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Thread: corneal graft

  1. #1

    Default corneal graft

    A week ago last Tuesday I caught a sort of glimmer from Bijouís eye, and looked closely: it looked like the sheen of lipidosis; not something sheís ever had, but not unknown. I looked on Wednesday morning but could see nothing. Later in the day, with her eye at an angle, I saw it again and by the evening was sure there was something wrong. By the time I got to the vet on Thursday afternoon there was a defined opaque area and, as I by then suspected, an ulcer! I could not believe how quickly it happened; when he examined under magnification, dye and a special blue light, Coen saw an actual piercing of the cornea: not all the way through, obviously, but it appeared to have let a bacterial infection in under the surface. His theory was that when whatever had caused the injury came out, it pulled and separated layers of the cornea allowing the bacteria to enter and multiply. Fast. He prescribed antibiotic drops three hourly, vitamin B 12 drops to help the cornea heal and something else: not an anti-inflammatory, as that would adversely affect one of the other medicaments.

    I donít know what pierced the cornea but a good guess would be a thorn as they are minutely barbed. As for infection: Iíd been cutting back brambles in the field the day before and had quite a few scratches with raised red edges. Of course, skin has a blood supply that helps to fight off infection; the cornea doesnít. It hadnít really occurred to me, until Coen pointed it out, that the raised red bits round my scratches were not just the body healing but were infected areas. That was just a day after Iíd been doing the job; jsut shows how fast bacteria get to work We donít know when Bijou was injured and bacteria could have been active before their effect became noticeable.

    By Monday the eye was worse and so we went to an ophthalmologist at Bordeaux: my vetís referral; not the one I know. Dr Goulle did a profound examination and said the bacteria were basically eating the cornea and the only remedy was surgical. He would remove the entire infected area, which meant microsurgery. He would then do a graft, using a bio material created from the bladder of a pig. I have read about this somewhere, but not in connection with eyes! Naturally this is a VERY expensive operation. It did cost less than two years insurance for all the dogs Ė one way of putting it in perspective.

    I collected Bijou this morning. She is VERY much happier than she was, but does not like her Elizabethan collar. The nictitating membrane has been stitched to her upper eyelid to protect the eye, and I must clean the area with the usual ophthalmic cleanser. She also has more antibiotics, another vitamin, morphine (although the vet thinks that may not really be necessary; I will know if she has real pain or is playing to the gallery) and something else. She must stay indoors and away from the other dogs to avoid any risk of having the eye touched; for her evacuation needs I must take her out on a lead and prevent her sticking her head in any vegetation. Itís better, too if I keep her out of any wind.

    I must take her to Coen again in ten days so he can check that the stitches are holding up OK, and she will have them out in three weeks. Then we'll know how successful it has been. Dr Goulle did say that she is a very healthy girl and he is pretty confident.

    The vet who performed the operation told me he does several corneal grafts a week Ė mostly brachycephalic breeds, and about 80% are French Bulldogs, which are very popular here. Most of the dogs are, like Bijou, referred to him by other vets from a wide area.

    Iím still in shock. I had never had a dog have an eye problem until after I had mine Ė even if mine wasnít, strictly speaking, a problem with the eye. There is absolutely no connection between the two things, but it seems ridiculously coincidental.

    In the UK we walked the dogs in the woods, there were brambles, fallen logs, tree and bush twigs etc., and we never had a dog with any eye injury or problem. Here, over the past 16 years, Crumble and Raziela both had unexplained ulcers with no obvious sign of injury (and no problems of dry eyes, either) and both healed. I found Ruth one morning with her eye out of its socket, drying; the vet said it was past trying to save. Ruth wasnít really mine but thereís too long a story about why I didnít let her go back to her legal owner. Lovely Hazel had to have her eye removed after it was badly injured in an attack by another dog. And one puppy, just three weeks old and who had only really just begun to walk had a tiny splinter in its eye. I saw that as a dark speck and it was removed by the vet; fortunately just a minor surface injury, but absolutely inexplicable. Under the microscope it was certainly wood. There was firewood in the house, but the pup hadnít left its pen and it requires some force to make something penetrate the cornea, even just a fraction.

    None of those involved expensive treatments. They were very worrying, certainly, but not on a par with this.

    Bijou is now in my bedroom, happy to be allowed on the bed but NOT happy at being apart from everyone. When I have time to sit she will come in the sitting room with me, and weíll have some ďusĒ time.

    Jane

  2. #2

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    Bijou had a check up with my local vet today, just to ensure that the stitches were holding well. As I entered the waiting room, all three partner vets of the practice were there and one said “Bonjour Madame Naylor!” I couldn’t immediately think of her surname, even though it’s outside on a brass panel to the right of the entrance door. I replied “Bonjour Doctor Sabrina.” She laughed and said she’d never been called that before; it was a strange mixture of formal and familiar: she preferred just “Sabrina” or Dr Massoni (her real name) if one must be formal. Then Katrien asked “So am I Dr Katrien?” and Coen (Katrien’s husband) said he didn’t think Dr Coen sounded quite right. There seemed to be a lot of hilarity in general and FranÁoise, the receptionist, said “It’s Coen’s birthday today; he’s 38”. He quickly said “No I’m not; I’m 25!” I said they should call me Jane: my doctor calls me that and I’ve seen him far less frequently than I’ve seen them.

