Eyelid Flap Research Articles

Qualitative use of ICG angiography and lymphography in periorbital surgery

ABSTRACT Purpose Open imaging fluorescence devices have been utilized in surgical oncology, vascular and plastic surgery; however, the role of indocyanine green (ICG) in periorbital surgery and lymphatics has not been explored. Methods A prospective, single-center diagnostic study was conducted from 2021 to 2022 utilizing ICG to assess both the periorbital vasculature and lymphatics. Fluorescence was captured with open-imaging fluorescent devices. For ICG angiography, a total of 5–10 mg of ICG was given intravenously at various time points to visualize intraoperative blood flow to eyelid flaps, vascular tumors, or extraocular muscles. For ICG lymphography, 0.03–0.06 mg of ICG was injected subcutaneously to visualize the periorbital and facial lymphatic drainage. Results Twenty-two patients underwent ICG angiography. Periorbital vascular supply was seen in eyelid reconstructions (n = 8), anophthalmic reconstructions (n = 2), lacrimal gland tumors (n = 2), orbital venous malformations (n = 2), tumor metastasis (n = 1) and benign tumors (n = 1). The anterior ciliary arteries were visualized to the extraocular muscles in fracture repairs (n = 3) and muscle biopsies (n = 2). Ten patients underwent ICG lymphangiography highlighting the global periorbital lymphatic system. Conclusion ICG allows for visualization of the vasculature of extraocular muscles and tumors, assessing perfusion of flaps during reconstruction and the global periorbital lymphatic drainage pathways.

Changes in Lacrimation in experimentally induced Corneal Ulcers in Rabbits, treated with Third Eyelid Flap, Hyaluronic Acid and Platelet-Rich Plasma products

Changes in Lacrimation in experimentally induced Corneal Ulcers in Rabbits, treated with Third Eyelid Flap, Hyaluronic Acid and Platelet-Rich Plasma products

Fresh preserved canine amniotic membrane (CAM ) as graft for surgical management of melting corneal ulcer/ keratomalacia in a dog

A four-year-old female Spitz with signs of blepharospasm, ocular discolouration, corneal oedema, gelatinisation of cornea and epiphora from the right eye, for 20 days was presented at Teaching Veterinary Clinical Complex, Pookode. Fluorescein dye test (FDT) revealed intense staining of the cornea. The condition was diagnosed as keratomalacia. Under general anaesthesia, fresh preserved canine amniotic membrane (CAM) transplantation was performed along with a third eyelid flap. Antibiotic eye drops and supportives were initiated. Monitoring of corneal healing was done on the 10th, 20th, 30th and 45thdays, post-surgery. FDT turned negative on day 20. Conjunctival hyperaemia, pannus, corneal opacity and oedema improved postoperatively, resulting in good corneal clarity, fundic reflection and normal vision by day 45. The present article reports the successful management of keratomalacia using CAM as graft.

Levator Palpebrae Superioris With Inferior Oblique Muscle Flaps for Total Ocular Surface Reconstruction.

A healthy middle-aged man sustained extensive burns after a motor vehicle accident, including fourth-degree burns to the ocular adnexa. He had bilateral eyelid necrosis with complete tissue loss to the orbital rim. Progressive corneal thinning occurred bilaterally despite frequent lubrication, weekly amniotic membrane placement, and a Gunderson flap, ultimately requiring evisceration of his OS. In accordance with family wishes to perform all interventions for the OD, he underwent ocular surface reconstruction with levator palpebrae superioris (LPS) and inferior oblique (IO) muscle flaps, supplemented with an orbital fat transfer and bucket-handle muscle flap. These flaps were covered with porcine urinary bladder matrix and remained viable with complete globe coverage postoperatively. Although local eyelid flaps traditionally involve tissue supplied by branches of the external carotid artery, this case suggests that orbital-internal carotid artery based flaps utilizing the LPS and IO muscles may achieve ocular surface coverage after complete periocular and facial soft tissue loss.

