Treatment
Local medical therapy was started with Moxifloxacin eye drops (Vigamox®, Alcon Pharma GmbH, Freiburg, Germany) six times in day, Atropine eye drops (Atropin-POS 1%®, Ursapharm GmbH, Saarbrücken, Germany) s.i.d. and autologous serum eye drops five times per day. Systemic Cefalexin (Cefaseptin®, Vetoquinol, Ismaning, Germany) 20 mg/kg b.i.d. and 2 mg/kg Robenacoxib (Onsior®, Elanco, Homburg, Germany) s.i.d were administered orally.
Surgery was performed within a range of three hours to two weeks after initial diagnosis. Anaesthesia was induced intravenously with 0.5 mg/kg diazepam (Faustan®, Temmler Pharma, Marburg, Germany) and 0.5mg/kg levomethadone in a fixed combination with 0.025 mg/kg fenipramide (L-Polamivet®, Intervet, Unterschleißheim, Germany). Anaesthesia was maintained via endotracheal intubation with 1 % isoflurane (Isofluran CP, CP Pharma, Burgdorf, Germany) dissolved in oxygen at a flow rate of 10ml/kg/min.
After placing the dog in dorsal recumbency the head was stabilized in a vacuum-bag. The eye was prepared for surgery and a Barraquer eyelid speculum was inserted. A 15 mm SIS disc (Vetrix® BioSIS ECM, Vetrix, Cumming, USA) was rehydrated in balanced salt solution (BSS®, Serag Wiessner, Naila, Germany) and trimmed to exact size of the ulcer thus filling the defect completely (fig. 1). The ulcer bed was not prepared before the SIS was placed. A nictitating membrane flap was placed by horizontal matress suture pattern (three stitches) in the upper eyelid with Nylon-suture 4-0 (Ethilon®, Ethicon, Flensburg, Germany). Care was taken not to dislodge the disc out of the defect during this procedure (fig. 2). Preoperative medication was continued with Moxifloxacin and Atropine applied directly on the nictitating membrane. Cefalexin and Robenacoxib were prescribed for two weeks and for four days, respectively.
The flap was left in place for a minimum of three weeks. The owners were instructed to look for purulent discharge and signs of pain during this period. The patients were re-examined at time of releasing the nictitating membrane flap (all cases), five days after releasing the nictitating membrane flap (one case) and three weeks after release (two cases).