Clinical evaluation of Morgan pocket technique for surgical correction of third eyelid (glandula nictitans) prolapse in dogs: 45 eyesABSTRACT
Nictitans gland prolapse, or cherry eye disease, requires prompt treatment in dogs. Despite various surgical methods described for different breeds, consensus on the most effective technique is lacking. This study aimed to evaluate the Morgan pocket technique for treating Nictitans gland prolapse in Turkish Shepherd and other dog breeds. The study analyzed 39 dogs (45 eyes) with the condition. Preoperative ophthalmic examinations, including ophthalmoscopy, tonometry, Schirmer tear test I, fluorescein staining, and ultrasonography, were conducted. All cases underwent surgical treatment using the Morgan pocket technique, and clinical results, recurrence, and complications were assessed. The Turkish Shepherd dog was the most common breed (27 eyes, 71.6%), followed by Rottweilers and Cane Corsos (7.7%). The success rate of the Morgan pocket technique was 97.44% overall and 96.29% in Turkish Shepherd dogs specifically. The most affected dogs were male (84.6%) and under two years old (71.8%). Postoperative recurrence occurred in only one Turkish Shepherd dog, with no technique-related complications observed. The study concluded that the Morgan pocket technique is advantageous due to its ease of application and high success rate, with high reliability indicated by the low recurrence rate and absence of complications.
Keywords:
third eyelid gland; cherry eye; turkish Shepherd dog; pocket technique
RESUMO
O prolapso da glândula nictitante, ou doença do olho de cereja, em cães requer tratamento imediato. Apesar dos vários métodos cirúrgicos descritos para diferentes raças, não há consenso sobre a técnica mais eficaz. O objetivo deste estudo foi avaliar a técnica de bolsa de Morgan para tratar o prolapso da glândula nictitante no Shepherd turco e em outras raças de cães. O estudo analisou 39 cães (45 olhos) com a condição. Foram realizados exames oftalmológicos pré-operatórios, incluindo oftalmoscopia, tonometria, teste lacrimal de Schirmer I, coloração com fluoresceína e ultrassonografia. Todos os casos foram submetidos a tratamento cirúrgico usando-se a técnica de bolsa de Morgan, e os resultados clínicos, a recorrência e as complicações foram avaliados. O cão Pastor Turco foi a raça mais comum (27 olhos, 71,6%), seguido por Rottweilers e Cane Corsos (7,7%). A taxa de sucesso da técnica de bolsa Morgan foi de 97,44% no geral e de 96,29% especificamente em cães da raça Pastor Turco. A maioria dos cães afetados eram machos (84,6%) e tinham menos de dois anos de idade (71,8%). A recorrência pós-operatória ocorreu em apenas um cão da raça Pastor Turco, sem complicações relacionadas à técnica. O estudo concluiu que a técnica de bolsa Morgan é vantajosa devido à sua facilidade de aplicação e à alta taxa de sucesso, com alta confiabilidade indicada pela baixa taxa de recorrência e pela ausência de complicações.
Palavras-chave:
glândula da terceira pálpebra; olho de cereja; cão Pastor Turco; técnica de bolso
INTRODUCTION
The glandula nictitans (third eyelid gland) is a mobile fold of the conjunctiva, located in the inferior nasal fornix. It is held in a retracted position in the orbital fossa by the muscular fascia and smooth muscle fibers originating from the periorbita. In addition, this gland has a tubuloacinar seromucoid gland structure and contributes 30-57% of the aqueous part of the tear film (Premont et al., 2012; Sapienza et al., 2014; Multari et al., 2016;Demir and Altundağ, 2020). Other important functions include providing immunological support for the eye, physical protection of the cornea, and distribution of tear film produced (Yaygıngül et al., 2019).
Prolapse of the third eyelid is the most common primary disease of the glandula nictitans, reported mostly in dogs and to a lesser extent in cats (Michel et al., 2020). This disease is often referred to as "cherry eye" or "haws" because of the appearance of a small pink or reddish ball-like structure in the medial canthus of the eye (Dehghan et al., 2012; Sapienza et al., 2014).
The etiology and pathogenesis are unknown, but it is hypothesized that the disease is hereditary and due to a juvenile defect associated with laxity of the connective tissue connection between the glandula nictitans and periorbita (Yaygıngül et al., 2019;Demir and Altundağ, 2020; Deveci et al., 2020).
