title: Modified lamellar keratoplasties for the treatment of deep stromal abscesses in horses.
abstract: OBJECTIVE
  To describe a surgical modification of deep lamellar endothelial keratoplasty (DLEK) and posterior lamellar keratoplasty (PLK) procedures, to facilitate surgery on standing horses under-sedation.
  
  
  METHODS
  Four client-owned horses, for which the owners declined surgery under general anesthesia, underwent standing corneal lamellar keratoplasty procedures for the treatment of deep corneal stromal abscesses.
  
  
  METHODS
  All four horses were placed in stocks and sedated with detomidine. Local eyelid and retrobulbar blocks were performed to provide local analgesia and akinesia, and each horse's head was stabilized and supported by soft pads placed on a mobile cart. Deep lamellar endothelial keratoplasties (DLEKs) and posterior lamellar keratoplasties (PLKs) were performed on two horses each, for the treatment of deep stromal abscesses (DSA). Following the first DLEK, a mid-stromal two-step anterior lamellar keratectomy modification was used to facilitate rapid closure of the anterior chamber immediately following removal of the abscess.
  
  
  RESULTS
  Each of the four horses had similar cosmetic and postoperative visual outcomes, compared to previously published results. Intra-operative complications were most prevalent in the first DLEK case (i.e., focal iris and lens damage and postoperative anterior chamber collapse) and were all but eliminated in the remaining three cases. Similar to previously reported findings, greater postoperative corneal fibrosis was observed in the DLEK cases.
  
  
  CONCLUSIONS
  In horses with deep stromal or endothelial abscesses, for which general anesthesia is not an option, both the modified DLEK and PLK corneal procedures may be performed as an alternative to enucleation on the standing, sedated horse.
authors.affiliation: Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, 27606, USA.|Equine Ophthalmology Service, Pferdeklinik Muenchen-Riem, Graf-Lehndorff-Strasse 36, Munich, 81929, Germany.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: McMullen
authors.affiliation: Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, 27606, USA.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Gilger
authors.affiliation: BluePearl Veterinary Partners, Tampa, FL, 33614, USA.
authors.forename: Tammy M
authors.initials: TM
authors.lastname: Michau
mesh_terms: D000038:Abscess / Q000601:surgery / Q000662:veterinary*; D000818:Animals; D003316:Corneal Diseases / Q000601:surgery / Q000662:veterinary*; D003319:Corneal Stroma / Q000601:surgery*; D016039:Corneal Transplantation / Q000379:methods / Q000662:veterinary*; D005260:Female; D006734:Horse Diseases / Q000601:surgery*; D006736:Horses / Q000601:surgery; D008297:Male
keywords: deep lamellar endothelial keratoplasty; deep stromal abscess; equine ophthalmology; posterior lamellar keratoplasty; sedation; standing surgery