Derek W Y Chow1, Hans D Westermeyer2. 1. Veterinary Specialty Hospital, Hong Kong, 1/F & 2/F 165 Wanchai Road, Wan Chai, Hong Kong Island, Hong Kong SAR, China. 2. Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, 1060 William Moore Drive, Raleigh, NC, 27606, USA. hdwester@ncsu.edu.
Abstract
OBJECTIVES: To retrospectively evaluate the complications, graft clarity, and outcomes associated with the use of commercially available porcine urinary bladder submucosa (ACell Vet(™) ) alone for corneal reconstruction in dogs and cats. PROCEDURES: Dogs or cats receiving an ACell Vet(™) graft for corneal reconstruction due to severe ulcerative keratitis or after a keratectomy to remove a corneal sequestrum were included. All received a single layer of ACell Vet(™) , bandage contact lens, and temporary tarsorrhaphy. Bandage contact lens and temporary tarsorrhaphy were removed after graft vascularization or epithelialization. Topical steroids, cyclosporine, tacrolimus were started after epithelialization. Based on their last examination, outcomes were categorized into five groups based on the presence of corneal vessels, appearance of the scar, and the ability to visualize the posterior and/or the anterior segment through the grafted area. RESULTS: There were 82 eyes included in the study, with 68 eyes with sufficient follow-up time for final assessment. Scarring was minimal in 47 eyes, moderate but not enough to obscure visualization of the posterior segment in 12, and severe in nine. There were five eyes that developed phthisis bulbi, glaucoma or were enucleated and nine that were lost to follow up. Graft dehiscence occurred in 19 eyes. Twelve healed without additional surgical intervention while three required a second graft, two became phthisical, and two were enucleated. CONCLUSIONS AND CLINICAL RELEVANCE: Corneal reconstruction with ACell Vet(™) alone is a viable alternative and results in minimal scarring and complications in cats. In dogs, scarring is more pronounced than in cats and graft dehiscence rate is higher compared to conventional techniques.
OBJECTIVES: To retrospectively evaluate the complications, graft clarity, and outcomes associated with the use of commercially available porcine urinary bladder submucosa (ACell Vet(™) ) alone for corneal reconstruction in dogs and cats. PROCEDURES: Dogs or cats receiving an ACell Vet(™) graft for corneal reconstruction due to severe ulcerative keratitis or after a keratectomy to remove a corneal sequestrum were included. All received a single layer of ACell Vet(™) , bandage contact lens, and temporary tarsorrhaphy. Bandage contact lens and temporary tarsorrhaphy were removed after graft vascularization or epithelialization. Topical steroids, cyclosporine, tacrolimus were started after epithelialization. Based on their last examination, outcomes were categorized into five groups based on the presence of corneal vessels, appearance of the scar, and the ability to visualize the posterior and/or the anterior segment through the grafted area. RESULTS: There were 82 eyes included in the study, with 68 eyes with sufficient follow-up time for final assessment. Scarring was minimal in 47 eyes, moderate but not enough to obscure visualization of the posterior segment in 12, and severe in nine. There were five eyes that developed phthisis bulbi, glaucoma or were enucleated and nine that were lost to follow up. Graft dehiscence occurred in 19 eyes. Twelve healed without additional surgical intervention while three required a second graft, two became phthisical, and two were enucleated. CONCLUSIONS AND CLINICAL RELEVANCE: Corneal reconstruction with ACell Vet(™) alone is a viable alternative and results in minimal scarring and complications in cats. In dogs, scarring is more pronounced than in cats and graft dehiscence rate is higher compared to conventional techniques.