Spontaneous and Surgical Trauma to the Eye. Richard R Dubielzig



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Transcription:

Spontaneous and Surgical Trauma to the Eye Richard R Dubielzig

Ocular Trauma

Expulsive Choroidal Hemorrhage Sudden Loss of Intraocular Pressure

Early Cellular Events after Trauma

Lens Epithelial Cell Proliferation after a Porcupine Quill Injury

Porcupine quill injury Lens epithelial cell proliferation and migration

Porcupine quill injury Lens epithelial cell proliferation and migration

Lens Epithelial Cell Proliferation & Migration

Lens Epithelial Cell Proliferation & Migration on Tapetum

Scleral Rupture Blunt Trauma

Scleral Rupture Blunt Trauma In a series of 52 dogs 6 Boston Terrier, 5 Yorkies, 4 Shih Tzu, 2 Labs 11 less than 3 years old, 13 more that 10 years old In a series of 80 Cats 56 DSH, 11 DLH 15 less than 3 years old, 29 more than 10 years old

Episcleral Retinal Extrusion Scleral Rupture

Fibrosis Internal to the Choroid

Endophthalmitis or Panophthalmitis Breeds in 954 Canine Cases Shih Tzu..120 Labs...71 Lhasa Apso...25 Dachshund.....10 Boston Terrier 41 Golden Retriever 17 German Shepherd...20 AKC Most Popular Breeds in USA 1. Labrador retrievers 154,616 2. Golden retrievers 56,124 3. German shepherds 46,963 4. Beagles 44,610 5. Dachshunds 42,571 6. Yorkshire terriers 37,277 7. Boxers 34,340 8. Poodles 33,917 9. Chihuahuas 28,466 10. Shih Tzus 28,294

Endophthalmitis

Factor 8 Volcanoes in the subretinal space, extending from the choriocapillaris

Endophthalmitis with Foreign Body 68 cases in dogs Large Breed dogs are over-represented Plant foreign body the most common by far

Plant Foreign Bodies

Stick in the Eye

Septic Implantation Syndrome 139 in dogs & 36 in cats Syndrome features Suppurative endophthalmitis Fibrous posterior synechia Lens capsule rupture with a suppurative infiltrate into the lens Bacterial colonies in the lens protein away from the neutrophils, less often, fungi No particular breed 56/139 dogs less than 6 years-old 18 of 36 cats less than 6 years-old 37 dogs more than 10 years-old and 9 cats more than 10

Septic Implantation Syndrome (10 cases)

Lens capsule rupture with a suppurative infiltrate into the lens

Gram+ Bacteria

2 examples of Mixed Bacteria Mycotic

Septic Implantation Syndrome is Caused by a Cat Scratch Until Proven Otherwise

Blunt Trauma to the Retina 12 hours After Blunt Trauma

Retinal Effects of Blunt Trauma

Retinal Effects of Blunt Trauma

Retinal Effects of Blunt Trauma

97 cases in dogs Proptosis 18 Shih Tzu, 10 Pekingese, 8 Yorkies 48 less than 6 years and 19 more than 10 2 cases in cats

Proptosis Typical Lesions Seen Muscle tearing Episcleral fibrosis Optic nerve necrosis First pure necrosis Second Gitter cells and malacia Finally fibrosis and atrophy Extension of the conjunctival epithelium toward or beyond the equator Hair in the episclera Corneal desiccation

Optic Nerve Trauma/Proptosis

Acute Optic Nerve Necrosis

3 Day Optic Nerve Necrosis

Optic Nerve Malasia, Gitter Cells

End-stage Fibrosis of the Optic Nerve (Trichrome Stain)

Exposure of the cornea Corneal Desiccation

Sclera Episcleral Fibrosis

Contusion Glaucoma/ Angle Recession Glaucoma 41 cases in dogs No particular breed 13 less than 6 years-old 17 greater than 10 years-old 204 cases in cats 141 DSH, 23 DLH, 10 Siamese 29 less than 6 years-old 101 greater than 10 years-old

