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Advances in veterinary ophthalmology

By Charlotte Dawson, head of the Royal Veterinary College’s Ophthalmology Service, and Amy Andrews, Resident in Ophthalmology

With so much of life appearing to grind to a halt over the past year, it is easy to lose sight of progress happening away from the eerily quiet high streets. Just as with human medicine, the world of veterinary medicine and research has been progressing, despite the challenging circumstances. Our own area of veterinary ophthalmology is one where there has been much progress over recent years, and this has continued in the period since the pandemic struck. 

We treat eye conditions of dogs, cats, and other small animals at RVC Small Animal Referrals in Hertfordshire. We also deliver an ophthalmology service to the College’s Equine Referral Hospital on the same campus and to exotics species referred to our Camden-based Beaumont Sainsbury Animal Hospital.

Over the past year we have upgraded some of our equipment to build upon the surgery we can offer to small animals and exotics species, as well as horses. As a result of that, along with the skills and knowledge within our team, we have been able to perform surgery that does not appear to have been undertaken in the UK before. This development opens the door to further treatments to help an ever-increasing range of patients.

Technological advancement 

For nearly 50 years, veterinary ophthalmology has been progressively refined, and microsurgical procedures performed under the operating microscope are now commonplace for surgery of the cornea and intraocular structures. Advancements in ophthalmic operating microscopes have enhanced surgical success of corneal procedures, facilitated vitreoretinal interventions and improved training of ophthalmic surgeons.

A new operating microscope delivered in recent months has enabled us to offer procedures not previously available in the UK. The presence of the new system at our Queen Mother Hospital for Animals has allowed the system previously there to move to RVC Equine and enhance what can be offered there.

The new operating microscope came with a keratometer, retinal viewing system, HD camera and video recorder. These maximise clinical outcomes for patients, while also aiding teaching and supporting research. The Zeiss Opmi Lumera 700 ophthalmic microscope and associated equipment was purchased with the support of the Animal Care Trust, the RVC’s registered charity.

The new system has improved our ability to perform precise, accurate and atraumatic surgery and has extended the spectrum of surgical procedures offered to small animal referral patients. Its integrated keratometry is an evaluation tool for guided corneal suture placement subsequent to tissue transplantation or any other surgery which involves corneal suturing, for example cataract surgery. Postoperative astigmatism is reduced and, consequently, visual outcome can be improved. 

The inverted tubes and the non-contact fundus viewing system attachment equip the microscope for vitroretinal procedures, which are currently only offered in very few centres in Europe. For example, the system enables the procedure of re-attaching retinas, which can save and restore the vision of animals with acute detached retinas.

Poppy’s Story

Close collaboration between the Ophthalmology Service and our Exotics Referral Service, along with advanced technology, enabled a Guinea pig to benefit from cataract surgery. It was the first recorded procedure of its kind in the UK.

Two-year-old Poppy was referred to the ophthalmology team due to her loss of vision, which made her jumpy. She was diagnosed with bilateral mature cataracts and phacolytic (lens-induced) uveitis.

Although surgery is the sole definitive treatment for restoring vision in patients with cataracts, it is an elective procedure not commonly undertaken in Guinea pigs, due to the prohibitive cost of surgery. However, Poppy’s owner felt that her quality of life was significantly hampered by her loss of vision and was keen for the surgery to take place.

Though it was the first cataract surgery on a Guinea pig we had undertaken, we were able to extrapolate from many experiences of rabbit cataract surgeries, which present similar challenges. The surgery was aided by the use of the new operating microscope.

The density of Poppy’s cataract alongside the fibrinous sheet beneath the anterior lens capsule made phacoemulsification, the conventional technique for cataract surgery, unviable. An intracapsular lens extraction was performed instead, which involved removing the lens in its entirety. Jo Hedley, Head of the RVC Exotics Referral Service, and her team were present to lend their expertise. Poppy was closely monitored by the Intensive Care Unit following surgery and made a smooth recovery.

Poppy’s owner has noted that she is now visual in the right eye again. Although easily startled before surgery, Poppy is now a lot brighter and happier. Poppy’s owner is very pleased with the improvement in her quality of life.

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