THE SURGICAL REPAIR OF THE CORNEA OF THE DOG USING PERICARDIUM AS A KERATOPROSTHESIS INTRODUCTION

Braz. J. vet. Res. an tin. Sci.,

São Paulo, v. 32. n. 4. />. 251-255. 1995

THE SURGICAL REPAIR OF THE CORNEA OF THE DOG USING PERICARDIUM AS A

KERATOPROSTHESIS

REPARAÇÃO CIRÚRGICA DA CÓRNEA DE CÃO USANDO PERICÁRDIO COMO PRÓTESE

Paulo Sérgio de M oraes KARKOS', Angélica de M endonça V az S A IA T U v , Telm a A parecida M A LERBA ’, Miguel BUKNIKK JU N IO R 4.

SUMMARY

Significant advances in corneal repair have been made in the past. Tissue graft has been used to repair full-thickness defects of the cornea and sclera. Equine pericardium preserved in glycerol was used to repair full-thickness corneal lesions after lim- bal melanoma excision and corneal wound with iris prolapse. A six-year old male, German Shepherd, with 1 cm of diameter, dark-pigmented mass at the temporal limbus of the right eye, with two months of evolution, and a four month old female mixed breed dog. with a corneal wound and iris prolapse, in the left eye. secondary to a cat scratch 5 days earlier. In both cases a piece of pericardium was sutured close to the corneal defects. An antibiotic ointment and atropine I % eye drops were used. The intraocular pressure was low in the following days, but arose to normal values. All other structures were normal. A granulation tissue initially grew near the patch, and the opacity of the pericardium remained. Dexamethasone eye drops and ointment were used, and the granulation tissue disappeared two months after surgery. Eighteen months follow-up showed the eyes in good condition, although opaqueness was still present.

UNITERMS: Dogs; Cornea; Pericardium; Prosthesis.

INTRODUCTION

research in human and veterinary ophthalmology.

In veterinary ophthalmology, and specially in small animals, several techniques are used to repair corneal lesions: tarsor- rhaphyi,2i; conjunctival flap l5J4 and third eyelid flap"; tissue adhesives lv; contact le n se s'; corneal-scleral transposition1'’; au to g e n o u s c o rn e a l tran sp lan t''* ; h o m o lo g o u s c o rn eal g rafts'1" ' ' uw and. synthetic g r a F ’7.

Keratoprostheses, by using alloplastic materials such as acry­ lic' or carbon2, have been developed as an alternative mode o f treatment for a group o f diseases like alkaline burns, seve­ re dry eye syndrome and severely vascularized corneas.

on the extent of the lesion, a fullthickness keratoplasty must be done.

The pericardium has been used in the repair of the oesopha­ gus and thoracic w all'5 w ith good results. In veterinary ophthalmology it has been used in the repair o f entropion, fillin g o f the orbital cavity follow ing enucleation3 and repair o f the sclera and third eyelid'.

This paper is to report two cases in dogs, in which we used the pericardium to repair corneal lesions after a limbal melanoma removal and corncal wound, with iris prolapse.

Harvesting and Preservation of the Pericardium

nate in the anterior uvea, they are slow growing and locali­ zed tumors Surgical excision o f those tumors is indicated with a good prognosis’1. The average age for finding epibul- bar melanocytomas is 6 years'', and breed incidence is higher in the German Shepherd"’. Penetration of the anterior cham ­ ber is not uncommon during tumor removal, and depending

The pericardium must be harvested from an animal which did not die of an infectious disease. One cleans the fat tis­ sue from the pericardium and, with no special care, the piece of pericardium can be put in a recipient with glycerol 98% in salt solution and kept at room tem perature. The maximum storage period is undetermined and the membra­ ne can be used after a 30 day period o f preservation. Before

1 P ro fessor T itu lar - F a culd ade d e M e d ic in a V eterinária e Z o o te c n ia da U S P 2 - M é d ic o V eterin ário - Faculdade d e M e d ic in a V eterinária e Z o o te c n ia da U S P 3 - P ós-grad uanda Facu ld ad e d e M ed icin a V eterinária e Z o o te c n ia da U S P 4 • Professor O p h th a lm o lo g y D ep artm en t - McCíilI U n iv ersity

liA R R O S. P.S.M .: SAFATI.I-. A M V.; M A l.h R B A .T .A .. B l'R N IL R J l ’NIOR. \ l The surgical repair o l the cornca o f ihc dog using pcricardiumas ;i kcraloproslhcsis_/Repara<,ao cim irgica da com ca dc can uvando p cricard iocoin o pr& csc/ li r a /. J . vel. Res. anini. Sci., Sao Paulo, v. 12. n. 4. p 251-255. IW5.

use. the fragm ent o f pericardium must be rehydrated in balanced salt solution.

Case One

A six - year old. male German Shepherd was referred to the O p h th a lm o lo g y S e c tio n o f th e V e te rin a r y T e a c h in g Hospital, University of São Paulo for examination.

The dog presented a black mass developed in two months, with 1 cm diameter, and located at the temporal limbus o f the right eye (Fig. I ). No other anomaly was noted. A super­ ficial sclcro-keratectomy for removal of the mass was indi­ cated. During surgery, a penetrating keratectomy was per­ formed. due to the extension of the neoplasia, and a graft of equine pericardium preserved in glycerol 98% was sutured at the lesion site, using simple interrupted 6-0 silk sutures (Fig.2). A Gentamicin ophthalmic ointment and atropine \% eye drops were administered Q1D for 15 days, as well as a dexamethasone 0.1% eyedrops QID.