Management of traumatic ulcerative keratitis in a Red Serow

Red Serow Capricornis rubidus is an elusive herbivore native to the montane forests of the Himalaya. Currently it is categorized as ‘Vulnerable’ in the IUCN Red List and placed under Schedule I species of the Wildlife Protection Act, 1972. A serow was presented with complaints of mild inappetence, irritability, sporadic scratching of head over the enclosure barrier and serous ocular discharge from the left eye. Based on detail clinical examination, the animal was diagnosed with unilateral conjunctivitis, corneal oedema, and ulcerative keratitis. A combination of Xylazine @ 1.5mg/ kg body weight and Zolatile® (zolazepam and tiletamine) @ 2.5 mg/kg body weight was used to chemically restrain the animal, followed by auriculo-palpebral nerve block using 1 ml of 2 % lignocaine hydrochloride. The affected eye was adequately cleaned with isotonic sterile Normal Saline solution (NSS). Combination of 0.5 ml of ceftriaxone and 0.5 ml of flubiprofen was injected into upper and lower palpebral conjunctiva. The cornea and the third eyelid flap were carefully sutured using 5-0 and 3-0 Vicryl, respectively. Finally, tarsorrhaphy was done using 2-0 nylon. Post-operative care consisted of an antibiotic regimen of Cephalaxin @ 20 mg/ kg body weight b-i.d-twice in a day for seven days along with probiotic supplement (Vizylac®) and Vitamin A capsules (Aquasol A®) orally once daily for the next 30 days. The animal showed complete recovery within 30 days of proper treatment, monitoring, care and management.

Corneal Ulcer in a Sheep - Treatment with Third Eyelid Flap

Background: Corneal ulcers are frequently reported in the literature in several species, however, the treatment of traumatic lesions on the corneal surface of ruminants is still poorly described. The use of the third eyelid flap is questioned when applied to deep ulcers, since the technique prevents the evolutionary follow-up of corneal healing and compromises care. However, several authors report its successful use for the treatment of superficial and deep corneal ulcers. This technique protects the ocular surface and prevents the occurrence of new lesions or their aggravation. The aim of this study was to report the treatment of corneal ulcers in sheep through the third eyelid flap associated with the use of topical antibiotics.Case: A 2-year-old Dorper sheep, with ocular discomfort, conjunctival hyperemia and mucopurulent secretion in the left eye, was assisted in a private rural property in the West region of Bahia, Brazil. The owner reported that before seeking veterinary help he used a spray based on oxytetracycline and hydrocortisone, which worsened the animal's condition. Upon inspection, it was observed eyelid asymmetry, slight lateralization of the head to the left, periorbital alopecia on the left face, intense blepharospasm in the left eye, with projection of the third eyelid occurring at times. The ophthalmic examination was performed after application of anesthetic eye drops based on proxymetacaine to reduce eye discomfort. A corneal stromal lesion, edema and fibrovascular tissue in the left eye were identified, but the cause of the lesion was not defined, with lagophthalmia, entropion, dystychiasis or ectopic cilia being ruled out. So, it was suggested that the lesion had occurred by a foreign body, such as dust or feed fiber. The contralateral eye showed no changes, Schirmer 15 mm, no changes in sensory and sensory reflexes and negative fluorescein. No signal clinical disease. Due to the severity of the lesion, it was performed a third eyelid flap associated with drug treatment with ciprofloxacin eye drops, every 8 h for 21 days. The animal was placed in the right lateral decubitus position and palpebral akinesia was achieved with the application of 2 mL lidocaine without vasoconstrictor in the region of the auriculopalpebral nerve. This was followed by the routine performance of the third eyelid flap.Discussion: The delay in seeking veterinary care and the application of spray based on oxytetracycline and hydrocortisone aggravated the lesion, since the corticosteroid delays corneal healing and favors the aggravation of the lesion. After desensitization of the cornea, the animal allowed eye manipulation and it was possible to observe the lesion and choose the best treatment, with option for the third eyelid flap because it is a simple and fast technique, does not require special equipment or materials, ideal for performed in the field and is widely used in the treatment of injuries involving the cornea and, besides that, helps to contain corneal perforation and protect the ocular surface. Corneal debridement was also performed to remove necrotic debris and improve drug action, in addition to using broad-spectrum antibiotic eye drops until complete regeneration of the lesion. Twenty-one days after the surgical procedure, the patient had no ocular discomfort, the flap was removed and no changes in the corneal surface were observed. The treatment was considered satisfactory for the healing of the corneal ulcer, guaranteed the esthetics and visual function of the sheep.Keywords: keratitis, surgery, ciprofloxacin, ocular, ruminant.

