Subconjunctival enucleation with orbital implant placement in standing horses: 20 cases (2014-2017)

Update on surgical cosmetic solutions in equine ophthalmology

Following eye removal surgery, ocular cosmetic solutions exist for the equine patient. The objective of this review is to summarize the current best evidence on equine ophthalmic cosmetic solutions. A literature review of ophthalmic cosmetic solutions in horses was conducted. Four cosmetic solutions are described. Cosmetic outcome, return to work, owner satisfaction, complication rates, implant choice and future perspectives are discussed under the light of most recent publications. Seventeen peer-reviewed articles were selected: five retrospective studies, four case series, five case reports and three narrative reviews. Additionally, two congress proceedings were included. Recent publications identify intrascleral prosthesis and intraorbital implants adjoined to a corneoscleral shell as cosmetically superior. The orbital meshwork implant requires improvement to be cosmetically acceptable. Return to work is deemed feasible and standing sedation is an option for orbital implant placement beneath sutured eyelids. 3D printing creates new possibilities for implant development.

A novel supraorbital surgical approach for enucleation in dromedary camels (Camelus dromedaries): cadaveric study

BACKGROUND

Enucleation and exenteration are widely utilized ophthalmic procedures in veterinary practice, involving the complete removal of the eye and comprehensive extraction of orbital contents, respectively. These procedures are indicated for pain relief, excision, and management of neoplasia metastases, and addressing severe medically untreatable conditions.

AIM

This study aimed to develop an orbital enucleation surgical approach. The study evaluated the applicability of the new approach and investigated the impact of the surgical procedure.

METHODS

Anatomical dissection of three cadaveric heads and surgical orbital enucleation in four cadaveric heads were performed. Anatomical data was collected, and feasibility, safety and applicability of the procedure were assessed.

RESULTS

Anatomical dissection showed a distinctive large orbital fossa, providing a suitable surgical window to access orbital structures. The procedure was found to be feasible, facilitating the complete removal of the orbital content. Notably, the preservation of intact eyelids was prioritized to enhance cosmetic appearance.

CONCLUSION

The presented orbital enucleation technique proved to be feasible, safe, reproducible, and required basic surgical skills to perform.

Al-thnaian TA, Alkhodair KM, Tharwat M, El-Sherif MW. A modified supraorbital surgical approach for enucleation- exenteration in dromedary camels (camelus dromedarius): Clinical study

Enucleation and exenteration are widely utilized ophthalmic procedures in veterinary field. Enucleation in camels is like other large animals, typically performed under the influence of heavy sedation and loco-regional analgesia. The aim of the current study was to introduce a new surgical approach to enucleate the eye of camels through supraorbital fossa approach. for that purpose, the technique was applied to seven camels referred to the King-fisal teaching veterinary hospital for unilateral enucleation. Assessment of applicability, safety and feasibility of this technique was done. All procedures were performed in the kush (sitting) position under the influence of heavy sedation with Xylazine HCl in combination with retrobulbar nerve block. A "C" shaped skin incision was made in the skin and fascia of the supraorbital fossa to enter the orbital cavity, after which the periorbital fat was gripped, dissected and removed. Bleeding controlled by electrocautery and visible large blood vessels were ligated. After ligation the optic nerve and ophthalmic blood vessels, the eyeball was dissected sharply and freed from the orbital bony attachment. Finally, the orbital fascia and skin were sutured with simple interrupted pattern separately. The approach proved successful in all camels, with the enucleation procedure being both feasible and easily performed. The mean surgical time was approximately 46.6±12.4 minutes. The minimal occurrence of short and long-term complications was encouraging, and the cosmetic outcomes were notably improved. The supraorbital approach is a safe and effective technique for camel ophthalmic surgery, showing advantages in exposure and minimal complications. Further research is needed for validation and broader clinical applications.

An Ex Vivo Pilot Study to Assess the Feasibility of 3D Printing of Orbital Implants in Horses

Severe ophthalmic conditions such as trauma, uveitis, corneal damage, or neoplasia can lead to eye removal surgery. Poor cosmetic appearance resulting from the sunken orbit ensues. The aim of this study was to demonstrate the feasibility of manufacturing a custom-made 3D-printed orbital implant made of biocompatible material for the enucleated horse and usable in conjunction to a corneoscleral shell. Blender, a 3D-image software, was used for prototype design. Twelve cadaver heads of adult Warmbloods were collected from the slaughterhouse. On each head, one eye was removed via a modified transconjunctival enucleation while the contralateral eye was kept intact as control. Ocular measurements were collected on each enucleated eye with the help of a caliper and used for prototype sizing. Twelve custom-made biocompatible porous prototypes were 3D-printed in BioMed Clear resin using the stereolithography technique. Each implant was fixated into the corresponding orbit, within the Tenon capsule and conjunctiva. Heads were frozen and thin slices were then cut in the transverse plane. A scoring system based on four criteria (space for ocular prosthesis, soft-tissue-coverage, symmetry to the septum, and horizontal symmetry), ranging from A (proper fixation) to C (poor fixation), was developed to evaluate implantation. The prototypes reached our expectations: 75% of the heads received an A score, and 25% a B score. Each implant cost approximately 7.30€ and took 5 hours for 3D-printing. The production of an economically accessible orbital implant made of biocompatible porous material was successful. Further studies will help determine if the present prototype is usable in vivo.