Download Full Text - International Journal of Livestock Research

International Journal of Livestock Research
eISSN : 2277-1964 NAAS Score -5.36
Vol 7 (3) Mar ’17
Original Research
A Clinical Study on Evaluation of Extracapsular Cataract Surgery in
Canines
Munna Lal* , Suresh Kumar Jhirwal, Praveen Kumar Bishnoi, Tarun Kumar Gahlot,
Satyaveer Singh and Krupa K. Soni
Department of Veterinary Surgery and Radiology, College of Veterinary and Animal Science,
Rajasthan University of Veterinary & Animal Sciences, Bikaner- 334001 (Rajasthan), INDIA
**
Part of M.V. Sc., research work, Rajasthan University of Veterinary & Animal Sciences, Bikaner334001 (Rajasthan), INDIA
*Corresponding author: [email protected]
Rec. Date:
Jan 25, 2017 16:55
Accept Date:
Feb 15, 2017 04:17
Published Online:
February 27, 2017
DOI
10.5455/ijlr.20170215041714
Abstract
Cataracts are the most frequent cause of blindness in dogs which are characterised by a focal or diffused
opacity of lens or lens capsule. Present clinical study was conducted on 12 dogs suffering from cataract.
After the detailed ophthalmic and ultrasonographic examination, 7 (9 eyes) out of 12 dogs were
surgically treated by extracapsular lens extraction method using operating microscope. The return of
ambulatory vision was observed in 6 eyes out of 9 operated eyes and failure of vision was noted in 3 eyes.
Peri-operative complications such as haemorrhage, meiosis and iris prolapse and post-operative
complications such as posterior capsule opacity, suture breakage and glaucoma were reported. Higher
incidence of cataract was noted in German shepherd (33.33%) followed by Pomeranian (25%), Cocker
spaniel (16.67%), Mongrel (16.67%) and Spitz (8.33%). In this study it was found that extracapsular
cataract extraction under general anesthesia along with retrobulbar nerve block is proved to be an
effective method to treat the cataract.
Key words: Cataract, Extracapsular Lens Extraction Method, Operating Microscope
How to cite: Lal, M., Jhirwal, S., Bishnoi, P., Gahlot, T., Singh, S., & Soni, K. (2017). A Clinical study on
Evaluation of Extracapsular Cataract Surgery in Canines. International
Research, 7(3), 93-99. DOI: http://dx.doi.org/10.5455/ijlr.2017021504171 4
Journal
of
Livestock
water soluble (Hart 1992 and Shahzad et al., 2012). Cataract, the opacity of crystalline lens is regarded as
[email protected]
DOI 10.5455/ijlr.20170215041714
Page
and has a protein concentration of 33% of its total weight; and most of these proteins are transparent and
93
Introduction
The eye is one of the most important sense organ associated with vision. The lens is a unique structure
International Journal of Livestock Research
eISSN : 2277-1964 NAAS Score -5.36
Vol 7 (3) Mar ’17
major cause of blindness in dogs (Magrane 1961) affecting thousands of dogs annually (Davidson and Keil
2001). Many different processes can cause cataract and they may progress at a variable rate. Loss of
vision due to cataract may be accompanied by secondary conditions such as uveitis and glaucoma
(Gelatt 1981).
The age of onset of cataract is variable, usually from 5-8 years of age. In some breeds, cataracts appear at
higher frequency than the general population. Commonly affected breeds of dog include the American
cocker spaniel, Poodle, Boston terrier, Miniature schnauzer, Bichon frise, and Labrador retriever (Cook
2008). There are numerous causes of cataract. Common etiologies are categorised as heritable (genetic)
disorders, senile (age related) degeneration, congenital (birth defects), traumatic (capsule rupture), toxic
reaction in the lens (progressive retinal degeneration, uveitis and glaucoma) geographical location (UV
light), nutritional (deficiency of an amino acid – arginine etc.), metabolic diseases (diabetes etc.) and
electricity (electric shock during bites on wires) (Patil et al., 2014). Diagnosis of cataract involves
systemic and ophthalmic examinations such as assessment of vision (menace test and obstacle course
test), reflex test (pupillary light reflex and corneal reflex) and ultrasonographic examination of eye
(Mustafa et al., 2014). Treatment of cataract in dogs can be either medical or surgical but surgical
treatment is regarded as the most promising treatment for cataract in dogs (Startup 1967 and Whiltely
et al., 1993). In the early days, the success rate for the cataract operations were relatively low (Startup
1967) but more recently the surgery has been accomplished successfully in over 95 % cases of cataract
(Davidson et al., 1991), but in 5% cases complications may prevent recovery of vision.