Corneal Stromal Abscess in a Dog

ABSTRACTBackground: The eye is an important sense organ responsible for sight. The cornea is the outermost of many eye layers, being predisposed to several lesions, some of them being frequent in small animal clinics meanwhile others are unusual and seldom reported in specialized literature. The stroma abscess is a common condition in horses, but atypical in dogs, it's a condition in which a microperforation in the corneal epithelium allows microorganisms or a foreign body to penetrate the corneal stroma, and those become inside the cornea after a re-epithelialization, producing an intense inflammatory response. Therefore, this case reports a case of deep stromal abscess in a Shih Tzu dog.Case: A 4-year-old female Shih Tzu, weighing 4.6 kg, was submitted to ophthalmic examination in which the left eye presented an opaque yellowish-white protruding structure located on the right side, in the center of the cornea (3 o´clock position), bulbar and palpebral conjunctival hyperemia and congestion, chemosis, blepharospasm, and a moderate amount of mucous discharge. The clinical diagnosis was stromal abscess with reflex uveitis. A differential diagnosis should include conditions affecting the anterior part of the cornea, such as an epithelial inclusion cyst and a corneal ulcer. The inclusion cyst, contrarily to the corneal abscess, doesn't cause pain, meanwhile, the corneal ulcer was ruled out by the Fluorescein Staining Test. The recommended treatment was surgical, through lamellar keratectomy, followed by overlapping pedicled conjunctival graft and third eyelid flap. In association with the surgical treatment, oral antibiotics, anti-inflammatory, and opioids, plus topical antibiotics and autologous serum eye drop. Seventy days post-surgery, the previously observed inflammatory signs were no longer present. In the conjunctival graft insertion site perpetuated a scar leucoma with few blood vessels. The therapy was proven effective in solving the stromal abscess and in visual maintenance. Despite the located opacity due to leucoma, it barely causes any impairment, once its lateral position won't impact the central vision, which is more important to predator species than the peripheral vision.Discussion: Stromal abscess is a pathological condition in which an initial perforating corneal injury leads to a rupture of the epithelial barrier, allowing the access of bacterial, fungus, or foreign bodies of organic nature. The morbidity is more frequent in horses, but this report shows that although uncommon, stromal abscesses can occur in dogs. The diagnosis was achieved by an analysis of the clinical history and findings. Conditions that affect the anterior cornea must be among differential diagnoses. Treatment aims for the removal of infectious material with debridement and curetting of the stroma, by performing the lamellar keratoplasty technique, which produces a corneal wound. The implementation of a pedicled conjunctival graft allows, the influx of growth factors, active replication of stromal collagen by fibroblasts, and direct arrival of antibiotics through the blood supply to the exposed portion of the cornea. The third eyelid flap is questioned by some authors, once it complicates the post-op follow up, and hinder the topical therapy from directly reaching the eye surface. Autologous serum: A blood-derived product often used to control corneal melting. The Federal Medicine Board determined that autologous serum eyedrops therapy has been scientifically proven effective, being used worldwide in the treatment of severe eye surface conditions. In Veterinary, studies also demonstrated that autologous serum can improve improve the corneal re-epithelialization in dogs. Keywords: autologous serum, keratectomy, ophthalmology, veterinary.Título: Abscesso estromal em córnea de cãoDescritores: soro autólogo, ceratectomia, oftalmologia, veterinária.

Use of SoftShield® collagen lenses in feline corneal sequestrum surgery

Feline corneal sequestrum develops secondary to the quantitative or qualitative deficit of the lacrimal tear film or represents a sequela in the healing process of corneal ulcers. The classic surgical approach is keratectomy and corneal-conjunctival flap for which not only special equipment is required (surgical microscope, cornea surgery kit), but also good knowledge of the technique of corneal sutures. For 32 cats diagnosed with corneal sequestrum (Persian, Exotic Shorthair, British Shorthair and Domestic Shorthair), a new surgical protocol was performed: keratectomy, application of the SoftShield® collagen contact lens and third eyelid flap. The sutures were maintained for three weeks. The healing of the cornea was achieved with minimal scarring, compared to the cases in which the corneal-conjunctival flap was performed. This surgical technique for feline corneal sequestrum can be performed by any veterinarian because it does not require special equipment or knowledge of corneal suture techniques.

