Veterinary Medicine - January 2009 - (Page 21)

4. The nictitating membrane is excised at its base with Mayo scissors. 5. The nictitating membrane including the gland of the third eyelid before the ﬁnal cut at the medial canthus. 6. The remaining bulbar conjunctiva has been incised 3 to 5 mm posterior to the limbus, and the extraocular muscles transected near their scleral attachments. 7. The retractor muscle ﬁbers and optic nerve have been severed, and the globe can be removed after the remaining conjunctiva is excised. the optic nerve and the associated short and long posterior ciliary vessels before they enter the sclera. We do not perform this step; it is a matter of surgical preference. To improve the cosmetic appearance postoperatively, place an orbital meshwork of nonabsorbable mono lament suture (such as 4-0 nylon), anchored to the orbital rim periosteum, in a continuous pattern (Figure 8). Close the conjunctiva and subcutaneous tissues with 5-0 absorbable polyglactin 910 in a simple continuous pattern. Appose the skin with 4-0 nonabsorbable mono lament nylon or polypropylene in a simple interrupted or cruciate pattern (Figure 9). Patients may be discharged the same day and should be given appropriate postoperative antibiotic, anti-in ammatory, and analgesic medications. In addition, Elizabethan collars are recommended until suture removal to prevent self-trauma. DISCUSSION This article describes a modi cation to the routine subconjunctival enucleation technique3 that involves removing the eyelids and nictitating membrane before excising the globe. This method of- fers good visibility and better access to the globe and extraocular muscles. After eyelid margin and nictitating membrane removal, the globe is easily visualized and manipulated. Extraocular muscles can be easily followed to their attachments, and the globe can be positioned to see the optic nerve before transection. Some authors advocate clamping the optic nerve with hemostats or ligating the associated vasculature before optic nerve transection7,8; however, omitting these procedures has not had a negative impact on the surgical outcome in previous studies or in the case series described here (see boxed text).9 Easier access to the optic nerve is particularly important in cats because their tight palpebral ssures and short optic nerves make enucleation more challenging. The optic chiasm can be damaged if excessive traction is placed on the globe, resulting in possible blindness in the contralateral eye after enucleation.7,10 The modi ed subconjunctival enucleation technique offers an alternative approach for globe removal in dogs and cats. This technique is not indicated in patients with corneal ulcers or ocular infections. In such cases, a transpalpebral technique is more appropriate. VETERINARY MEDICINE January 2009 21

Table of Contents Feed for the Digital Edition of Veterinary Medicine - January 2009

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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