Extracapsular cataract extraction (ECCE) is an effective and most economical procedure of lens
extraction and is preferred worldwide by many ophthalmic surgeons (Williams et al., 2004) and regarded
as method of choice by veterinary ophthalmologists (Gelatt 1981).
Materials and Methods
In the present clinical study 12 cases of canine cataract included during a period of six months, which
were presented at the Department of Veterinary Surgery and Radiology, Bikaner (Rajasthan). History
pertaining to age, sex, breed, eye affected, vision changes, any injury to eye, time elapsed since
occurrence of opacity and use of recent medications and presence of diabetes was recorded. The affected
eyes were checked for clarity of cornea, opacity of lens, type of cataract (immature, mature [Fig. 1a] and
hypermature [Fig. 1b]), conjunctival appearance, conjunctival vascularity and discharge if any. Detailed
(Menace test), reflex test (Pupillary light reflex test and Corneal reflex test) and ultrasonographic
Page
examination.
Different Types of Cases of Cataract in Dogs
[email protected]
94
ophthalmic examinations of all the 12 cases (24 eyes) were carried out by the assessment of vision
DOI 10.5455/ijlr.20170215041714
International Journal of Livestock Research
Fig. 1a: Mature cataract in a Mongrel
dog
eISSN : 2277-1964 NAAS Score -5.36
Vol 7 (3) Mar ’17
Fig.1b: Hypermature cataract Cocker
paniel dog with glaucoma
Considering the history about the vision obtained and the observations made during the detailed ophthalmic
examinations of the patient, 9 eyes from 7 dogs were subjected to ECCE as peer the method described by
the Gelatt and Gelatt (2001) (Fig. 2a-Fig. 2f) under general anaesthesia (injection Ketamine @10mg/kg
i/m and inj. Xylazine @1mg/kg i/m) using operative microscope.
Surgical Procedure of Extracapsular Cataract Extraction (ECCE) Method
Fig. 2d: Removal of hypermature cataractous lens
Fig.2e: Suturing of cornea with 8/0absorbable Fig.2f: Recovered cataractous lenses
suture material
[email protected]
DOI 10.5455/ijlr.20170215041714
95
Fig.2c: Injection of viscoelastic material
Fig.2b: Staining of anterior lens capsule by trypan
blue dye
Page
Fig.2a: Incision on cornea with Keratotome
International Journal of Livestock Research
eISSN : 2277-1964 NAAS Score -5.36
Vol 7 (3) Mar ’17
In this method a stab incision was made with the help of keratotome knife on cornea at 2 O' clock position
and 0.2 ml Trypan blue dye was injected into the anterior chamber that stained the anterior lens capsule.
After 30 seconds dye was washed with the normal saline solution and viscomet was filled in the anterior
chamber of the eye. The anterior capsulotomy was done by “can opener” method using 24 G double bended
hypodermic needle. Incision was extended to 1 and 3 O'clock position using corneal scissors by full
thickness cut circumferentially. Lens was extracted with manual counter pressure at opposite poles of
limbus using muscle hook and lens scooper. Then irrigation of anterior chamber was done by Simcoe's
irrigation aspiration cannula to remove out small pieces of capsule or cortical material. Corneal incision
was closed with 8/0 absorbable suture material using simple inte rrupted suture. After
completion of the surgery subconjuctival injection of Gentamicin (0.5 ml) and Dexamethasone (0.5
ml) was given using 24 G needle. Eye lids were closed by horizontal mattress suture to protect
the eye (Gelatt and Gelatt, 2001). Post-operative follow-up of all the cases was done weekly, upto four
weeks. Surgical outcome was graded as based on parameters (good, fair and failure) as reported earlier by
Patil et al., 2014. The eye which had minimal corneal opacity, normal shaped cornea, minimal incisional
scar, round pupil with presence of pupillary light reflex, minimal adhesions, almost clear posterior
capsule and no residual cortex, four weeks after the cataract surgery considered as good surgical result
and the eye in which good surgical result was hampered by some postoperative complications,
sufficient to prevent restoration of good vision but not as great as to necessitate the loss of the eye or to
result in total blindness considered as fair surgical result. Failure of the surgery was considered as total
corneal opacity, secondary glaucoma and severe postoperative complications following the surgery.
Results and Discussion
In the present study, out of 12 cases of dogs, German shepherd dogs had higher incidence of cataract
(33.33 %) followed by Pomeranian (25.00 %), Cocker spaniel (16.67 %), Mongrel (16.67 %) and Spitz
(08.33 %). Whitley (1988) had also opinioned the higher susceptibility of Cocker spaniel, German
shepherd, Poodle, Schnauzer, Labrador retriever, Lhasa apso and Dalmatian breeds of dog to cataract.
