Lendectomy

Introduction

• Lendectomy, also known as intracapsular lens extraction (ICLE), is the term used for removal of the lens and its capsule via a large perilimbal corneal incision. The technique is used for the treatment of anterior lens luxation, and in some cases prophylactically for the treatment of lens subluxation (the condition immediately preceding lens luxation, where the lens remains in situ but becomes increasingly unstable).
• In dogs, lens luxation is usually hereditary and bilateral. There is a strong breed predisposition in the Lancashire heeler and terrier breeds. It is also seen in the border collie.

Uses

• To remove an anteriorly luxated lens, and in some cases prophylactically to remove a subluxated lens.
  Not recommended for the treatment of posterior lens luxation due to the high risk of retinal detachment .

Advantages

• Surgical removal of an anteriorly luxated lens is the only treatment available that may successfully restore vision and prevent secondary complications such as glaucoma and blindness .

Disadvantages

• Difficult surgical technique: magnification, correct microsurgical instrumentation and microsurgical experience are essential.
  Referral to a specialist ophthalmologist is recommended.
• Post-operative complications may be severe, including wound breakdown, corneal ulceration , bacterial infection, anterior uveitis , secondary glaucoma, retinal detachment , blindness.
• Even in surgically successful cases, post-operative vision is reduced due to hyperopia (long-sightedness) caused by the absence of a lens.
• In dogs, the condition is usually bilateral, so monitoring and/or surgery of the contralateral eye may be required.

Preparation

• Sterile preparation of peri-ocular skin and flushing of conjunctival sac and ocular surface with dilute povidone-iodine solution (0.2%) .
• Lateral canthotomy may be required prior to corneal incision.

Requirements

Materials required

Minimum equipment

• Eyelid retractors (Castroviejo or Barraquer).
• Mosquito artery forceps (fine, curved).
• Number 15 Bard-Parker blade and handle.
• Fine rat-tooth forceps with tying platform.
• Stevens tenotomy scissors.
• Westcott scissors.
• Lens vectis (lens loop).
• Fine needle holders (Castroviejo or Troutman; curved, no catch).
• Magnifying eye loupes (2x -4x).

Ideal equipment

• Deflatable bean bag for head support.
• Eyelid retractors (Castroviejo or Barraquer).
• Mosquito artery forceps (Fine, curved).
• Number 64 Beaver blade and handle.
• Colibri forceps with tying platform.
• Stevens tentotomy scissors.
• Corneal scissors (left and right).
• Westcott scissors.
• Irrigating lens vectis (lens loop).
• Fine needle holders (Castroviejo or Troutman; curved, no catch).
• Anterior chamber irrigating cannula.
• Operating microscope.
• Operating chair.
• Automated vitrectomy unit.

Minimum consumables

• 8/0 vicryl on spatulated 3/8ths or 1/2 curved needle.
• Viscoelastic gel: hydroxypropylmethylcellulose (HPMC) in syringe, with Rycroft cannula.
• Cellulose spears.

Ideal consumables

• 9/0 vicryl on spatulated 3/8ths or 1/2 curved needle.
• Viscoelastic gel: hydroxypropylmethylcellulose (HPMC) in syringe, with Rycroft cannula.
• Viscoelastic gel: hyaluronic acid (HA) in syringe, with Rycroft cannula.
• Cellulose spears.

Sources

Publications

• Recent references in PubMed.
• Curtis R (1990) Lens luxation in the dog and cat. Vet Clin North Am Small Anim Pract 20 , 755.