Composite axial eyelid flap in the surgical management of orbitopalpebral neurofibromatosis

Background: Orbitopalpebral neurofibroma is a progressive and debilitating disease with the potential of affecting the orbital, temporal and facial region. Lack of capsule and its infiltrative nature yields to difficulty in complete removal. Aims and Objectives: In this interventional case study, nine patients between the ages of 12–30 years diagnosed with orbitopalpebral neurofibromatosis underwent palpebral remodeling with composite axial eyelid flap for esthetic purpose and alleviation of visual impediment. Material and Methods: The clinical course for every individual was scored using Ptosis, Canthal involvement, and Oculopalpebral Diastasis (PCD) score on regular follow-ups. Results: For majority of the cases, an improvement was noted on the PCD scale. Conclusion: This series demonstrates that a tailored approach to each individual helps in attaining a balance between function and esthetic outcomes.

Surgical management of infectious and noninfectious melting corneal ulcers in cats

A melting ulcer, characterized by the stromal dissolution of the cornea, is an important eye lesion that develops due to various reasons and threatens vision. Restoration of this lesion, which causes loss of corneal transparency, requires aggressive medical and surgical treatment. In medical treatment, stromal degeneration is controlled with agents that support topical antibacterial and stromal healing. Surgical treatment is applied using various techniques to remove structures damaged due to the progression of corneal melting and to promote corneal healing. In this study, lamellar keratectomy and the third eyelid flap techniques were combined with topical medical therapy in 20 cat cases with melting ulcers. The aim of this study was to alert to general practitioners that this condition is an important cause of progressive eye loss and necessitates urgent intervention and to show that this treatment approach is easy to implement and has successful results. Key words:

Bilateral Third Eyelid Flap Surgery in a Domestic Shorthair with Severe Acute Bullae Keratopathy

Bilateral Third Eyelid Flap Surgery in a Domestic Shorthair with Severe Acute Bullae Keratopathy

Blood Perfusion in Rotational Full-Thickness Lower Eyelid Flaps Measured by Laser Speckle Contrast Imaging.

Large upper eyelid defects can be repaired by rotational full-thickness lower eyelid flaps. The aim was to measure the blood perfusion in such flaps, and how it is affected by the length of the flaps, and the degree of rotation and stretching. Nine patients underwent the Quickert procedure for entropion repair in which a full-thickness eyelid flap of approximate width 0.5 cm and length 2 cm was dissected in the lower eyelid. This generates a full-thickness eyelid flap similar to that used to repair large upper eyelid defects. Perfusion was measured using laser speckle contrast imaging, before and after the flap was rotated 90° and 120°, and stretched using forces of 0.5, 1, and 2 N. Blood perfusion decreased gradually from the base to the tip of the flap; being 75% of the reference value 0.5 cm from the base, 63% at 1.0 cm, 55% at 1.5, 23% at 1.75 cm, and 4% at 2.0 cm. Rotating the flaps by 90° or 120° had little effect on the perfusion. Stretching reduced the perfusion from 63% to 32% at 2 N, when measured at 1 cm. The combination of stretching and rotation did not lead to any further decrease. Blood perfusion in lower eyelid rotational flaps seems to be more sensitive to stretching than to rotation. Provided the flap is no longer than 1.5 cm, the perfusion will be greater than 20%, even when rotated, which should be sufficient for adequate survival and healing.

Perfusion in Upper Eyelid Flaps: Effects of Rotation and Stretching Measured With Laser Speckle Contrast Imaging in Patients.

The aim of this study was to investigate how the blood perfusion in human upper eyelid skin flaps is affected by the length of the flap and the degree of stretching and rotation of the flap. Twenty-nine upper eyelids were dissected as part of a blepharoplastic procedure in patients. The 1-cm wide proximal end of the flap remains attached, to mimic a random pattern skin flap (hereafter called a "skin flap"). Blood perfusion was measured with laser speckle contrast imaging before and after the flap was stretched with forces of 0.5, 1, and 2 N. The flap was then rotated 90°, and the same tensions were applied. Blood perfusion decreased gradually from the base to the tip of the flap. The flap was only well perfused in the proximal 1 cm (60% at 0.5 cm and 37% at 1.0 cm) and was minimally perfused beyond 2 cm (22% at 2.0 cm). Stretching the nonrotated flaps affected perfusion slightly (decreased to 43% at 0.5 cm). Simply rotating the flaps by 90° had no significant effect on the perfusion. The combination of rotation (90°) and stretching reduced the perfusion to 22% at 2 N, when measured 0.5 cm from the base. Blood perfusion in upper eyelid skin flaps decreases rapidly with distance from the base of the flap. Rotating and stretching the skin flap reduces blood perfusion even further, leading to minimal perfusion in this kind of flap at distances greater than 1.5 cm from the base.