Limbal Sclera Iris Acute Traumatic Cyclodialysis

Angle Recession Cat Owl

Anterior Chamber Collapse Syndrome/Early life Trauma

Early-life Trauma Anterior Chamber Collapse Syndrome

Early-life Trauma Anterior Chamber Collapse Syndrome 69 cases in the COPLOW archive Species break down: 24 feline 40 canine 1 primate (rhesus) 1 marsupial (wallaby) 1 Avian (chicken) 1 Bovine (Holstein) 1 Equine (Arabian horse)

Early-life Trauma Anterior Chamber Collapse Syndrome 69 cases in the COPLOW archive Ages at Enucleation: Less than one year: 28 > 0.4: 4 > 0.6: 12 > 0.8: 9 0.8 to 1 year: 3 One to two years: 19 Two to three years: 8 Greater than 3 years: 14 Range = 4 to 12 years

Early-life Trauma Anterior Chamber Collapse Syndrome Symptoms Breakdown: n=70 Glaucoma: 54 Buphthalmic: 42 Both eyes effected: 3

Early-life Trauma Anterior Chamber Collapse Syndrome History Always/ since birth/congenital: 26 Known injury 15 8 under 1 month of age 4 under 1 year of age 1 under 2 years of age Since acquired: 10 4 acquired under 6 months of age 1 acquired at 4.5 years

Early-life Trauma Anterior Chamber Collapse Syndrome

Early-life Trauma Anterior Chamber Collapse Syndrome

Early-life Trauma Anterior Chamber Collapse Syndrome

Early-life Trauma Anterior Chamber Collapse Syndrome

Early-life Trauma Anterior Chamber Collapse Syndrome

Early-life Trauma Anterior Chamber Collapse Syndrome

Early-life Trauma Anterior Chamber Collapse Syndrome

Early-life Trauma Anterior Chamber Collapse Syndrome

Early-life Trauma Anterior Chamber Collapse Syndrome

Early-life Trauma Anterior Chamber Collapse Syndrome

Histologic Effects of Surgical & Non-Surgical Ocular Interventions Orbital Conjunctival Cyst after Enucleation Surgery Cyst

Conjunctival Depo Injection

Intraocular Injection

Intraocular injection sites

Vitreous prolapse following intraocular aspiration

Corneal Surgical Incision Sites

Corneal Surgical Incision Site - anterior synechia

Wound Healing Problems

Laser Photocoagulation - ciliary body of blue-eyed dog

Nerve and Vessel Necrosis

Laser Retinopexy Lens Optic Nerve

Retinal Morphology Immediately after Retinopexy to Repair 2 Week-old Detachment

Laser Surgical Wound

Complications Due to Silicone Oil *

The morphology of eyes enucleated due to complications following phacoemulsification

Dehiscence of the Surgical Wound and/or Epithelial Downgrowth

Complications following Phacoemulsification The most frequent histopathological abnormalities detected were: Endophthalmitis, shortly after surgery Glaucoma, delayed onset Retinal detachment and neovascular glaucoma Posterior synechia Lens epithelial membranes The most frequent clinical abnormalities reported were: glaucoma (86%) uveitis (82%)

Post-operative Glaucoma

Exposure of Lens Protein -- Phacoclastic Uveitis

Endothelial and Descemet s Changes

Trichrome Cytokeratin

Doubling of Descemet s Membrane

Lens epithelial membranes (LEMs)

Lens epithelial membranes (LEMs)

Lens fiber regrowth (LFR) 28% of cases etiology of posterior capsular opacification (PCO)/LFR role of IOLs

Lens Fiber Regrowth Soemmering s Ring Cataract

Five Problem Areas Identified PIFVMs Lens Fiber Regrowth Lens Epithelial Membranes Endophthalmitis Dehiscence Lens Protein Exposure Health of the Corneal Endothelium & Descemet s

Gonioimplant, Ahmed Valve Uncomplicated Dehiscence and Exposure Epithelial Ingrowth

Intrascleral Prosthesis

The expected appearance of a healthy scleral shell

Intrascleral Prosthesis Failures 62 in Dogs 23 because of tumors 12 because of epithelial downgrowth 30 because of corneal degeneration 28 had severe inflammation 11 in Cats 9 because of tumors 8 melanoma, 1 post-traumatic sarcoma

Tumors Feline FDIM Canine Melanoma Canine LSA

Epithelial Down Growth