A finely fo­cused op­er­a­tion

EQUUS - - Case Report -

Spark was placed un­der gen­eral anes­the­sia for the pro­ce­dure. “Oc­u­lar surgery is del­i­cate work in a very small area,” says Sand­meyer, “so we use a mi­cro­scope fo­cused di­rectly on the eye to see what we are do­ing.”

Sand­meyer opened the lac­er­a­tion with a scalpel and pared off the ragged wound edges. She also re­moved the por­tion of the iris that had been pro­ject­ing out of the globe. “The rest of the iris was still at­tached and healthy, so we just let that float back into the eye,” she says. “He’ll al­ways be miss­ing a tiny piece of it, but that won’t af­fect how the rest of it func­tions; his pupil will still di­late and con­strict.”

Sand­meyer did a sec­ond vi­sion

check of the lens to en­sure it wasn’t rup­tured or oth­er­wise dam­aged. “If it had been, we could have re­moved it, leav­ing him re­ally far­sighted, or put in a pros­thetic lens.”

Next, she flushed out the cloudy aque­ous fluid and re­placed it with a bal­anced salt so­lu­tion. “The body gen­er­ates eye fluid rapidly, and so within a few hours of surgery, the salt so­lu­tion is re­placed with healthy aque­ous fluid,” she says.

Sand­meyer stitched the lac­er­a­tion closed with tiny su­tures and cre­ated a con­junc­ti­val graft to pro­tect the area. “We cre­ate a small stalk of tis­sue, from the con­junc­tiva around the eye,”

novem­ber

2014 she ex­plains. “One end is still at­tached to the blood sup­ply, but the other is sewn over the wound. This flap pro­tects the area.”

Spark re­cov­ered un­event­fully from the anes­the­sia and seemed to be able to see clearly right away. The next day the stal­lion was sent home with de­tailed in­struc­tions for three weeks of med­i­ca­tion. “Med­i­cat­ing eye in­juries can be very time-con­sum­ing and dif­fi­cult,” says Sand­meyer. “He was get­ting mul­ti­ple med­i­ca­tions in his eye four times a day in the be­gin­ning. Even­tu­ally, horses start to ob­ject, and it can be­come quite the bat­tle.”

To make the process eas­ier, Spark was out­fit­ted with an oc­u­lar lavage sys­tem, a nar­row tub­ing placed un­der the eye­lid and se­cured to his mane. Then, his med­i­ca­tions could be in­jected into the end of the tube to be de­liv­ered di­rectly into his eye.

After three weeks, Spark was re­turned to the clinic for a follow-up exam. “He healed re­ally well,” says Sand­meyer. “The eye was clear and all our tests in­di­cated his vi­sion was func­tion­ally nor­mal. There’s a lot that could have gone wrong in those three weeks; in­fec­tion could have de­vel­oped, and some horses end up dam­ag­ing the eye again if they rub it on some­thing. But his eye looked great.”

Con­junc­ti­val grafts, like Spark’s, are left in place in­def­i­nitely but do not in­ter­fere sig­nif­i­cantly with vi­sion. “He has to see around it, but it’s very tiny,” says Sand­meyer. “And even if the graft wasn’t there, he’d still have the scar on that area block­ing his vi­sion.”

De­spite how se­ri­ous the in­jury had ap­peared at first, Spark’s pos­i­tive out­come isn’t un­usual, says Sand­meyer: “I know eye in­juries can look re­ally bad, but if you get help right away and are able to con­trol the in­flam­ma­tion you’d be sur­prised just how well they can do.”

All the struc­tures that support vi­sion ap­peared to be in­tact and func­tion­ing, and in­deed, Spark’s prog­no­sis for re­gain­ing vi­sion was good.

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