The average age of the affected dogs was observed as 6.64 years. Williams et al., 2004 reported that old
age dogs had higher prevalence of cataract and after 13.5 years of age all dogs had some degree of lens
opacity. Unilateral cataract was observed only in 3 cases out of 12 (25 %), while rest of the 9 cases (75
%) had bilateral involvement of the eyes. Barnett (1980) had recorded hereditary cataracts in
different breeds with bilateral involvement.
menace reflex test and corneal reflex test. For pupillary light reflex test 11 eyes showed positive reflex, 12
eyes showed negative reflex and 1 eyes showed sluggish reflex. In ultrasonographic examinations 21 eyes
[email protected]
DOI 10.5455/ijlr.20170215041714
Page
test, 16 eyes showed negative menace reflex test and corneal reflex test and 1 eye showed sluggish
96
In the ophthalmic examination of 24 eyes; 7 eyes showed positive menace reflex test and corneal reflex
International Journal of Livestock Research
eISSN : 2277-1964 NAAS Score -5.36
Vol 7 (3) Mar ’17
showed hyperechogenicity of lens because of cataract while 3 eyes that were normal showed the
anechogenicity of lens. The inbuilt light source of operating microscope was used for the illumination
during all the surgeries. Startup (1967) stated that, the illumination was highly important during the
cataract surgery. Incision from 10 O’clock to 2 O’clock on dorsal circumference through anterior clear
cornea was observed as a good incision site. Iris prolapse was observed intra-operatively only in one eye
which was easily repositioned during the surgery.
Trypan blue dye was used to stain the anterior capsule of lens before anterior capsulotomy. Chung et al.,
2005 had used trypan blue 1% safely for assisting visualisation of the anterior capsule during phacoemulsification of mature cataract. Viscoelastic material was good in maintaining the anterior chamber
space during intraocular manipulations and protected non-regenerative corneal endothelium by
coating it. Whitley (1988) had mentioned the use of this material to protect the corneal endothelium
during the intraocular surgery. The delivery of the lens nucleus with vectis was smooth in all cases, but
some amount of cortical material remained in the anterior chamber, which was removed
successfully with the irrigation-aspiration cannula using Ringer's lactate solution. Ameerjan (2005)
advised to remove cataractous lens with the help of vectis and recommended that closure of anterior chamber
can be done with absorbable suture material polyglactin 910 and polyglycolic acid or non-absorbable
suture like nylon and prolene 10/0.
Perioperatively, haemorrhage and meiosis were observed in one case each and postoperative
complications such as posterior capsular opacity, suture breakage, corneal edema and iris prolapse were
observed in 3 cases after ECCE. Collinson and Peiffer (2002) reported that failures of manual
extracapsular surgical procedures were more commonly associated with postoperative synechia and
glaucoma, compared with failures of phacoemulsification, which, were more commonly associated with
infection and haematogenous retinal detachments. Jhala et al., 2009 reported the postoperative
complications such as corneal opacity, corneal edema, posterior capsular opacity and uveitis. Joy et al.,
2011 also reported corneal edema, corneal opacity, suture dehiscence and subsequent iris prolapse was
usually met in dogs with poor owner compliance.
Return of vision was not observed in most of the cases at the end of first week but in two cases owners
reported improvement in the activities of dogs. Startup (1967) had mentioned that a variable period of
adjustment of vision was required following the cataract surgery. Good surgical result (Fig.3) was
observed in 44.44 % operated eyes (4 out of 9 eyes), fair result was seen in 22.22 % operated eyes (2
Whitley et al., 1993 recorded 90% success rate and stated that extracapsular lens extraction method
would be a more successful procedure for cataract surgery for veterinarians with less experience of
[email protected]
DOI 10.5455/ijlr.20170215041714
Page
outcome in 75% of the cases operated by extracapsular cataract extraction method. However,
97
out of 9 eyes) and failure was noted in 33.33 % (3 out of 9 eyes). Spruell et al., 1980 got satisfactory
International Journal of Livestock Research
eISSN : 2277-1964 NAAS Score -5.36
Vol 7 (3) Mar ’17
microsurgery with lack of advanced instruments and owners with less spending willingness for their
cataractous dogs.
After 1 st week
After 2 nd week
After 4 th week
Fig3: Postoperative follow up images of operated case at 1st , 2nd and 4th week
Acknowledgement
We extend our sincere gratitude to AINP-DIMSCA, ICAR, New Delhi and College of Veterinary and
Animal Science, Rajasthan University of Veterinary and Animal Sciences, Bikaner-334001 for providing
necessary facilities and funds to carry out this work.