In the past 30 years, various studies on prolapse of the third eyelid have been published (Dehghan et al., 2012;Das et al., 2022). The predisposition of the disease in large breeds and brachycephalic dog breeds is among this information. The breeds in the literature are the British and American Cocker Spaniel, Basset Hound, Beagle, Boston Terrier, British and French Bulldog, Lhasa Apso, Pekingese, Shih-Tzu, Poodle, Newfoundland, Great Dane, St Bernard, Neapolitan Mastiff, Cavalier King Charles Spaniel, Shar Pei, and Cane Corso. However, there is insufficient data on dogs other than these breeds (Dehghan et al., 2012; Premont et al., 2012; Sapienza et al., 2014; Multari et al., 2016; Barbe et al., 2017; Michel et al., 2020). Glandula nictitans prolapse occurs between 2 months and 7 years of age and has been reported mostly in young dogs up to 2 years of age (Dehghan et al., 2012; Multari et al., 2016; Barbe et al., 2017). It has also been reported that male dogs are more frequently affected than female dogs (Multari et al., 2016) and prolapse of the gland is mostly unilateral in 20-40% of cases, but there are also bilateral cases (Michel et al., 2020).
Definitive treatment for third eyelid prolapses is performed surgically operation (Barbe et al., 2017; Demir and Altundağ, 2020; Deveci et al., 2020). Before the 80s, total or partial gland removal was performed as an operative treatment (Dehghan et al., 2012;Multari et al., 2016). However, postoperative follow-up results of these procedures have shown that keratoconjunctivitis sicca (dry eye) occurs in cats and dogs because of decreased tear production and microdamage to the keratoconjunctival epithelium. In this respect, various techniques have been developed to reposition the gland instead of removing it have been developed (Dehghan et al., 2012; Premont et al., 2012; Sapienza et al., 2014; Multari et al., 2016). In this context, although approximately 10 techniques have been reported in the veterinary literature, the "anchorage technique" based on the principle of fixing the gland and the "Morgan pocket technique,” which includes the principle of pocket formation, are used (Demir and Altundağ, 2020; Michel et al., 2020).
In such cases, the Morgan pocket technique is the most used technique in such cases (Premont et al., 2012; Multari et al., 2016; Barbe et al., 2017; Michel et al., 2020). Although approximately 60% recurrence was observed with the anchorage technique, this rate was limited to approximately 6% with the Morgan pocket technique (Premont et al., 2012; Sapienza et al., 2014). It has also been reported that the chance of success in the postoperative period is higher, and the probability of complications is approximately 10% (Michel et al., 2020; Oguntoye et al., 2022). This technique involves making two parallel bulbar conjunctival incisions, one dorsal and one ventral to the prolapsed gland, pushing the gland ventrally inward, joining the incisions with simple continuous sutures so that the gland remains inside, and positioning the suture ends in such a way that they do not irritate the cornea (Dehghan et al., 2012; Multari et al., 2016; Barbe et al., 2017).
This study aimed to contribute to the literature by evaluating the use of the Morgan pocket technique, clinical evaluations, and possible complications in the correction of third eyelid prolapse in Turkish Shepherd and other breeds of dogs.
MATERIALS AND METHODS
The study protocol was approved by the Local Ethics Committee on Animal Experiments, Harran University (session and permit number: 2023/002/12).
Animal material
The study consisted of 39 dogs (n=45 eyes) of different breeds that were hospitalized at the Harran University Animal Hospital Surgery Clinic with a reddish mass in one or both eyes and diagnosed with third eyelid prolapse. The Morgan pocket method was used as the operative technique in dogs and a postoperative 6-month follow-up was performed. Ophthalmic examinations, including intraocular pressure measurements using ophthalmoscopy (Omega 500, Heine Optotechnik; 2.2 PanRetinal, Volk Optical Inc.) and tonometry (Icare® Tonovet Plus, Madison, USA), were performed for each affected eye preoperatively (Figure 1A). In addition, corneal and tear secretions were evaluated and recorded using Schirmer tear test I (ERC Schirmer Tear Test Strips, Türkiye) and fluorescein staining (Fluorescéine Pharmargus, Pharmaceutical Research and Production Co. Istanbul,) (Figures 1B, 1C). Ultrasonography (Mindray z60, China) with a 7.2 to 11MH microconvex probe device was used for the ultrasonographic examination of the affected eyes (Figure. 1D). In addition to the medical records of the dogs, breed, sex, age, bilateral or unilateral affected eye, efficacy of the surgical method, recurrence, possible complications, and prognosis were also recorded.