Intraocular pressure was low at the first week post surgery, raising to normal values (Schitz) on the 30 ill day. 'flic ante­ rior cham ber had normal depth throughout the follow-up period. Fundus exam revealed no abnormality.

Granulation tissue grew over part of the graft and sutures at the limbnl sight, disappearing after two months of topical steroid administration.

Eighteen m onths after surgery, the eye structures were in good condition and both vision and aesthetics were preser­ ved (Fig.3). Opacity o f the cornea persisted at the site of implant.

Case Two

A four-month old female, mixed breed dog was referred to the ophthalmology section of the veterinary teaching hospi­ tal. University of São Paulo, for repair o f a corneal wound, secondary to a cat scratch 5 days earlier. At presentation, a round vesicular mass, 1.5 cm square, at the 6 o' clock posi­ tion near the limbus was present (Fig. 4). A shallow anterior chamber with an irregular pupil was noted.

Partial keratectomy and iridectomy o f the portion of the iris incarcerated in the corneal wound were performed at the site of lesion (Fig.5). and an equine pericardial graft was used to close the lesion, by using a simple interrupted 7-0 prolene suture (Fig. 6).

FIGURK 1 Case l:Tcmporal position of the black mass.

FIGURE 2

Case I : Graft in position, one week after surgery.

FIGURK 3 Case I: Graft eighteenmonths alter surgery.

B \K R O S. P S.M.: SA IA T I.I-. A M V.; M A l.H R B A . T.A.: BU R N IhR JUNIOR. M. The surgieal repair o f t h e c o m e a o í thc d og using pencardiumas a kerau>p<oMhcsis./Rcparaçàocirnjrgica da córnea de eà o usando pencárdio c o n io prótese/ l i r a / . J . v et. Res. a n im . Sei.. São Paulo. \ . 32. n. 4. p. 25 1 -2 5 5 . 1995.

Four months later, a normal anterior chamber and cornea in good condition with opacity at the graft site could be observed.

DISCUSSION

The development of alloplastic material and its use in surgi­ cal repair revealed applications in ophthalm ology and sti­ mulated investigations of these materials as keratoprosthe- sis\ Various types o f autologous grafts or donor tissue, as well as tissue adhesives, have been used in the treatment o f corneal wounds.

FIGURE 6 Case 2: Prosthesis sutured at the corneal lesion.

Biological membranes, especially pericardium, have been used in veterinary ophthalm ology with good results. The pericardium was well tolerated by the canine cornea, and no extrusion o f the implant or necrosis o f the surrounding tis­ sue were noted. This is good material because it is easy to sict. to store and to use.

Case'

FIGURE 4

The vesicular mass at 6 O'clock, at presentation. In both cases, during the follow-up. a deep anterior cham ­

ber revealed that the graft did properly seal the corneal lesion and that the aqueous did not leak.

Low IOP in the first days after surgery probably was due to the anterior uveitis, that remissed in a few days with topical steroid. Granulation tissue disappeared in two months o f steroid treatment.

Opacity at the site o f im plantation did not interfere with vision because it was out o f the visual axis.

FIGURE 5

Case 2: l-ullthickness kcratccloinv and iridectomy.

T hese results suggest that the pericardium should be a good material to repair lesions o f the cornea and experi­ m ental in v estig a tio n s are being co n d u cted in o rd e r to understand the behavior o f this membrane and surrounding tissues.

IJA RR O S, P.S.M ; SA F A T L Ii, A.M V.. M A l.liR B A , T .A .; BU RN IH R JU N IO R . M. T he su rgical rep air «I lhe co rn e a o f the d o g u sing p ericurdium as a k eratopros thesis./R eparação cirrúrgica da có rn ea d e cfio u sando p eric á rd io c o m o pró tese/ B r a / , J . v et. R es. a n im . Sei., Sào Paulo, v. 32. n. 4, p. 251-255. 1995.

RESUMO

A substituição da córnca em lesões oculares tem merecido a atenção dos oftalmologistas, sendo que vários materiais têm sido usados para este fim. () pericárdio de eqüino, conservado em glicerina, foi usado no reparo de lesões penetrantes de córnea de dois cães, um pela excisão de melanoma límbico, outro pela presença de estafilomu periférico. Cão, Pastor Alemão, com 6 anos de idade, apresentando massa de I cm de diâmetro, localizada na região temporal do limbo esclero-corneano do olho direito, com 2 meses de evolução e cão de 4 meses, mestiço, que teve ferida sua córnea esquerda com prolapso de íris, em conseqüência de arranhadura de gato. 5 dias antes, foram examinados no Serviço de Oftalmologia do Hospital Veterinário da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo. As lesões de ambos os animais foram repara­ das com fragmento de pericárdio de eqüino para fechamento do defeito produzido. Aplicação de pomada antibiótica e colírio de atropina de 1% foi instituída no pós-operatório. A pressão intra-ocular foi baixa nos primeiros dias subseqüentes à cirurgia, mas foi gradativamente aumentando chegando a valores normais. Inicialmente, tecido de granulação foi observado próximo ao implante, e opacificação do pericárdio permaneceu. Colírio de dexametasona foi então indicado, sendo que o tecido de gra­ nulação desapareceu dois meses após a cirurgia. A câmara anterior permaneceu profunda durante toda a evolução. O acompa­ nhamento pós-operatório mostrou os olhos em boas condições após dezoito meses.

UNITERMOS: C ães; Córnea; Pericárdio; Prótese.

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Recebido para publicação em 6/10/94 Aprovado para publicação em 3/4/95