the anterior chamber immediately following removal of the abscess.Results: Each of the four horses had similar cosmetic and postoperative visual out-comes, compared to previously published results. Intra-operative complications were most prevalent in the first DLEK case (i.e., focal iris and lens damage and postoperative anterior chamber collapse) and were all but eliminated in the remaining three cases. Similar to previously reported findings, greater postoperative corneal fibrosis was observed in the DLEK cases. Conclusions: In horses with deep stromal or endothelial abscesses, for which general anesthesia is not an option, both the modified DLEK and PLK corneal procedures may be performed as an alternative to enucleation on the standing, sedated horse.

 

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