A Evaluation of intraocular pressure with tonometer. B Quantitative evaluation of tears with the Schirmer Test-I. C Evaluation of the cornea with fluorescein staining. D USG evaluation of the posterior chamber of the eye and visualization of the hyperechoic prolapsed third eyelid (yellow arrow).
Amoxicillin-clavulanic acid combination (8-9 mg/kg SC, Synulox, Pfizer, Türkiye) was administered as an antibiotic to all dogs in the perioperative period. Xylazine hydrochloride (1-2 mg/kg IM, Xylazinbio 2%, Intermed, Türkiye) was administered as premedication, and ketamine hydrochloride (10-20 mg/kg IM, Ketasol, Interhas, Türkiye) was administered to induce general anesthesia. A silicone-cuffed endotracheal tube was then placed, and gas anesthesia was maintained with sevoflurane (2-3% inhalation, Sevorane, Abbott, U.K.) and 100% oxygen supplied by respiratory support.
In all animals, the periorbital region was sterilized with 10% povidone-iodine solution, and the cornea and conjunctiva were sterilized with 0.9% NaCl solution. For the operation position, the unilateral cases were placed in the lateral position with the involved eye on top, and the bilateral cases were placed in the sternal position. The eye contour was covered with a sterile cervical cloth. A Barraquer eye retractor was used to open the upper and lower eyelids (Figure 2A). The third eyelid was detected, and to expose the bulbar surface, a size 0 silk thread was placed laterally and medially and secured using mosquito forceps. To better access the glandula nictitans, forceps were used to pull the gland nictitans outwards (Figure 2B). Two superficial elliptical incisions were applied to the bulbal conjunctival free surface of the third eyelid (ventral and dorsal), one on each side, and easily inserted into the pocket by twisting, as described in the Morgan pocket technique. Then, the incision lines created on the conjunctival surface were closed with simple continuous sutures using 3/0 or 4/0 absorbable thread (PGA; Katsan, Katgut ind. trade. Izmir/ Türkiye) (Figure 2C). The suture knots were positioned at the beginning and end of the conjunctival surface and fixed to the outer surface such that they did not touch the corneal surface (Figure 2D). In bilateral cases, the procedure was repeated in the other eye. A 0.9% NaCl solution was instilled intermittently into the eye until the end of the operation.
A Using a Barraquer eye retractor to open the upper and lower eyelids. B Silk thread placed laterally and medially to expose the bulbar surface and secured with mosquito forceps. C Closure of the incision lines formed on the conjunctival surface with simple continuous sutures by placing the prolapsed third eyelid into the pocket formed. D Postoperative image.
In the postoperative period, 3% boric acid (Nutriwin Chemistry Pharma Industry Trade. Co. Ltd. Konya/Türkiye) solution was injected for local antisepsis of the operation area, and marbofloxacin (Vigamox 0.5%, Alcon Lab., U.S.A.) was applied as local antibiotic eye drops three times a day for 10 days. In addition, a systemic antibiotic combination of amoxicillin clavulanic acid (8-9mg/kg SC, Synulox, Pfizer, Türkiye) and nonsteroidal anti-inflammatory drugs (Meloxicam, 0,1mg/kg once daily, Metacam ®, Boehringer Ingelheim) were also administered. It was also recommended and prescribed to be administered every day postoperatively. The elizabeth collar was worn for two weeks postoperatively. The patients were recalled to the hospital for follow-up 15 days after the operation, and all patients were followed up for at least 6 months.
SPSS 22.1 was utilized for data analysis. Normality of the data sets was assessed using the Shapiro-Wilk normality test. Categorical variables (e.g., race, age, sex, and bilateral or unilateral prolapse) were summarized using percentages. Continuous variables (e.g., intraocular pressure and Schirmer tear test results) were reported as means or medians with corresponding ranges. The paired-sample chi-square test was employed to analyze the data and compare findings. Statistical significance was determined at a threshold of P<0.05.
