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Efficacy Of Different Conjunctival Flaps For Corneal Ulceration In The Dog

By: Mubashra Mukadas | Dr. Mazhar Iqbal.
Contributor(s): Dr. Muhammed Arif Khan | Dr. Shahkeel | Faculty of Veterinary Sciences.
Material type: materialTypeLabelBookPublisher: 1997Subject(s): Department of Clinical Medicine & SurgeryDDC classification: 0499,T Dissertation note: The use of conjunctival flaps is one of the procedures adopted for the repair of cornea in cases of corneal ulceration where the medicinal therapy has limited or no effect. In the begining of the twentieth century many ophthalmic surgeons of human side as well as veterinarians used conjunctiva for the repair of corneal ulcers. They adopted many procedures for this purpose but only a few were found to be successful. These procedures were used to relieve the animal from keratopathies such as infectious keratitis, severely chemically burnt eye, damage of the cornea during accident and progressive deep ulcers. These conditions mostly cause discomfort due to ocular pain and impairment of vision and corneal surgery becomes a necessity. During this study, fifteen healthy mongrel dogs of either sex were used. These dogs were divided into 5 groups of 3 animals each. The animals of group 1, 2, 3 and 4 were operated upon for the repair of experimentally produced corneal ulcers using conjunctival hood, bridge, complete and pedicle flaps respectively. Group No.5, was kept to serve the purpose of control animals. The cornea was superficially scratched with scalpel blade in all the animals from group No.1 through group No.4 to produce corneal ulcers. The animals were then kept for 15-20 days till corneal ulcers were fully developed. The corneal ulcers thus produced were repaired afterwards, using four different types of conjunctival flaps mentioned earlier. For preparing conjunctival hood flap, a 1800 incision was made in the bulbar conjunctiva at the limbus and the conjunctiva was superficially dissected towards the fornix. The flap was then pulled centrally and sutured to the sciera with simple interrupted sutures using 6-0 silk. The complete or double hood flaps were prepared by continuing the limbal based conjunctival incision 360° around the limbus. Superficial dissection of the conjunctiva was performed 1-1.5 cm towards the fornices, thus dorsal and ventral flaps were created (by mobilizing the bulbar conjunctiva) and advanced over the cornea to meet centrally. These flaps were apposed with horizontal mattress sutures of 6-0 silk. To prepare bridge or bucket handle flaps, the conjunctiva was first superficially dissected from the limbus and the flap was created via a second incision in the conjunctiva 1-1.5 cm from and parallel to the limbal incision. The flap was then made free and shifted over the corneal ulcer and sutured with simple interrupted sutures using 6-0 silk. The pedicle flaps were dissected and advanced from the limbus and sutured to sciera, covering the corneal ulcers, with simple interrupted sutures of 6-0 silk. The conjunctival defects were left un-sutured. These procedures were first carried out on the left eyes of all the dogs and then repeated on the right eyes after the healing of left ones. It was concluded on the basis of this study that: 1. The raw bulbar surface of conjunctiva providing direct access of vascular and fibrous connective tissues can be used, to repair the corneal ulcers. 2. Vision remains almost normal during post operative period without the use of any contact or intra ocular lens. 3. There was no recurrent corneal erosion or penetrating infection, so deeper layers of cornea as well as other intra ocular structures remained normal. 4. Use of topical and/or systemic antibiotics for a long time in the post operative period was not needed. The successful attempt at repairing the corneal ulcers with the conjunctival flaps strengthened the belief in cases where there was no other way of saving the animal's vision except surgical intervention. So, it is incumbent upon the veterinarian to involve himself devotedly in the operative procedure with the aim of achieving good results. Whether he succeeds or otherwise, he must have a satisfaction of being loyal to his profession.
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The use of conjunctival flaps is one of the procedures adopted for the repair of cornea in cases of corneal ulceration where the medicinal therapy has limited or no effect. In the begining of the twentieth century many ophthalmic surgeons of human side as well as veterinarians used conjunctiva for the repair of corneal ulcers. They adopted many procedures for this purpose but only a few were found to be successful. These procedures were used to relieve the animal from keratopathies such as infectious keratitis, severely chemically burnt eye, damage of the cornea during accident and progressive deep ulcers. These conditions mostly cause discomfort due to ocular pain and impairment of vision and corneal surgery becomes a necessity.

During this study, fifteen healthy mongrel dogs of either sex were used. These dogs were divided into 5 groups of 3 animals each. The animals of group 1, 2, 3 and 4 were operated upon for the repair of experimentally produced corneal ulcers using conjunctival hood, bridge, complete and pedicle flaps respectively. Group No.5, was kept to serve the purpose of control animals. The cornea was superficially scratched with scalpel blade in all the animals from group No.1 through group No.4 to produce corneal ulcers. The animals were then kept for 15-20 days till corneal ulcers were fully developed. The corneal ulcers thus produced were repaired afterwards, using four different types of conjunctival flaps mentioned earlier.

For preparing conjunctival hood flap, a 1800 incision was made in the bulbar conjunctiva at the limbus and the conjunctiva was superficially dissected towards the fornix. The flap was then pulled centrally and sutured to the sciera with simple interrupted sutures using 6-0 silk. The complete or double hood flaps were prepared by continuing the limbal based conjunctival incision 360° around the limbus. Superficial dissection of the conjunctiva was performed 1-1.5 cm towards the fornices, thus dorsal and ventral flaps were created (by mobilizing the bulbar conjunctiva) and advanced over the cornea to meet centrally. These flaps were apposed with horizontal mattress sutures of 6-0 silk. To prepare bridge or bucket handle flaps, the conjunctiva was first superficially dissected from the limbus and the flap was created via a second incision in the conjunctiva 1-1.5 cm from and parallel to the limbal incision. The flap was then made free and shifted over the corneal ulcer and sutured with simple interrupted sutures using 6-0 silk. The pedicle flaps were dissected and advanced from the limbus and sutured to sciera, covering the corneal ulcers, with simple interrupted sutures of 6-0 silk.

The conjunctival defects were left un-sutured. These procedures were first carried out on the left eyes of all the dogs and then repeated on the right eyes after the healing of left ones.
It was concluded on the basis of this study that:

1. The raw bulbar surface of conjunctiva providing direct access of vascular and fibrous connective tissues can be used, to repair the corneal ulcers.

2. Vision remains almost normal during post operative period without the use of any contact or intra ocular lens.

3. There was no recurrent corneal erosion or penetrating infection, so deeper layers of cornea as well as other intra ocular structures remained normal.

4. Use of topical and/or systemic antibiotics for a long time in the post operative period was not needed.

The successful attempt at repairing the corneal ulcers with the conjunctival flaps strengthened the belief in cases where there was no other way of saving the animal's vision except surgical intervention. So, it is incumbent upon the veterinarian to involve himself devotedly in the operative procedure with the aim of achieving good results. Whether he succeeds or otherwise, he must have a satisfaction of being loyal to his profession.

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