Surgical Repair of Corneal Laceration Complicated by Iris Inclusion in a Dog

The prolapsed iris through a corneal perforation shallow anterior chamber with hyphema, miosis and is frequently encountered in small animal practice. dyscoria. The pupil was found to be distorted in the The condition may occur following progression of direction of corneal laceration. The physiological complicated corneal ulcers [1] or as a result of full parameters were within the normal range and the thickness corneal lacerations [2]. A prolapsed iris prolapsed iris tissue appeared to be fresh. Hence should be treated as an ocular emergency and requires surgical iris reposition and corneal wound repair under immediate surgical intervention for better prognosis. general anaesthesia was resorted too. The surgical repair usually involves correct reposition Treatment of viable iris tissue or excision of the incarcerated tissue, as well as adequate closure of corneal wound Topical instillation of 1% atropine sulphate [3]. The different corneal bandaging techniques using ophthalmic solution was done prior to surgery to contact lenses, collagen based biomaterials, cyano- achieve mydriasis. Pre-operatively, ceftriaxone acrylate tissue adhesives, corneal graft, third eye lid sodium was administered at the rate of 25 mg/kg body flap, conjunctival flap and temporary tarsorrhaphy for weight intravenously. The dog was premedicated with the repair of full thickness defect in cornea has also atropine sulphate at the rate of 0.045 mg/kg body been described [4]. However, traumatic prolapse of iris weight followed by xylazine hydrochloride at the rate and its surgical repair are less frequently documented. of 1.5 mg/kg body weight, both given intramuscularly. This paper presents a case of corneal laceration General anaesthesia was induced with ketamine complicated by iris inclusion in a dog and its surgical hydrochloride at the rate of 5 mg/kg body weight, repair using collagen sheet prepared from bovine administered intramuscularly. Anaesthesia was mainsmall intestine submucosa adjunct to corneal suturing tained by intravenous infusion of a combination of after iris reposition. xylazine hydrochloride and ketamine hydrochloride, equal quantity by volume and diazepam, given 'to Case History and Clinical Observations effect' along with 5% dextrose saline. The periocular A six month old male non-descript dog was area was carefully clipped and scrubbed with presented to the Veterinary College Hospital, povidone iodine solution diluted with normal saline Mannuthy with the complaint of a dark brown colored (0.2%). The corneal and conjunctival surfaces were mass protruding out from the right eye. History irrigated with isotonic balanced salt solution and the revealed trauma by a sharp object four hours ago. The periocular area was painted with povidone iodine animal was dull and depressed. On clinical solution. The dog was positioned in left lateral examination, the mass was found to be iris, which got recumbency with the eye placed under the objective entangled in the perforated cornea at 10 O'clock lens of the operating microscope (10x). Povidone position (fig. l). The dog showed epiphora, severe iodine (5% w/v) was instilled and the face was draped. blepharospasm and photophobia. Ophthalmic The Castroviejo lid speculum was applied for better


Introduction
examination revealed distorted cornea with focal corneal oedema and fibrin clot at the site of laceration, The prolapsed iris through a corneal perforation shallow anterior chamber with hyphema, miosis and is frequently encountered in small animal practice.dyscoria.The pupil was found to be distorted in the The condition may occur following progression of direction of corneal laceration.The physiological complicated corneal ulcers [1] or as a result of full parameters were within the normal range and the thickness corneal lacerations [2].A prolapsed iris prolapsed iris tissue appeared to be fresh.Hence should be treated as an ocular emergency and requires surgical iris reposition and corneal wound repair under immediate surgical intervention for better prognosis.general anaesthesia was resorted too.The surgical repair usually involves correct reposition Treatment of viable iris tissue or excision of the incarcerated tissue, as well as adequate closure of corneal wound Topical instillation of 1% atropine sulphate [3].The different corneal bandaging techniques using ophthalmic solution was done prior to surgery to contact lenses, collagen based biomaterials, cyanoachieve mydriasis.Pre-operatively, ceftriaxone acrylate tissue adhesives, corneal graft, third eye lid sodium was administered at the rate of 25 mg/kg body flap, conjunctival flap and temporary tarsorrhaphy for weight intravenously.The dog was premedicated with the repair of full thickness defect in cornea has also atropine sulphate at the rate of 0.045 mg/kg body been described [4].However, traumatic prolapse of iris weight followed by xylazine hydrochloride at the rate and its surgical repair are less frequently documented. of 1.5 mg/kg body weight, both given intramuscularly.This paper presents a case of corneal laceration General anaesthesia was induced with ketamine complicated by iris inclusion in a dog and its surgical hydrochloride at the rate of 5 mg/kg body weight, repair using collagen sheet prepared from bovine administered intramuscularly.Anaesthesia was mainsmall intestine submucosa adjunct to corneal suturing tained by intravenous infusion of a combination of after iris reposition.
xylazine hydrochloride and ketamine hydrochloride, equal quantity by volume and diazepam, given 'to