RESULTS
In the present study, 45 cases of third eyelid prolapse were evaluated in 39 dogs. Table 1 presents the list of data, including the breeds and their percentages. The most common breed was the Turkish Shepherd dog (71.6%), which differs from the literature (P<0.05) (Figure 3A). The second most common breeds were the Cane Corsa (7.7%) and Rottweiler (7.7%) breeds (Figure 3B). Third eyelid prolapse was observed more frequently in male dogs (84.6%) than in female dogs (15.4%) (P<0.05). The age data list includes dogs from many age groups (Table 2). According to the classification, the proportion of dogs between 0-6 months was 33.3%, between 7-11 months was 20.5%, between 1-2 years of age was 18%, and > 2 years of age was 28.2%. Age classification between races was not statistically significant. In Turkish Shepherd dogs, the most affected breed, the highest incidence was observed in 2-3 year old cases (10.4%). The proportion of male dogs included the Turkish Shepherd dogs (61.5%; P<0.05).
A Preoperative and postoperative image in Turkish Shepherd Dog. B Preoperative and postoperative image in a Cane Corsa dog.
Among the 45 eyes assessed, the proportion of unilateral cases was (38.5%) in the right eye and (41%) in the left eye, whereas the proportion of bilateral cases was (20.5%) (Table 3) (Figure 4). No statistically significant differences were observed between the right and left eyes. Physical examination of patients with third eyelid prolapses revealed conjunctival hyperemia and epiphora. Fluorescein staining and ophthalmoscopic examination did not reveal any corneal or fundus lesions. Ultrasonographic examination revealed no lesion in the posterior camera of the eye; however, the prolapsed glandula nictitans was a hyperechoic mass in the medial canthus of the eye. The results obtained in cases in which intraocular pressure was evaluated (mean±std 20.1±2.1 mm Hg, referends: 11-25mm Hg) were within the reference ranges and were not statistically significant. Schirmer tear test results (mean±std 17.64±2.41 mm/min, reference: 18- 20 mm/min) were slightly below the reference values. During the operation, 0.9% NaCl solution was intermittently instilled into the eye to prevent complications because the anesthetic agent increased the dryness of the eye. The Morgan pocket technique was applied to all 45 eyes. The success rate in all the cases was 97.44%. Recurrence (2.56%) was observed in only one case (case 14). According to the owner, the elizabethan collar was not used, and the dog had irritated the eye with its paw. The patient was operated on again 15 days later using the same method. No recurrence or complications were encountered during the six-month follow-up. The use of collars in all cases without recurrence demonstrated the importance of collar use in this operation. Case 22 had chronic lameness in the right forelimb, and clinical and radiographic examination revealed osteosarcoma-like bony growths in the right radius-ulna bone. The patient was referred to the Department of Pathology for definitive diagnosis after the operation. In Case 25, follicular conjunctivitis was present in the eyes where the prolapse was formed. This disease was treated first and then operated on, and no complications were encountered during the postoperative follow-up.
Case of unilateral or bilateral third eyelid prolapse observed in some Turkish Shepherd Dogs.
A total of 27 eyes were evaluated in the Turkish Shepherd dog, which had the highest number of cases in this study. The rates were 33.4% in the right eye, 43.6% in the left eye, and 23% in bilateral cases. The only case of recurrence (case 14) was in the Turkish Shepherd dog breed. No statistically significant differences were observed between the eyes of this breed. Although there are not enough data in the literature regarding the use of the Morgan pocket technique in the treatment of third eyelid prolapse in Turkish Shepherd breed dogs, the study demonstrated that the use of the Morgan pocket technique was successful in this disease, with a rate of 96.29%, except for the case of recurrence, as in other breeds.
No complications related to the surgical technique or in the operated eyes were encountered during the 6-month postoperative follow-up period. Only the pathological biopsy result of case 22 was osteosarcoma. The necessary communication was established with the patient’s owner, and the disarticulation operation of the related extremity was performed in the following process.