Bullous Keratopathy in a dog treated with Third Eyelid Flap and Autologous Serum Eye Drops

Background: Bullous Keratopathy (BK) is characterized by decompensation of the corneal stroma resulting in visual impairment by corneal opacity, discomfort, excessive tearing, blepharospasm and pain. The aim of this study was to report a case of BK in a dog and the complete recovery of the ocular structure and visual function, with a third eyelid flap associated with the use of autologous blood serum topically.Case: A 2-year-old Shih Tzu male dog, weighing 4.3 kg, with recurrent bilateral eye discomfort was brought to Ophthalmologist Veterinarian Assistance. The patient had already been seen by other veterinarians, but the signs returned in a short period of time after the prescription was suspended. During physical examination it was observed moderate blepharospasm in the right eye, epiphora in the left eye, and in both eyes was noted exophthalmos, medial corneal entropion, caruncle trichiasis and ectopic cilia in the upper and lower eyelids. Fluorescein test was positive in both eyes, and a large bullous, opaque and gelatinous lesion with irregular appearance was observed occupying a large part of the cornea of the right eye. Superficial corneal ulcer was diagnosed in left eye and BK in right eye, both probably in consequence of ectopic cilia presence. Surgical intervention was made, with the cauterization and excision of the ectopic cilia and third eyelid flap in the right eye. The cauterization of caruncle trichiasis was not authorized by the owner. Moxifloxacin eye drops in the dose of one drop four times a day in both eyes, lubricant based on hyaluronic acid in the dose of one drop four times a day in both eyes, and autogenous blood serum, obtained from the centrifugation of a blood sample of the dog itself, in the dose of one drop every hour in the right eye for 24 hours, and meloxicam in the dose of 0.1 mg/kg every 24 h for 3 days were prescribed. Elizabethan collar was recommended until removal of the third eye flap. During the surgery, a sample of eye secretion was collected and sent for culture and antibiogram and did not show growth of microorganisms. After seven days of the procedure, the animal did not show eye discomfort and corneal ulcer in the left eye was healed. The third eye flap remained stable until the return of 28 days and after removal of the capton, adhesions were identified, which were removed with Castroviejo scissors after application of topical anesthetic proxymetacaine hydrochloride eye drops. A fluorescein test was performed and the absence of corneal keratitis was confirmed. Discrete corneal scars (macula) were identified.Discussion: The patient in this report had several changes in ocular morphology that favored the formation of recurrent injuries which contributed to the formation of BK. The use of topical medications as unique treatment was not performed due to the severity of the lesion and the presence of alterations such as medial entropion, caruncle trichiasis and ectopic cilia that needed surgical corrections to resolve the causes of the lesions. In order to protect the cornea and provide compression of its epithelium, a third eyelid flap was performed, a low-invasive procedure that is quick and easy to perform. Ectopic cilia were cauterized to eliminate one of the causes of the corneal injuries, however, the other changes could not be corrected because they were not authorized by the owner. The adjuvant uses of ocular lubricant based on hyaluronic acid, a broad-spectrum topical antibiotic and mainly autogenous blood serum favored the epithelial reconstruction of the cornea by providing protection, vitamins, growth factors, immunoglobulins, anti-collagenolytic and bacteriostatic substances. The protocol used it enabled a rapid reduction in patient discomfort, reversal of injuries and recovery of visual function.

