Lamellar keratoplasty for the treatment of feline corneal sequestrum
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2015-11-30
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O sequestro corneal felino caracteriza-se por uma lesão corneal pigmentada. Esta lesão apresenta várias tonalidades e pode afetar diferentes camadas da córnea. A fisiopatologia do sequestro não é completamente conhecida, contudo o trauma corneal é considerado um importante fator desencadeador e as raças braquicefálicas são mais frequentemente afetadas. O sequestro corneal é uma lesão dolorosa, cujo tratamento pode ser médico ou cirúrgico. Quando o tratamento médico é usado como tratamento único, o tempo de cicatrização e o resultado final não são satisfatórios. Cirurgicamente várias técnicas podem ser usadas na remoção do sequestro e restauro da integridade da córnea, no entanto, a fim de restaurar a capacidade de visão do animal, a queratoplastia é a única opção. Este estudo retrospetivo analisa 25 sequestros corneais diagnosticados em 20 gatos e cujo tratamento foi efetuado por queratoplastia lamelar. Esta técnica implica a remoção da região corneal afetada pelo sequestro e a colocação de um transplante corneal proveniente de um globo ocular fresco ou congelado. Desta forma, a integridade e a transparência da córnea são restauradas. No total foram realizadas 27 queratoplastias lamelares, pois duas córneas foram submetidas a uma segunda queratolastia. A probabilidade de rejeição do transplante é reduzida pela remoção do endotélio deste, bem como através do uso de medicação imunossupressora tópica. A recorrência do sequestro após esta intervenção cirúrgica é pouco comum, e neste estudo ocorreu apenas num caso. A informação contida neste estudo retrospetivo foi recolhida durante um período de estágio de 4 meses no Hospital Veterinário de Trás-os-Montes e outro período de 3 meses no Fundació Hospital Clínic Veterinari, UAB.
Feline corneal sequestrum is a disease characterized by a pigmented corneal lesion. Various degrees of corneal discoloration as well as corneal depth involvement are reported. Corneal sequestrum pathophysiology is not yet completely elucidated; however corneal trauma is generally accepted as an important initiating factor and brachycephalic breeds are the most frequently affected. This is a painful condition which needs to be assessed medically or surgically. Time until healing and final results are not satisfactory when medical treatment is used as a single therapy. Surgically, various techniques are available for sequestrum removal and re-establishment of corneal integrity; however, to completely restore animal’s vision ability, keratoplasty is the option of choice. This retrospective study includes 25 corneal sequestra which were diagnosed in 20 cats and managed by lamellar keratoplasty. With this surgical procedure the corneal sequestrum is removed and a fresh or frozen lamellar corneal graft is used to restore corneal integrity and transparency. A total of 27 keratoplasties were performed, since two corneas underwent a second keratoplasty. Probability of graft rejection is reduced by the removal of the graft’s endothelial layer and topical immunosuppressive therapy. Recurrence of the sequestrum is uncommon after this technique and in this study only occurred in one case. The information present in this retrospective study was collected during a period of clinical training of 4 months in Hospital Veterinário de Trás-os-Montes and a 3 month period in Fundació Hospital Clínic Veterinari, UAB.
Feline corneal sequestrum is a disease characterized by a pigmented corneal lesion. Various degrees of corneal discoloration as well as corneal depth involvement are reported. Corneal sequestrum pathophysiology is not yet completely elucidated; however corneal trauma is generally accepted as an important initiating factor and brachycephalic breeds are the most frequently affected. This is a painful condition which needs to be assessed medically or surgically. Time until healing and final results are not satisfactory when medical treatment is used as a single therapy. Surgically, various techniques are available for sequestrum removal and re-establishment of corneal integrity; however, to completely restore animal’s vision ability, keratoplasty is the option of choice. This retrospective study includes 25 corneal sequestra which were diagnosed in 20 cats and managed by lamellar keratoplasty. With this surgical procedure the corneal sequestrum is removed and a fresh or frozen lamellar corneal graft is used to restore corneal integrity and transparency. A total of 27 keratoplasties were performed, since two corneas underwent a second keratoplasty. Probability of graft rejection is reduced by the removal of the graft’s endothelial layer and topical immunosuppressive therapy. Recurrence of the sequestrum is uncommon after this technique and in this study only occurred in one case. The information present in this retrospective study was collected during a period of clinical training of 4 months in Hospital Veterinário de Trás-os-Montes and a 3 month period in Fundació Hospital Clínic Veterinari, UAB.
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Dissertação de Mestrado Integrado em Medicina Veterinária, Ciências Veterinárias
Palavras-chave
Oftalmologia veterinária , Gatos , Transplante da córnea , Sequestro corneal felino