Case History and Clinical Observations
effect' along with 5% dextrose saline.The periocular A six month old male non-descript dog was area was carefully clipped and scrubbed with presented to the Veterinary College Hospital, povidone iodine solution diluted with normal saline Mannuthy with the complaint of a dark brown colored (0.2%).The corneal and conjunctival surfaces were mass protruding out from the right eye.History irrigated with isotonic balanced salt solution and the revealed trauma by a sharp object four hours ago.The periocular area was painted with povidone iodine animal was dull and depressed.On clinical solution.The dog was positioned in left lateral examination, the mass was found to be iris, which got recumbency with the eye placed under the objective entangled in the perforated cornea at 10 O'clock lens of the operating microscope (10x).Povidone position (fig.l).The dog showed epiphora, severe iodine (5% w/v) was instilled and the face was draped.blepharospasm and photophobia.Ophthalmic The Castroviejo lid speculum was applied for better

To cite this article:
Sarangom SB, Baburaj NK, D'Sa TE, Venugopal SK (2012) Surgical repair of corneal laceration complicated by iris inclusion in a dog, Vet World, 5(10): 624-626, doi: 10.5455/vetworld.2012.631-633exposure.The adhesions between the protruded iris thickness lacerations penetrate the chamber rapidly and cornea were gently separated and the iris was and may traumatize the intraocular structures and replaced back to its normal position with the help of an hence require complete ophthalmic and physical iris spatula.The blood clots in the anterior chamber examination.were carefully removed by gentle flushing with In the present case, the clinical signs were similar balanced salt solution using an irrigation canula.The to that reported by Mandell and Holt [6].The edges of corneal wound were grasped with Colibri reposition of iris was resorted to since the tissue was forceps and were apposed by simple interrupted found to be fresh.The topical instillation of cycloplegic, sutures using No. 6-0 monofilament polyamide 1% atropine sulphate solution (ophthalmic) helped to without perforating the cornea completely (fig.2).The dilate the pupil and also to decrease the discomfort of anterior chamber was reconstituted with balanced salt the patient.Monofilament polyamide being nonsolution along with a small air bubble before placing irritant, non-capillary and biologically inert was the last corneal suture.A collagen diskette prepared preferred for suturing the cornea.The corneal sutures from submucosa of bovine small intestine was spread were placed deeply in the stroma down to the over the cornea after soaking with gentamicin eye Descemet's membrane without perforating the cornea drops for 15 minutes and temporary tarsorrhaphy was completely, as the endothelium is exquisitely sensitive done.
to trauma [3].Even though anaesthesia was induced Postoperatively, moxifloxacin eye drops (four with ketamine hydrochloride, the combination with times daily) and flurbiprofen eye drops (two times diazepam for maintenance reduced the ketamine daily) were instilled for 7 days.Orally, cefixime at the induced increase in intraocular pressure and thereby rate of 10mg/kg body weight and meloxicam at the suture tension [7].Topical instillation of flurbiprofen rate of 0.2 mg/kg body weight were administered for 5 provided considerable analgesia and helped to control days.Elizabethan collar was used postoperatively for inflammation.The corneal sutures were removed on th two weeks to prevent self mutilation.The corneal sutures the10 day, although corneal wounds depend on th were removed on the 10 day.Mild vascularisation sutures for tensile strength for at least 16 days [8].and opacity were noticed at the suture line (fig.3), Corneal healing with vascularisation was noticed on th which resolved later and the animal had an uneventful the 7 day itself.Also, the collagen based biomaterial, recovery.
bovine small intestine submucosa used in the present case was found to reduce the healing period of corneal Discussion defect as observed by Anoop et al. [9].The prognosis Corneal injuries are common in canines, especially for vision and cosmetic appearance in case of in puppies in which the ocular protective mechanisms prolapsed iris and lacerated cornea is fair to good if the like menace reflex are not fully developed.The damaged cornea is repaired, provided the intraocular prolapsed iris through a corneal laceration is an ocular structures are not severely damaged by trauma.The emergency that result in severe ocular pain and may complications associated with iris prolapse and lead to loss of vision, if left untreated.According to corneal laceration included uveitis, endophthalmitis, Sansom [5], the extrusion of iris through the cornea panophthalmitis, anterior synechia, pigmentation, will seal the wound, but remains as a potent tract to secondary glaucoma and dehiscence of suture.
However, no such complications were noticed in the intraocular infection.The objects inducing full emergencies.Vet.Clin.North Am.Small Anim.Pract.