García-Pertierra García, Sofía

Universitat Autònoma de Barcelona. Facultat de Veterinària

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Advances of corneal surgery in small animalsGarcía-Pertierra García, Sofía Veterinary Medicine School, UAB                 June 2016The cornea is a unique portion of the outer fibrous tunic of the eye. Itstransparency has a major refractive function while maintaining a barrier betweenthe eye and the environment. Corneal disease, which are common both in dogs andcats, may result in corneal insults as: opacification, vascularization, ulceration,pigmentation, oedema or perforation. Surgical intervention is often required inorder to re-establish its normal role, improving the patient’s vision and quality oflife. Keratectomy, conjunctival graft and corneoscleral transposition have been untilnow, the main surgical techniques performed in veterinary ophthalmology fortreating these conditions. The aim of this review is to present other therapeuticoptions rising in importance, both in our field and in human ophthalmology.Figure	1.		Corneal	layers	in	small	animals.	11. Ledbetter	EC,	Gilger BC.	Chapter	11:	Canine	Cornea:	Diseases	and	Surgery.	In:	Gelatt KN.	Essentials	of	Veterinary	Ophthalmology.	3rd	rev.	John	Wiley&Sons;	2014;	p.2172. Gelatt KN,	Brooks	DE.	Chapter	8:	Surgery	of	the	ornea and	sclera.	In:	Gelatt KN,	Gelatt JP.	Veterinary	Ophtalmic Surgery.	Missouri:	Saunders	Elsevier;	20113. Andrew	SE,	Tou S,	Brooks	DE.	Corneoconjunctival transposition	 for	the	treatment	of	 feline	corneal	sequestra:	a	retrospective	study	of	17	cases.	Vet	Ophthalmol 2001;4(2):107-111	 	4. Townsend	WM,	Rankin	AJ,	Stiles	J,	Krohne SG.	Heterologous	 penetrating	keratoplasty for	treatment	of	a	corneal	sequestrum in	a	cat.	Vet	Ophthalmol 2008;11(4):237-278	5. Laguna	F,	LeivaM,	Costa	D,	Lacerda R,	Peña	T.	Corneal	grafting	for	the	treatment	of	feline	corneal	sequestrum:	a	retrospective	study	of	18	eyes	(13	cats).	Vet	Ophthalmol 2015;18(4):291-296	 				6. Tan	DTH,	Dart	JKG,	Holland	EJ,	Kinoshita	S.	Corneal	transplantation.	Lancet	2012	May;379:1729-17617. Kalpravidh M,	Tuntivanich P,	Vongsakul S,	Sirivaidyapong S.	Canine	amniotic	membrane	transplantation	for	corneal	reconstruction	after	the	excision	of	dermoids in	dogs.	Vet	Res	Commun 2009;33:1003–10128. Dulaurent T,	Azoulay T,	Goulle F,	Dulaurent A,	Mentek M,	Peiffer RL,	Isard PF.	Use	of	bovine	pericardium	(Tutopatch®)	graft	for	surgical	repair	of	deep	melting	corneal	ulcers	in	dogs	and	corneal	sequestra in	cats.	Vet	Ophthalmol 2014;17(2):91–999. Brunelli ATJ,	Vicente	FAM,	Chahud F,	Oria AP,	Bolzan AA,	Campos	CF,	Doria FA,	Laus JL.	Sclerocorneal limbal stem	cell	autograft transplantation	in	dogs.	Arq.	Bras.	Med.	Vet	Zootec 2009;59(5):1194-1204	 	Keratectomy CG10 CCT11 KeratoplastyPK12 ALK13 EK14 AM15 BM16IndicationsEpithelial	damage✔ ✔ ✔ ✔ ✔ ✗ ✔ ✔Ulcerativekeratitis✗ ✔ ✔ ✔ ✔ ✗ ✔ ✔Corneal	sequestrum+/- ✔ ✔ +/- ✔ ✗ ✔ ✔Descemetocele ✗ ✔ ✔ ✗ ✔ ✗ ✔ ✔Perforation ✗ ✔ ✗ ✗ ✔ ✗ +/- +/-Endothelialdiseases✗ ✗ ✗ ✔ ✗ ✔ ✗ ✗Transparency ↓↓ ↓ ↓ ↑ ↑↑ ↑ ↑↑ ↑Rejection - - - ↑ ↓ ↑ ↓ ↓Availability ↑ ↑ ↑ ↓↓ ↓ ↓↓ ↓ ↓Figure 2. Comparative table between different techniques. (10) Conjunctival graft; (11) Corneoconjunctivaltransposition; (12) Penetrating keratoplasty; (13) Anterior lamellar keratoplasty; (14) Endothelial keratoplasty; (15)Amniotic membrane transplantation; (16) Biomaterials transplantation.(✔)	Yes;	(✗)	No;	(+/-)	Controversial;	 (↑)	Good	outcome;	(↓)	Bad	outcome;	(-)	Irrelevant.		Amniotic membrane7:	Intraop and	2	Months	after	surgery Biomaterials8:	1	Month	and	2	Months	after	surgerySuperficial	keratectomy2 Conjunctival	graft2 Corneoscleral transposition3PK4:	Postop	and	16	Months	after	surgery ALK5:	Postop	and	4	Months	after	surgery EK	in	a	human	patient6Limbal Stem	Cells	Transplantation9Ø Corneal grafting is becoming the main technique dueto providing more positive results of visual outcome.Ø Development of new materials and conservationmethods allow to increase this procedure’s availability.Ø Deeper research is needed into corneal immuneresponse and immunosuppressive treatment as wellas the use of laser, cross-linking, keratoprosthesis andstem cells transplantation techniques.

Advances of corneal surgery in small animals

https://ddd.uab.cat/pub/tfg/2016/174578/TFG_sgarciapertierragarcia_poster.pdf

Advances of corneal surgery in small animals

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