DISCUSSION
The third eyelid presents as a reddish hyperplastic mass in the medial canthus of the eye (Chahory et al., 2004). Since it is one of the lacrimal organs of the eye and contains cartilage and lymphoid follicles, it is one of the primary eye diseases in dogs that causes dry eye with inflammation (Kelawala et al., 2016; Demir and Altundağ, 2020). The treatment was performed surgically. The Morgan pocket technique continues to be increasingly used in many dog breeds with an easy application and an average success rate of approximately 94% (Gelatt et al., 2013;Kim et al., 2020). The aim of this study was to clinically evaluate third eyelid prolapse disease in Turkish Shepherd dogs (71.6%) and some other breeds, and the effectiveness of the Morgan pocket technique in this disease.
Various techniques have been developed for the treatment of third eyelid prolapse in dogs (Multari et al., 2016; Deveci et al., 2020). These treatment procedures are evaluated in two main groups: pulling the gland to its anatomical position with the help of a suture or creating a pocket and embedding it into the gland. Anchoring techniques are based on fixing the gland using sutures (Barbe et al., 2017;Demir and Altundağ, 2020; Kumar and Akr, 2020). In some studies using anchorage techniques, varying percentages were reported, such as 41.2% in Gross's technique (Gross, 1983), 93.4% in Plummer et al. (2008), 100% in eight dogs treated by Kaswan and Martin (1985), and 100% in a large study (122 eyes) by Sapienza et al. (2014) were reported. In addition, disadvantages such as decreased mobility of the gland, lacrimal cyst formation, and corneal ulcers have been reported with anchorage techniques (Sapienza et al., 2014; Multari et al., 2016; Deveci et al., 2020). The Morgan pocket technique is preferred because it does not restrict the mobility of the gland, is easy to apply, and does not change the morphology of the gland (Premont et al., 2012; Kumar and Akr, 2020). In studies on this technique, high success rates were reported as follows: Mazzucchelli et al. (2012) (155 eyes) 87.5%, Premont et al. (2012) 90.9%, Morgan et al. (1993) (89 eyes) 94.1%, Dehghan et al. (2012) 97% in 28 dogs, Simonazzi and Zanichell (2002) 95.2%, Deveci et al. (2020) (20 eyes) 94.1%, Yaygıngül et al. (2019) 96.1% in 26 dogs, Sağlıyan and Günay (2018) (18 eyes) 94.4%. In addition, it was reported that no undesirable results were encountered in most studies. In the present study, the Morgan pocket technique was applied in the third eyelid prolapse of 45 eyes in 39 dogs, and no complications related to the technique were encountered, with a 97.44% success rate. Moreover, the success rate of this technique in Turkish Shepherd dogs was 96.29%.
Third eyelid prolapse is thought to be a genetic disease, as it is observed mostly in large breeds and brachiacephalic breed dogs considering the reported studies (Kelawala et al., 2016; Lima et al., 2020; Michel et al., 2020). Some authors have suggested that there is a genetic predisposition in large dog breeds such as the Great Dane, Golden Retriever, English Bulldog, St Bernard, Weimaraner, Doberman, German Shepherd, Newfoundland Dog, and Irish Setter because of the relatively increased prevalence in these breeds (Dehghan et al., 2012; Sapienza et al., 2014; Multari et al., 2016; Barbe et al., 2017; Demir, 2022). Mazzucchelli et al. (2012) reported that brachycephalic breeds, including English and French Bulldogs, are common. Dehghan et al. (2012) reported that terriers (12 dogs, 42.86%), a small breed, were more common in their study. Michel et al. (2020) reported that the disease occurred in brachycephalic dogs (72 dogs, 54.5%) and large and giant dog breeds (43 dogs, 32.6%), with a statistically significant difference (P=0.023). In a study conducted by Yaygıngül et al. (2019) it was reported that the disease was observed mostly in mongrel breeds (30.77%), but occurred in Turkish Shepherd dogs (7.69%), although in small numbers. The data obtained from the dog breeds in the study indicated that most of the cases occurred in large-breed dogs (36 dogs, 94.8%), and Turkish Shepherd dogs (27 dogs, 71.6%) constituted the majority of the cases, which was statistically significant (P<0.05).
Prolapse of the third eyelid is mostly encountered in dogs aged between 6 and 24 months (Morgan et al., 1993; Simonazzi and Zanichell, 2002; Chahory et al., 2004; Mazzucchelli et al., 2012; White and Brennan, 2018; Deveci et al., 2020). In a study conducted by Das et al. (2022) the age of patients with the disease varied between 3-30 months. Premont et al. (2012) and Yaygıngül et al. (2019) reported that the disease was mostly found in dogs younger than 12 months of age. The age range of the cases in the present study was similar to the data in the literature, and mostly consisted of dogs aged 2 years and younger (71.8%).
