Surgical Repair of a Corneal Perforation or Descemetocele with Concurrent Lensectomy in Three Pinnipeds
Carmen M.H. Colitz1; Michelle Bowman2; Gretchen Cole2; Carl Budelsky3; Bethany Doescher4; Eric Anderson5
Concurrent keratopathy and cataracts are common in pinnipeds under human care. Ideally, lensectomy is performed in eyes with quiescent keratopathy; however, there are occasions where both must be addressed. Our objective is to describe the surgical approaches in 3 pinnipeds with corneal decompensation with concurrent lensectomy. A 24-year-old female harbor seal (Phoca vitulina) with subacute anterior lens luxation and acute secondary corneal perforation OD underwent corneal repair using an ACell VetTM corneal disc, then lensectomy, followed by conjunctival pedical flap. A 24-year-old female Hawaiian monk seal (Monachus schauinslandi) had a chronic anteriorly luxated cataract OS then developed a corneal stromal abscess that subsequently progressed to a descemetocele, then to a perforation. The lens nucleus was easily removed through the large perforation and the anterior chamber flushed of debris. Then, two BioSIStTM Ocular Discs were layered and sutured into the perforation. A conjunctival pedical flap was sutured over the site. Both phocids underwent contralateral lensectomy at the same surgery. A 13-year-old male California sea lion (Zalophus californianus) gradually developed a 3 x 3 mm descemetocele, despite quiescent keratopathy, and had a progressive cataract OS. The descemetocele was covered with a SISplus Ocular Disc, then lensectomy followed by conjunctival pedical flap. The sea lion did not have a cataractous lens contralaterally. Topical and oral antibiotics, antiinflammatory and pain medications were used in all patients postoperatively. The harbor seal was sighted the day after surgery and remained so long term. The conjunctival flap took over 2 months to become flat and well embedded in the host cornea. The monk seal's conjunctival flap became devitalized over 4 weeks, except for in the pedical. However, the remaining host cornea had significant vascularization that grew into the BioSIStTM graft. The male sea lion is currently recovering. All eyes were comfortable.Environmental factors as well as anterior lens luxation can exacerbate keratopathy; therefore, it is ideal to aggressively address keratopathy and remove luxations as quickly as possible. However, it is still possible to successfully address complicated cases surgically with cosmetic and comfortable results.