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Conjunctival Pedicle Grafts
Conjunctival pedicle grafts are used to treat deep corneal ulcers.

What is a corneal ulcer?
The cornea is the transparent structure at the front of the eye that allows light to enter. Traumatic injury, most commonly a scratch, can damage the surface of the cornea and expose the underlying tissue to cause an ulcer. If the ulcer is shallow then it will usually heal on its own within a few days. Sometimes, however, the ulcer may become very deep, and in such cases there is a risk that the eye may rupture. These deep corneal ulcers may require surgery in the form of a conjunctival pedicle graft. 

What is a conjunctival pedicle graft?
The conjunctiva is the pale pink tissue that covers the ‘white’ of the eye. It is a thin, relatively strong tissue containing many blood vessels. These properties make it a useful graft material to treat deep corneal ulcers.  

Conjunctival pedicle grafting is performed with the patient under general anaesthetic, and with the aid of an operating microscope. Using microsurgical instruments, a finger (‘pedicle’) of conjunctival tissue is freed from the ‘white’ of the eye and rotated so that it covers the ulcer (see diagram). Once in place it is stitched into the ulcer using very fine dissolvable suture material.
Often we will also place a stitch to partially close the eyelids to aid healing; this stitch is removed at the check-up examination.

Conjunctival pedicle graftingConjunctival pedicle grafting

What happens after the operation? 
The patient is often kept in our hospital for a day or two to ensure that the eye is healing satisfactorily. When they go home they usually need to wear a Buster collar for around a week so that they cannot rub at the eye. We give a course of pain-relieving tablets and antibiotic eye drops. The eye is usually a little uncomfortable and itchy, but this settles over a week or so.
You will need to keep your pet relatively calm and quiet for a few weeks following the surgery to allow the eye to heal. Usually this means lead or garden exercise only, no boisterous play and trying to reduce excitement and barking as much as possible.  

How long does the graft stay in place?
The cornea usually takes 6-8 weeks to heal beneath the graft, sometimes longer. After that time we usually recommend sectioning or removal of the graft. In a few cases, however, we may choose to leave it in place permanently. Sectioning of the graft (in which we cut the base of the graft to cut off its blood supply) can often be performed during a check-up examination using local anaesthetic eye drops. In some cases, however, the patient may need to be admitted for a few hours so that the graft can be sectioned or removed under sedation or a brief anaesthetic.

What is the effect on vision?
Whilst the graft is in place and the eye is healing the patient will have reduced vision. Following removal of the graft, vision should improve. There is usually some residual scarring of the cornea, but this scarring usually reduces over a period of months and the patient should regain useful vision. If the scarring is severe then we may dispense a course of eye ointment (‘Optimmune’) for a few weeks.

 


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