Surgical Outcome and Ocular Complications of Evisceration and Intraocular Prosthesis Implantation in Dogs with End Stage Glaucoma: a Review of 20 Cases

Abstract

ABSTRACT. Surgical outcome and complications following evisceration and implantation of intraocular silicone prosthesis (ISP) in 20 canine eyes with end-stage glaucoma were analyzed, including clinical signs, complications, cosmetic appearance, and owners' responses. The mean postoperative follow-up time was 312 days. Major short-term surgical complications were central corneal ulceration (6/20) and infections (3/20), while long-term complication was keratoconjunctivitis sicca (KCS) (2/20). All patient owners (100%) showed satisfied with the surgical outcome and postoperative cosmetic effect including 85% of the owners gave an excellent or good rating of satisfaction. No more medication needed for long term control except the KCS cases. With careful case selection and postoperative care, evisceration with ISP implantation proves a good and safe surgical procedure with minimal complications for end stage glaucoma. KEY WORDS: complications, end-stage glaucoma, intraocular silicone prosthesis (ISP).J. Vet. Med. Sci. 69(8): 847-850, 2007 End stage glaucoma is clinically characterized by a persistent increased intraocular pressure (IOP) with buphthalmos, ocular pain, and refractory to medical treatment [4,19]. This stage is commonly seen in dogs usually due to failure of early correct diagnosis or treatment, or rapid progression of the disease itself.The treatment options for painful blind eyes caused by glaucoma include cyclocryotherapy or laser cryoablation, intraocular prosthesis implantation, and enucleation [2, 4, 5-8, 15, 17-19]. However, the improvement of end stage glaucoma by cryo-and laser-therapy is usually limited [1,8,13,15,17]. Owners usually hesitate to have the dog received enucleation surgery. The intraocular prosthesis implantation has become a popular alternative for end stage glaucoma to offer a painless and cosmetically acceptable eye after surgery [6,7].Here we present 15 dogs/20 eyes with end stage glaucoma treated by evisceration and ISP implantation in Taiwan. The purpose of the study was to evaluate surgical complications, cosmetic appearance and owner responses following evisceration and ISP implantations in the dogs.Medical records of 20 canine eyes with end-stage glaucoma treated with evisceration and ISP implantation at the Ophthalmology Clinic of the National Taiwan University Veterinary Hospital were analyzed. The dogs with intraocular infection or neoplasm were excluded for the procedure. The eyes with KCS or mild corneal ulcers were stabilized medically until substantial improvement or recovery prior to being considered to receive surgery. The eyes with pre-operatively stable and improving condition of KCS were also included for the surgery because postoperative size reduction of globe from buphthalmia and proper medical control of KCS usually work well for the cases with mild or moderate KCS cases. The cases of severe KCS were excluded for the surgery due to infection concern.The operated eyes were prepared and draped as routine intraocular surgery. A 5-8 mm, 120°~150°, dorsal l...

Magnetic resonance imaging susceptibility artifact due to pigmented intraorbital silicone prosthesis

“…Evisceration with placement of intraocular silicone prostheses is an alternative to enucleation performed by many veterinary ophthalmologists. Short‐term complications associated with this procedure are corneal ulcerations and infections, while the most common long‐term complication is keratoconjunctivitis sicca (KCS) 17 . A silicone prosthetic implant is also utilized in this procedure to fill the corneoscleral shell after intraocular contents are removed.…”

Evaluation of intraorbital prosthetic pigmentation using 0.3 and 1.5Tesla magnetic resonance imaging and computed tomography

“…Enucleation is recommended for blind and painful eyes such as those affected with chronic inflammation, trauma, intraocular neoplasia, endophthalmitis, or glaucoma . Evisceration is a potentially more cosmetic surgical procedure typically performed for end‐stage glaucomatous eyes . In both procedures, a silicone prosthesis is placed either within the corneoscleral shell or the intraorbital space .…”

“…[21][22][23] Evisceration is a potentially more cosmetic surgical procedure typically performed for end-stage glaucomatous eyes. [21][22][23][24] In both procedures, a silicone prosthesis is placed either within the corneoscleral shell or the intraorbital space. 24,25 Clinicians performing these procedures are cautioned when considering use of the brown ferrouspigmented prosthetic.…”

“…[21][22][23][24] In both procedures, a silicone prosthesis is placed either within the corneoscleral shell or the intraorbital space. 24,25 Clinicians performing these procedures are cautioned when considering use of the brown ferrouspigmented prosthetic. Although the probability of encountering this artifact in a clinical patient due to presence of an ocular prosthetic is likely rare, the results may be deleterious for the patient due to the increased anesthetic time needed to remove the prosthetic for accurate imaging.…”

Evaluation of polymethylmethacrylate as ocular implant in rabbits subjected to evisceration

“…In veterinary medicine, ocular secretion and decrease of orbital volume can be noted in animals after more than one year of the surgical procedure (Rahal et al, 2000a). Corneal ulcer, between 2 to 11 days postsurgery and keratoconjunctivitis, between 2 to 16 weeks of the post-operative period were also described by Lin et al (2007).…”