Clinical Aspects of Amniotic Membrane Implants in Corneal Repair in Dogs with Complicated Ulcers

Background: Among numerous disorders treated by veterinary ophthalmology, therapies employed to solve corneal ulcers stand out. Amniotic membrane transplantation is an effective surgical technique for the treatment of complicated corneal ulcers in the dog, with highly satisfactory visual and cosmetic outcomes. However, in veterinary ophthalmology, reports on the use of the amniotic membrane and its corneal reconstructive potential are scarce. The objective of this work was to evaluate, for 21 days, the clinical aspects and the effectiveness of transplantation of canine amniotic membrane for corneal healing in two cases of complicated ulcers in dogs.Cases: Two Shih-Tzu dogs were diagnosed with complicated corneal ulcer. They underwent surgical treatment with the use of a glycerin-preserved canine amniotic membrane implant, which was secured on the cornea or the limbus. A surgical microscope at a magnification of 16x was used. The devitalized tissues at the periphery of the ulcer were excised, and multiple layers of amniotic membranes were sutured onto the cornea and near the limbus with interrupted absorbable suture. Protection of the canine amniotic membrane implants was performed with a scarified third eyelid flap, which was attached to the upper eyelid, and maintained for 14 days. During the first 14 days after the procedure, topical treatment with antibiotic eye drops was administered; protease inhibitors were also used. Antibiotics were used systemically for 10 days. Between days 14 and 21 after the transplantation procedure, protease inhibitors, corticosteroids, and lubricant were administered topically. Healing and clinical aspects were evaluated on days 0, 14, and 21. The parameters evaluated were blepharospasm, dazzle and direct pupillary reflexes, and consensual and threat responses. Corneal vascularization, hypopyon, synechia, opacity, and fluorescein dye penetration into the cornea were evaluated. The patient whose membrane was attached to the cornea was named COr, and the animal whose membrane was attached to the corneal limbus was named PLi. Blepharospasm and positive fluorescein test were detected only on the first day of the experiment; whereas, the dazzle and pupillary reflexes, as well as the consensual response, were present in both animals at all evaluated time points. Only COr exhibited hypopyon on day 0. Synechia was not observed in any of the animals at any of the time points. On the 21st day, COr exhibited deep vascularization and an opaque scar, while PLi exhibited only discrete vessels without blood perfusion, secondary to corneal repair.Discussion: A smooth operation of the central and peripheral ophthalmic system was maintained at all periods evaluated. The protection provided by the membrane contributed to corneal healing by reducing stimulation of nerve endings on the epithelium and stroma, and suppressing the blepharospasm reflex. The amniotic membrane used as an adjuvant has antimicrobial and anti-inflammatory properties, inhibits proteinases and mediators of inflammation, and exerts a mechanically protective effect. The corneal vascularization observed in both animals is related to the healing processes stimulated by filling the deep corneal lesions with the membrane. When used in addition to drug therapy, the amniotic membrane can inhibit postinflammatory neovascularization, fibroblast activity, collagen deposition, scarring, and opacifications. Accurate diagnosis, and correct therapeutic and surgical management, is fundamental for the successful treatment of corneal ulcers. In this work, canine amniotic membrane preserved in glycerin was used for the surgical treatment of complicated ulcers in dogs along with adequate clinical therapy. This was effective independent of the different anchorage techniques used, and led to satisfactory clinical results and short-term corneal healing.

Successful management of corneal ulcer using third eyelid flap technique in an Assam Hill goat – A case report

Successful management of corneal ulcer using third eyelid flap technique in an Assam Hill goat – A case report

Effect of Human Amniotic Membrane Transplantation in Reconstruction of Canine Corneal Wound

In our experimental study we evaluated the efficacy of human freeze-dried amniotic membrane on healing of corneal wound defect in dogs. A corneal wound was performed by using corneal trephine 8.5 mm in diameter. A total of 14 dogs were divided into two groups of 7 dogs in each: (A) Control group; (B) AM group treated by transplantation of freeze-dried human amniotic membrane in conjunction with a third eyelid flap. Clinical outcome was monitored by evaluation of epiphora, ocular discharge, corneal vascularization, corneal opacity and corneal epithelization at the 7th, 11th, 15th and 30th days post surgery. Fluorescein staining was used to estimate the closure of the corneal wounds. Histopathological examination was performed in two dogs of each group; the thickness of the newly generated cornea was measured by using Image j analysis software. The control group was complicated with severe neovascularization, ocular discharge and corneal opacity. There were excessive thickness in the stroma of control group as reflect of inflammatory reaction. The AM group showed mild degree vascularization which was completely absent by the end of experiment. Corneal epithelialization was completed within 15 days after the transplantation in the AM group. In conclusion, transplantation of human amniotic membrane improves canine corneal epithelial wound healing effectively.