    Eventually one asked “This is just a check up for Bijou?”. They had the details of her surgery e-mailed by the specialist, so were up to date. I said I would also like someone to clean properly below her eye as I find it difficult as she wriggles and screams blue murder. OK, said Katrien; I’ll do that. Amazing. Bijou sat on the table, Katrien took a swab, identical to the ones I use, soaked it in the same cleanser, dabbed away just as I try to and Bijou neither wriggled nor squeaked. She may have made a couple of little whimpers but she sat still. Katrien said that SO many dogs behave better for her than for their owners, but it was probably easier as I was holding Bijou and she had two hands free. She said the nictitating membrane looked fine, clean and healthy; no inflammation; and the stitches were holding perfectly. Once she’d entered her notes on the computer and we left the surgery, Bijou went into “you’re my friend mode” and jumped up at Katrien, tail wagging madly. Katrien bent down and stroked her saying something along the lines of that Bijou was a naughty girl to be so difficult with her owner.

    Ten days to go before the stitches come out............

    Jane

  3. #3

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    Bijou went to the ophthalmic vet in Bordeaux today and had her stitches out. I don’t know HOW I managed it, but my appointment was actually for tomorrow: I put it down to being just a bit stressed at the moment.

    Her eye looks horrible, but it is “correct”. The centre is still white, and very fragile, but the edges of the graft are red: this is a good sign as it shows that the graft is being “fed” and not rejected by her body. She is not wonderfully happy as I now have to put three different drops no fewer than eight times a day in her eye. There must be intervals of between 1/4 and 1 hour between some, Tobrex and Twelve, and one lot, Clerapliq, are incredibly expensive. She continues with the Cystine tablets, which are actually to help human hair and nails! She must, as before not go outside except for natural needs, I must avoid her being in the wind if possible, keep her away from dust and pollen, and, of course, she keeps the Elizabethan collar on at all times!

    Bijou’s next appointment is next Tuesday. I thought with the regime of drops etc. that she needs, I simply could not go to the National d’ťlevage. Aline, though, may have come up trumps! Normally she’d be busy, but she’s just had an operation on her knee so is laid up. She'd phoned this morning just as I was about to leave and asked me to let her know how Bijou was when I got back. She will discuss it with Alain and if he’s agreeable they’ll look after Bijou while I’m away. As she said, having had the boarding kennels for so long they have got pretty used to dealing with medicament for owners; maybe nothing quite like this……….. They only have Omar, the very elderly Cairn Terrier now, and she won’t be a problem as she’s never been very interested in Bijou, or vice versa.

    I am VERY relieved with Bijou’s obvious progress, but we have a long way to go.

    Tchi is bouncing around like there was nothing wrong. She’ll have the stitches out after Easter: I didn’t mention that she has a BLACK bandage! How sensible

    Rascally seems virtually back to normal. My heart lifted the day she first picked up a toy, and she’s back to jumping up when I take their dinner or breakfast bowls through. Just sometimes her head seems to go a little lopsided. She didn’t need egg custard after all.

    Jane
    Last edited by Janelise; 04-14-2014 at 09:05 PM.

  4. #4

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    Glad everyone is doing so well, Jane ... huge relief!!
    Sheena Stevens

  5. #5

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    Thanks Sheena,

    I have had a difficult few weeks, not just with dogs, and now it all seems to be going OK. As I write, Bijou is stretched out and looking at me a bit reproachfully as she REALLY wants to go for a walk and it is very windy today. I feel so mean, but on the other hand am glad she wants to go out.

    Jane

  6. #6

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    Bijou had the first serious check up today: it's going a bit slowly, but older dogs can take longer to heal. However, both vets seemed quite happy and it is clear that her eye IS improving and that she has some vision. She has probably another four weeks of wearing the Elizabethan collar, not being allowed outside etc. Some of the stitches of the graft have already dissolved. I couldn’t see that, but under magnification the vet could. The area that has not yet adhered is diminishing appreciably and you can see tiny threads of blood leading to it; a good sign. Her eye looks pretty nasty, but it's a good sign! One of her drops, the vitamin B12, is to be increased in frequency: Oh Joy, more little battles to keep her still. She was good as gold with Aline and Alain: sometimes Alain did the drops on his own and she behaved and didn't scream the place down. She desperately wanted to play with a Bulldog puppy in the vet’s waiting room; her tail was wagging like mad and she seemed quite taken with him: he was cute.

    Jane

  7. #7

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    Yesterday Bijou went for a check -up with the ophthalmologist. He was pleased: "We are winning!” The graft has now taken completely and although the centre of her eye is still fairly fragile, it is healing very well. She can have the collar off, if supervised. The next control isn’t until June. Aline and Alain called in today and they noticed the improvement. There is still a long way to go and it is likely her eye will never look totally normal, but the worst is over.

    The best is that now she only has drops five times a day: one in the morning and evening each followed by another 15 minutes later, and one at midday. This means I can now go out for more than an hour without having to take her with me.

    Jane

  8. #8

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    Glad to hear that the operation has worked
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    Mark, and my Blen - Lexie DOB 7/07/11, and my B/T - Katie DOB 01/12/12

  9. #9

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    Today Bijou had an appointment with the surgeon who performed the corneal graft. He was very pleased and, although I must continue with two lots of drops three times a day, he doesn’t need to see her again until September. Yippee!

    On the way home I called in IKEA and picked up the sink wastes I forgot when I collected the sinks for my new house, kitchen and utility room. Hadn’t realised I should have had two packets for each; I thought it would be in the big box. After today I realise I hadn't read the label properly………… Before assembling the units I read the instructions and have now assembled nine IKEA kitchen base units without making a mistake - so far! Alain has offered to help me attach them to the walls and put the wall units up, but I shall have them ALL assembled first

    Jane

  10. #10

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    Great news, Jane, about the cornea. It is wonderful that such surgery is available to dogs.

    I've never been to an Ikea, although there is one in our town. I'm told they offer Swedish meatballs and coffee, so I've been trying to talk my bride into dropping by to check it out. But, she says we already have too much stuff, and why would I want somebody else's meatballs anyway?
    Last edited by RodRussell; 06-03-2014 at 09:52 PM.
    Rod Russell

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