Veterinary Medicine - January 2009 - (Page 22)

Enucleation in dogs and cats PEER-REVIEWED A modiﬁed subconjunctival enucleation technique: A case series Fifty-two dogs and 19 cats were presented for subconjunctival enucleation at the Animal Eye Specialty Clinics in Miami and Deerﬁeld Beach, Fla., between January 2006 and July 2007. Chronic glaucoma and suspected intraocular neoplasia were the most common reasons for eye removal in the dogs and cats, respectively. We obtained owner consent and performed the modiﬁed subconjunctival enucleation technique to assess its efﬁcacy and identify any adverse complications. Premedications were administered at routine dosages and included various combinations of butorphanol, acepromazine, glycopyrrolate, cefazolin, and meloxicam as determined by the species, age, and overall health of the animals. Induction was accomplished by administering routine dosages of intravenous propofol or a combination of intravenous ketamine and diazepam, and patients were intubated and anesthesia was maintained with isoﬂurane in oxygen. A ventilator breathing system was used. Patients were monitored during anesthesia by using capnography, pulse oximetry, and electrocardiography. Blood pressure and body temperature were also measured. Patients received intravenous lactated Ringer’s solution (5 ml/lb) during surgery. Retrobulbar injections6 (0.5 to 1 ml) of a combination of lidocaine hydrochloride 2% and bupivacaine 7.5% with or without epinephrine 1:1,000 were administered for more complete pain control in both dogs and cats, and the periorbital tissues and eye were aseptically prepared for surgery. Povidoneiodine ophthalmic solution (5% Betadine Ophthalmic Solution—Alcon Laboratories) was used to irrigate the area. We then performed the modiﬁed subconjunctival enucleation technique as described in this article. Adverse complications related to the enucleation, such as above-average intraoperative hemorrhage, optic nerve blindness in the contralateral eye, and incisional dehiscence, were not noted. In all cases, hemorrhage was minimal and easily controlled with direct pressure. All the patients were discharged with Elizabethan collars on the same day of the procedure and received postoperative analgesic, antibiotic, and anti-inﬂammatory drugs, including butorphanol or tramadol, amoxicillin trihydrate-clavulanate potassium, and carprofen or meloxicam, respectively. All patients returned for follow-up visits 10 to 14 days after surgery, at which time complete healing of the skin incision was conﬁrmed and the skin sutures and Elizabethan collars were removed. 8. An orbital meshwork of nylon suture has been anchored to the periosteum. 9. The conjunctiva and subcutaneous tissues are closed in a continuous pattern, and the skin is apposed in either a simple interrupted or cruciate (shown here) pattern. In our case series, this method was not associated with any adverse complications, and we think it may be particularly useful in general practice, where enucleation may not be a routine procedure. Long-term follow-up was not obtained in our case series. Keep in mind that a potential adverse effect related to enucleation using this or any technique is mucocele formation. 1. Spiess BM. Diseases and surgery of the canine orbit. In: Gelatt KN, ed. Veterinary ophthalmology. 4th ed. Ames, Iowa: Blackwell Publishing, 2007;539-558. 2. Slatter D, Wolf ED. Orbit. In: Slatter D, ed. Textbook of small animal surgery. Philadelphia, Pa: WB Saunders, 1993;1245-1263. 3. Kuhns E. Enucleation of the eye by subconjunctival ablation. Vet Med Small Anim Clin 1976;71:1433-1440. 4. Bellhorn R. Enucleation technique: a lateral approach. J Am Anim Hosp Assoc 1979;8:59-60. 5. Wolf ED. Enucleation of the globe. In: Bojrab M, ed. Current techniques in small animal surgery. Philadelphia, Pa: Lea & Febiger, 1990;119-123. 6. Accola PJ, Bentley E, Smith LJ, et al. Development of a retrobulbar injection technique for ocular surgery and analgesia in dogs. J Am Vet Med Assoc 2006;229(2):220-225. 7. Slatter D. Orbit. In: Slatter D, ed. Fundamentals of veterinary ophthalmology. 3rd ed. Philadelphia, Pa: Saunders, 2001;496-530. 8. Ramsey DT, Fox DB. Surgery of the orbit. Vet Clin North Am Small Anim Pract 1997;27(15):1215-1264. 9. Allgoewer I, Noller C, Reese S. Enucleation: Is ligation necessary? in Proceedings. Am Coll Vet Ophthalmol, 2006;45. 10. Stiles J, Buyukmihci N, Hacker DV, et al. Blindness from damage to the optic chiasm (letter to editor). J Am Vet Med Assoc 1993;202(8):1192. REFERENCES 22 January 2009 VETERINARY MEDICINE

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Veterinary Medicine - January 2009 Contents Leading Off Letters Research Updates Idea Exchange A Modified Subconjunctival Enucleation Technique in Dogs and Cats Local and Regional Anesthesia Techniques Author Guidelines Product Preview CE Form/Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - January 2009

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