Blood perfusion in Hewes tarsoconjunctival flaps in pigs measured by laser speckle contrast imaging

BackgroundHewes flap is a tarsoconjunctival eyelid flap, based at the lateral canthal tendon, and rotated and stretched to repair lateral defects in the lower eyelid commonly following tumor surgery. The aim of the present study was to monitor perfusion in a Hewes flap during reconstruction, which to the best of our knowledge, has not previously been done. MethodsA Hewes tarsoconjunctival eyelid flap was raised and the effects on blood perfusion of rotating the flaps by 90° and 180°, stretching the flaps with a force of 5 or 10 N, and repeated diathermic coagulation was monitored with laser speckle contrast imaging. ResultsRotating the flaps by 90° did not significantly affect perfusion, while further rotation to 180° reduced blood perfusion to 75% of the baseline value. When the tarsoconjunctival flaps were both rotated 90° and stretched with 5 N, the perfusion was reduced even further, to 63%. A further reduction in perfusion, to 36%, was seen when the higher force of 10 N was applied. Diathermy decreased blood perfusion to 56% after being applied once. Successive applications led to further decreases: 43%, 31%, and 15%, after the second, third and fourth applications. ConclusionsPerfusion in Hewes tarsoconjunctival flaps is affected by both rotation and stretching, but some perfusion is maintained despite these manipulations. Diathermy, however, has detrimental effects and should be avoided.

Clinical Evaluation of Surgical Procedures for Corneal Ulcer in Dogs

The present study was conducted on 12 dogs, irrespective of age sex and breed, having corneal ulcer to evaluate the response of surgical procedures on corneal ulcer. The animals were randomly divided into two groups, in group I temporary tarsorrhaphy and in group II third eyelid flap surgery was performed along with pre and post-operative systemic and local medication. Preoperative ophthalmoscopic examination was performed before starting the treatment, i.e. day 0, to check the general health status of the animals, followed by day 15, 30, 45 and 60 post-operative examination to record the healing of corneal ulcer. In group I lesser complications were observed as compared to group II and 66.66% and 50.00% dogs recovered without scar formation on 60th post-operative day in group I and II, respectively. Thus temporary tarsorrhaphy was observed superior then the third eyelid flap surgery as well as combination of moxifloxacin and flurbiprofen was found satisfactory for the healing of corneal ulcer.

Optimal Epinephrine Concentration and Time Delay to Minimize Perfusion in Eyelid Surgery: Measured by Laser-Based Methods and a Novel Form of Extended-Wavelength Diffuse Reflectance Spectroscopy.

This study investigates the hypoperfusion effects of epinephrine in local anesthesia in eyelid surgery. A novel form of extended-wavelength diffuse reflectance spectroscopy was evaluated. Blood perfusion in porcine eyelid flaps was measured using laser Doppler velocimetry and laser speckle contrast imaging, whereas the tissue response was measured using diffuse reflectance spectroscopy with a broad spectrum (450-1550 nm). Epinephrine was either injected cumulatively, 0.1 (1:10,000,000), 1.0 (1:1,000,000), 10 (1:100 000), and 100 μg/ml (1:10 000), to determine the dose-response relation, or given as a single dose (10 μg/ml). Control experiments were performed with saline or lidocaine. Increasing concentrations of epinephrine resulted in a gradual decrease in tissue perfusion, measured by laser Doppler velocimetry and laser speckle contrast imaging, approaching a minimum after the injection of 10 μg/ml. Similar tissue response was observed with diffuse reflectance spectroscopy. The time from the injection of epinephrine (10 μg/ml) to the stabilization of hypoperfusion was 75 seconds. After administration of 10 μg/ml epinephrine, about 20% of the blood perfusion remained, supporting the use of epinephrine in eyelid flaps with a narrow pedicle. 10 μg/ml epinephrine appears to be adequate for vasoconstriction before oculoplastic surgery. Incisions need only be delayed for about 1 minute. Extended-wavelength diffuse reflectance spectroscopy appears to be a promising technique for monitoring the tissue response following changes in blood perfusion in plastic surgery reconstructions. However, more rigorous validation of the technique is required before it can be implemented in clinical practice.