[email protected]
DOI 10.5455/ijlr.20170215041714
Page
1. Ameerjan 2005. Current concepts in the management of cataract in canine. (Paper presented at XXIX
Annual congress of ISVS & national symposium on Alternative teaching & Research to Animal
Experimentation in Vet surgery, pp: 35-38.
2. Barnett KC 1980. Hereditary cataract in Welsh springer spaniel. Journal of Small Animal Practice. 21:
621-25.
3. Chung CF Liang CC Lai JS Lo ES and Lam DS 2005. Safety of trypan blue 1% and indocyanine
green 0.5% in assisting visualization of anterior capsule during phacoemulsification in mature
cataract. The Journal of Cataract & Refractive Surgery. 31: 938-42.
4. Collinson PN and Peiffer RL 2002. Pathology of canine cataract surgery complications. New Zealand
Veterinary Journal. 50: 26-31.
5. Cook Cynthia 2008. Canine cataract surgery. Cataract & Refractive Surgery Today. pp: 19-21.
6. Davidson HJ and Keil SM 2001. Canine cataracts: A review of diagnostic and treatment
procedure. Journal of Veterinary Medicine. 96: 14-38.
7. Davidson MG Nasisse MP Jamieson VE English RV and Olivero DK 1991: Phacoemulsification and
intraocular lens implantation: a study of surgical results in 158 dogs. Progress in Veterinary and
Comparative Ophthalmology. 1: 233-238
8. Gelatt KN 1981. In: Veterinary ophthalmology, 2nd Edn. Gainesville, Florida. pp: 429- 60.
9. Gelatt KN and Gelatt JP 2001. Surgical procedures of the lens and cataracts. Small Animal
Ophthalmic Surgery: Practical Techniques for the Veterinarian, 3rd Edn. Butterworth-Heinemann,
Oxford, UK. pp: 286-34.
10. Hart W 1992. Adler’s physiology of the eye. 9th Edn. St Louis, USA, CV Mosby. pp: 131-164.
11. Jhala SK Parikh PV Patil DB Kelawala NH Sheth MJ Joy N and Patel AM 2009. Extracapsular
cataract extraction with intraocular lens implantation in dogs. Indian Journal of Veterinary Surgery.
30: 1-4.
12. Joy N Jhala SK Patil DB Parikh PV Sheth MJ and Mistry K 2011. Complications of extra- capsular
cataract surgery: a report of 54 cases. Indian Journal of Veterinary Surgery. 32: 27-30.
98
References
International Journal of Livestock Research
eISSN : 2277-1964 NAAS Score -5.36
Vol 7 (3) Mar ’17
Page
99
13. Magrane WG 1961. The normal eye. Canine ophthalmology, 2nd Edn. Lea and Febiger Philadelphia.
pp: 3-5.
14. Mustafa Arican Hanifi Erol Kurtulus Parlak Umit Kamis and Nuri Yavru 2014. Comparison of the
effects of intraocular pressure with phacoemulsification and extracapsular cataract extraction methods
in dogs with cataract. Eurasian Journal of Veterinary Surgery. 30: 188-194.
15. Patil VN Patil PB Parikh PV Talekar SH Patil DB Kelawala NH and Madhavi JS 2014. Cataract and
ECCE – An evaluation on 60 canine cases registered at Anand, Gujarat (India) region. European
Journal of Biomedical and Pharmaceutical Sciences. 3: 326-339.
16. Shahzad S Suleman MI Shahab H Mazour I Kaur A Rudzinskiy P and Lippmann S 2012. Cataract
occurrence with antipsychotic drugs. Psychosomatics. 43: 354-359.
17. Spreull JS Chawla HB and Crispin SM 1980. Routine lens extraction for the treatment of cataract in
the dog. Journal of Small Animal Practice. 21: 535-554.
18. Startup FG 1967. Cataract surgery in the dog. Journal of Small Animal Practice. 8: 667-691.
19. Whitley RD 1988. Focusing on eye disorders among purebred dogs. Veterinary Medicine. 83: 50-63.
20. Whitley RD McLaghlin SA Whitley EM and Gilger BC 1993. Cataract removal in dogs: the surgical
techniques. Journal of Veterinary Medicine. 88: 859-866.
21. Williams DL Health MF and Wallis C 2004. P revalence of canine cataract: Preliminary results
of cross sectional study. Veterinary Ophthalmology. 7: 29-35.
[email protected]
DOI 10.5455/ijlr.20170215041714