Long‐term treatment outcomes and risk factors for recurrence in feline corneal sequestrum: 72 cases (2009–2017)

Abstract

Background This study aimed to evaluate long‐term treatment outcomes in feline corneal sequestrum (FCS), compare the recurrence rates between different surgical techniques, identify possible recurrence risk factors and monitor the development of FCS in the contralateral eye. Methods The medical records of 72 cats (79 eyes) with FCS treated between 2009 and 2017 were retrospectively analysed. Results The most commonly affected breeds were Persian, domestic shorthaired and Burmesecats. The mean age was 6.9 years. Sixty‐five cats (90%) were affected unilaterally. Sixty‐six eyes (83%) underwent surgery: keratectomy in 34 eyes (52%) and keratectomy followed by a graft procedure in 32 eyes (48%). Recurrence occurred in 13 out of 66 eyes (19%) at a median of 245 days after surgery. Skull conformation, location of the FCS, type of surgical procedure and concurrent ocular surgery did not significantly affect the recurrence rate. Eighteen cats (27%) developed FCS in the contralateral eye at a median of 635 days after surgery. Limitations Limitations are related to the retrospective nature of the study, the use of telephone follow‐up for assessment of recurrence in some cats and the small number of cases. Conclusions Surgical excision had a successful outcome in most cases. The type of surgical procedure and skull conformation did not affect the recurrence rate. One‐quarter of the cats developed FCS in the contralateral eye.

Optimising treatment approaches for feline corneal sequestra to improve long‐term clinical outcomes

“…Medical treatment was not successful in the two other cases in which it was attempted: corneal perforation occurred in one eye within 21 days, and the sequestrum and blepharospasm persisted in the other eye with unchanged severity. 17 The low risk of perforation is consistent with what has been suspected previously, 11 although this has been poorly reported, likely due to inadequate follow-up.…”

“…13 Indeed, in Palella Gómez and colleagues' study, 27 per cent of cats that initially presented with unilateral disease developed sequestra in the contralateral eye after a median of 635 days. 17 It should also be noted that no recurrence occurred in the 11 cats in Palella Gómez and colleagues' study that were successfully medically treated when the owners declined surgery. Medical treatment was not successful in the two other cases in which it was attempted: corneal perforation occurred in one eye within 21 days, and the sequestrum and blepharospasm persisted in the other eye with unchanged severity.…”

“…In the cases where medical treatment was successful, the sequestrum sloughed off within a median of 30 days. 17 The short time until sloughing was interesting, as the only other study of medically managed sequestra reported that 59 per cent sloughed within two months. 24 However, it must be remembered that only a small number of cases were solely medically managed by Palella Gómez and colleagues, and because all cases in both studies were seen at referral centres, the findings are not fully representative of the chronicity of the sequestra before sloughing.…”

“…A study by Palella Gómez and colleagues, summarised on p 111 of this issue of Vet Record, sought to address this knowledge gap by assessing the long-term outcomes of 72 cats (with 79 affected eyes) presenting at a single UK referral centre with corneal sequestra between 2009 and 2017. 17 This retrospective study included not only the eyes that underwent surgical management (n=66) but also those for which surgery was not performed (n=13).…”

“…For those that also had a graft placed, a conjunctival pedicle graft was used in 20 eyes (63 per cent), a corneoconjunctival transposition (CCT) graft was used in 11 eyes (34 per cent) and a non-autologous grafting material (derived from equine amnion) was used in just one eye. 17 The decision on whether to place a graft comes down to a few key factors. Keratectomy without graft placement is appropriate only when the sequestrum remains superficial.…”