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Surgical Repair of Traumatic Corneal Laceration in a Cow.

Abstract

A crossbred cow was presented with corneal laceration of right eye with history of trauma by a sharp object. Ophthalmic examination revealed lacerated wound over the lateral margin of corneal limbus. The cornea appeared shrunk oedematous and opaque. Hyphema was also visible in anterior chamber. Keratorrhaphy was done under sedation and with regional nerve block in left lateral recumbency. The corneal laceration was sutured using simple interrupted suture pattern. After keratorrhaphy, temporary tarsorrhaphy was undertaken. Local infiltration of antibiotics and artificial tear drop was advised. Follow-up after 4 months revealed restoration of partial vision with complete corneal wound healing.

Keyword: Corneal laceration; cow; surgical repair

Introduction

Corneal lacerations are seen frequently in dogs and horses (Slatter and Dietrich, 2003) but limited literature is available in cattle. Bites, self-inflicted trauma and other accidents can partially or totally penetrate the cornea. Blunt trauma also causes globe rupture however, this tends to be along the limbus rather than dissecting across the central cornea (Macsai, 2011). The challenge in repairing the lacerated cornea results from inherent lack of elasticity of corneal tissue (Macsai, 2011). It is important to used proper closure of corneal wound. There are various techniques available for repair of full thickness defects in use of viz. contact lenses, collagen based biomaterials, cyanoacrylate tissue adhesives, third eye lid, acrylate tissue adhesives and corneal graft (Moore, 2003). The goal of corneal suturing is to make the wound watertight with minimal scarring and reconstruction of native nonastigmatic corneal contour (Wilkie and Whittaker, 1997). This report describe successful surgical management of corneal laceration in a cow.

History and Diagnosis

A crossbred cow aged 10 year was presented with history of trauma in right eye by a sharp object at milking shed. The owners reported that the injury had occurred four to six hours prior to presentation. On clinical examination, animal appeared dull, depressed with half closed right eye and epiphora. Ophthalmic examination of right eye was done by restraining the cow in lateral recumbancy. A lacerated wound over the lateral margin of corneal limbus was observed (Fig.1). The cornea appeared shrunk oedematous and opaque. Hyphema was also visible in anterior chamber. Immediate decision was taken for keratorrhaphy.

Treatment and discussion

Keratorrhaphy was carried out under sedation with Xylazine Hcl @ 0.05 mg/kg b.wt. Auriculopalpebral and four point retro-bulbar nerve block was achieved by administration of 2% Lignocaine Hcl to desensitise the eye lid and eye respectively. Topical instillation of Tobramycin eye drop in affected eye was done prior to surgery. The periocular area was carefully clipped and scrubbed with Povidone iodine solution diluted with normal saline (0.2%). The eye ball was rotated such that the whole of cornea was in operative field. Stay sutures were applied involving the bulbar conjunctiva to prevent from rotation. The corneal laceration was sutured with absorbable suture material poly-galactin 910 (vicryl) no. 3-0 using simple interrupted suture pattern (Fig. 2). After keratorrhaphy, the stay suture was removed and temporary tarsorrhaphy was done. A small space was left at medial and lateral canthus for instillation of topical antibiotics and artificial tear drops. Post-operatively the animal was given inj. Ampicillin-Cloxacillin 3.0 g, I/M b.i.d. for 7 days and inj. Meloxicam (a) 15 mL, I/M o.d. for 3 days. Topical instillation of Refresh tear (b) drops and Tobramycin drops q.i.d. for 7 days was advised. The sutures of tarsorrhaphy were removed after one week. After one week the corneal wound had healed but corneal edema and opacity was present. Follow-up revealed after 4 month of surgery clearing of cornea with small scar and (Fig. 3) the animal had partial vision.

Corneal laceration is common in different species of animals (Slatter and Dietrich, 2003). However there is lack of literature on corneal laceration in cattle. Blunt or sharp trauma usually cause globe rupture along the limbus rather than dissecting across central cornea (Slatter and Dietrich, 2003). In present report, the clinical signs were similar to that reported in dogs (Mandell and Holt, 2005), cats (Ito et al., 2014) and horses (Maggs et al., 2008). Regional nerve block using 2% Lignocaine with sedation was sufficient for performing eye surgery and keratorrhaphy (Bekele et al., 2014). Topical instillation of antibiotic eye drop in affected eye was done prior to surgery to minimise bacterial contamination. Corneal suturing using poly-galactin 910 was adequate in achieving good corneal healing with minimal scar formation and partial restoration of vision. However, Hollingsworth (2003) suggested that sutures should be placed deeply in stroma down to Descemet's membrane without perforating the cornea completely, as endothelium was exquisitely sensitive to trauma. Temporary tarsorrhaphy provided protection to ocular surface by reducing exposure and mechanical abrasion to the cornea (Gilger et al., 2007).

References

Gilger, B., Bentley, E. and Ollivier, F. (2007). Diseases and surgery of the canine cornea and sclera. In: Gelatt K, (eds). Veterinary Ophthalmology. 4th Edn., Blackwell Publishing; p. 690-752.

Hollingsworth, S.R. (2003). Corneal surgical techniques. Clin. Tech. Small Anim. Pract. 18: 161-67.

Ito, S., Terakado, K., Ichikawa, Y., Zama, T., Minami, T., Kudo, S. and Kanemaki N. (2014). Repair of a traumatic corneal laceration in a cat using a tectonic heterograft. E-Polish J Vet Ophth. 2: 1-6.

Macsai, M.S. (2011). Surgical Management and Rehabilitation of Anterior Segment Trauma. In: Cornea. Ed. Krachmer J.H., Mannis, J.M. and Holland E.J, 3rd Edn., Mosby, Elsevier Inc. p. 1655-69.

Maggs, D.J., Miller, P.E., Ofri, R. and Slatter, D.H. (2008). Cornea and sclera. In: Slatter's Fundamentals of Veterinary Ophthalmology. 4th Edn., W.B. Saunders, Elsevier Inc. Philadelphia, p. 175-02.

Mandell, D.C. and Holt, E. (2005). Ophthalmic emergencies. Vet. Clin. North Am. Small Anim. Pract. 35: 455-80.

Moore, P.A. (2003). Diagnosis and management of chronic corneal epithelial defects (Indolent corneal ulcerations). Clin. Tech. Small Anim. Pract. 18: 168-77.

Slatter, D. and Dietrich, U. (2003). Cornea and Sclera. In: Textbook of Small Animal Surgery. Ed. Slatter, D. 3 (rd) edn. W. B. Saunders, Philadelphia, p. 1368-96.

Wilkie D.A. and Whittaker C. (1997). Surgery of the cornea. Vet Clin North Am Small Anim Pract. 27: 1067-1107.

R.K. Udehiya (1), P. Verma, S.K. Mahajan and J. Mohindroo

Department of Veterinary Surgery and Radiology College of Veterinary Science Guru Angad Dev Veterinary and Animal Sciences University (GADVASU) Ludhiana - 141004 (Punjab)

(1.) Assistant Professor and Corresponding author.

E-mail: vet.rahul@gmail.com

(a) - Brand of Intas Animal Health, Ahmedabad

(b) - Brand of Allergan India Pvt. Ltd., Bengaluru
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Title Annotation:Short Communication
Author:Udehiya, R.K.; Verma, P.; Mahajan, S.K.; Mohindroo, J.
Publication:Intas Polivet
Article Type:Report
Date:Jul 1, 2016
Words:1080
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