Amniotic membrane grafting for traumatic complete spectaculectomy and keratomalacia in a Boelen's python (Simalia boeleni).

OBJECTIVE: To describe the surgical repair of traumatic complete spectaculectomy and keratomalacia in a snake. ANIMALS: A 10.5-year-old, female, Boelen's python (Simalia boeleni) was presented with iatrogenic, near-complete spectaculectomy associated with bacterial keratitis, keratomalacia, and hypopyon. PROCEDURES: Corneal samples for cytological evaluation and bacterial culture were collected. Following medical stabilization of the bacterial keratitis, a double-layered dry amniotic membrane graft was placed. The first amniotic membrane layer was placed over the cornea with the edges tucked under the peripheral remnants of the spectacle and secured in place with fibrin glue. The second amniotic membrane layer was placed over the entirety of the spectacle remnant and secured in place with a combination of fibrin glue and sutures. Topical and systemic antimicrobials, topical ophthalmic lubricants, and systemic non-steroidal anti-inflammatory therapy were administered postoperatively. RESULTS: Heterophilic keratitis was identified by cytology and Enterobacter cloacae, Pseudomonas aeruginosa, and Staphylococcus sciuri were cultured from the corneal samples. The amniotic membrane grafts remained in place for several weeks. At 4 months postoperatively, the spectacle was completely regenerated, the subspectacular space restored, and the cornea was transparent. Spectacular vascularization and fibrosis then slowly cleared over the following 6 months. CONCLUSIONS AND CLINICAL RELEVANCE: Amniotic membrane grafting with fibrin glue is a relatively simple and effective surgical method to reconstruct extensive defects in the reptilian spectacle and to assist in the management of bacterial keratitis associated with spectacle avulsion.

Outcome of application of amniotic membrane graft in ocular surface disorders.

OBJECTIVE: To determine the outcome of application of amniotic graft in ocular surface disorders. METHODS: This cross-sectional study was conducted at Dow University of Health Sciences, Karachi, from January 2010 to December 2012, and comprised patients with ocular surface disorders. Patients' presenting symptoms and signs were recorded. Previously harvested and frozen amniotic graft was applied in different types of ocular surface disorders, such as corneal ulcers, pterygium, keratomalacia, Steven-Johnson syndrome, etc. Following the surgery, patients were assessed for improvement in symptoms and signs related to epithelialisation in corneal ulcers.. RESULTS: Of the 50 patients, 30(60%) were male and 20(40%) female. The overall mean age was 40±19.3 years (range: 9 months to 80 years). Out of the 18(36%) cases of pterygium, there was recurrence in 5(27.7%) cases. There were 26(52%) patients of corneal ulcers, of whom re-epithelialisation occurred in 21(80.7%) patients. CONCLUSIONS: Amniotic membrane grafting was found to be a safe procedure for ocular surface disorders.

Porcine urinary bladder extracellular matrix grafts (ACell Vet® Corneal Discs) for keratomalacia in 17 equids (2012-2013).

OBJECTIVE: To describe the clinical course, outcomes, and complications associated with use of commercially available porcine urinary bladder extracellular matrix (ECM) grafts (ACell Vet(®) Corneal Discs) in equid patients with keratomalacia, and to evaluate the efficacy of ECM grafts as a viable alternative to other biomaterials for corneal grafting in equid patients. ANIMALS: Sixteen horses and one donkey (17 eyes) with unilateral keratomalacia severe enough to warrant surgical repair between August 2012 and September 2013. PROCEDURE: Retrospective medical record review to identify equid patients meeting inclusion criteria of (i) diagnosis with keratomalacia severe enough to warrant surgical repair and (ii) surgical repair with an extracellular matrix graft. RESULTS: Eleven geldings, four mares, and two colts met inclusion criteria. Patients averaged 9 years of age. Twelve of 17 eyes (71%) were considered infected based on either corneal cytology (10/17, or 59%) or corneal culture (12/17, or 71%) positive for bacteria (8/17, or 47%) or fungi (9/17, or 53%). At the time topical medications were discontinued, 16 eyes (94%) were visual. One operated eye ruptured 5 days postoperatively and was enucleated. Keratouveitis developed in 14/14 eyes that underwent regular examinations approximately 2 weeks postoperatively which responded to systemic nonsteroidal anti-inflammatory drug therapy. CONCLUSIONS: Extracellular matrix grafts may be a viable alternative to other biomaterials for corneal grafting in equids. Advantages include commercial availability and shelf storage.

360-degree conjunctival grafting for management of diffuse keratomalacia in a dog.

We present a report describing use of a 360-degree conjunctival graft for management of progressive keratomalacia refractory to medical treatment in a 5-month-old American Cocker Spaniel. In the dog of this report, the extension of melting to nearly the entire corneal surface limited surgical options. Following surgery and later resection of the graft, the patient is visual with minimal corneal opacity. Numerous corneal grafting techniques have been described in companion animals, but require special materials and may not be possible when melting is extensive. Although older animals or animals with additional corneal pathology may have less ideal outcomes in terms of corneal clarity than the patient of this report, we believe that 360-degree conjunctival grafting offers a viable and cost-effective option for management of cases with extensive keratomalacia that may otherwise have resulted in enucleation.

Amniotic membrane transplantation for corneal perforation related to vitamin A deficiency.

Corneal perforation is one of the most vision-threatening consequences of vitamin A deficiency. Amniotic membrane transplantation was performed in a 36-year-old man who presented with bilateral corneal ulcers. There was a small, sharply demarcated superficial ulcer with crevices of surrounding keratinized epithelium converging on the ulcer and minimal infiltration at the inferior periphery of the right cornea. A 3-mm perforation on a 9 x 7-mm area of stromal melting was noticed in the left cornea. The serum vitamin A level was 14.0 microg/dL (normal, 24.57 to 105.71 microg/dL) at presentation. A biopsy of the right corneal epithelium was performed to confirm the diagnosis. Multilayered amniotic membrane transplantation with debridement of the necrotic corneal stroma was performed on the left cornea. In addition to systemic vitamin A replacement, topical antibiotics and lubricants were also administered. The cornea ulcers healed in 10 days along with the restoration of the serum vitamin A level. The visual acuity improved from 20/250 to 20/20 in the right eye and from light perception to hand movement in the left eye at 3 months. Amniotic membrane transplantation could save eyes with corneal perforation related to vitamin A deficiency before reconstructive surgeries, such as penetrating keratoplasty, are necessary.