In the literature, it was emphasized that the number of male dogs was higher than the number of female dogs (Premont et al., 2012; Sapienza et al., 2014; Barbe et al., 2017; Michel et al., 2020; Oguntoye et al., 2022). In some studies, Deveci et al. (2020) reported a male dog ratio of 56%, Yaygıngül et al. (2019) 69%, Multari et al. (2016) 61% and Mazzucchelli et al. (2012) (155 dogs), 59%. In the study conducted by Premont et al. (2012), it was reported that the number of female dogs was slightly higher, and it was not statistically significant. The proportion of male dogs (84.6%) was significantly higher than that of female dogs (15.4%) (P<0.05).
In the literature on cherry eye disease, it is noteworthy that fewer bilateral cases have been reported than unilateral cases (Morgan et al., 1993; Mazzucchelli et al., 2012). In addition, in some studies, there was no statistically significant difference between the numbers of affected left and right eyes (Kaswan and Martin, 1985; Plummer et al., 2008; Multari et al., 2016). In the present study, similar to the literature data, it was observed that the number of cases observed in the right (38.5%) or left eye (41%) was higher than that observed bilaterally (20.5%). In this study, a slight difference was observed in the left eye, but the difference was not statistically significant. This rate was mostly unilateral (77%) in Turkish Shepherd dogs.
Because the third eyelid is connected to the lacrimal system, changes in tear production were examined using the Schirmer test in cases of prolapse (Barbe et al., 2017; Deveci et al., 2020). In a study conducted by Gupta et al. (2016) in 10 dogs, it was observed that the data were within the normal range in the preoperative and 1-month postoperative Schirmer test-1 evaluation of the cases in which the Morgan pocket technique was used; however, they reported that the gland was extirpated in one case and keratoconjunctivitis sicca developed in this case, and the test data was <5 mm/min. Michel et al. (2020) reported that when 132 dogs were evaluated using the Schirmer test, the Schirmer test-1 values of the dog population were not affected, and 38.1% of the population was followed for more than 12 months. Another study conducted by Das et al. (2022) reported that the values were slightly below the normal limits in cases in which the Schirmer test was performed and showed an increase of 3.33% on the 15th postoperative day. In this study, the Schirmer test was applied only in the preoperative period, and the values were slightly below the normal limits in all cases. It was assumed that this may have originated because the cases were in the acute period.
In dogs, using the Morgan pocket technique, various absorbable suture materials are used to close the incision line after embedding the gland (Chahory et al., 2004; Demir and Altundağ, 2020; Deveci et al., 2020). Premont et al. (2012) used polyglactin 910 (vicyrl) suture material in this procedure, and no adverse events were reported. Ukwueze et al. (2015) also used a chrome additive and obtained successful results were obtained. Deghhan et al. (2012) reported success by limiting the risk of inflammatory reactions using polydiaxanone (PDS) absorbable suture material. In this study, an absorbable (PGA) suture thread was used, similar to the suture materials used in the literature, and no adverse situations such as inflammatory reaction or suture loosening were encountered.
There are variable data in the literature regarding the use of local corticosteroids after a third eyelid operation. While some authors (Dehghan et al., 2012; Yaygıngül et al., 2019; Deveci et al., 2020) have not found it appropriate to use corticosteroids in the postoperative period with the idea that it would adversely affect the wound healing mechanism of the suture line, others (Tripathi et al., 2014; Zabel, 2015) reported that local application did not cause any negative situation in their study. In the present study, local corticosteroid application was not used in the postoperative period and local antibiotic drops were preferred.
In the literature, various complications such as ectropion, entropion, epiphora, mucopurulent discharge, conjunctivitis, lacrimal cysts, intraoperative corneal drying, corneal erosions, ulcerations, and macroblepharon have been reported in the postoperative period after surgery for third eyelid prolapse (Chahory et al., 2004; Premont et al., 2012; Multari et al., 2016; Rezaei et al., 2019; Yaygıngül et al., 2019; Demir and Altundağ, 2020; Michel et al., 2020; Oguntoye et al., 2022). Epiphora and conjunctivitis lesions that were noted on physical examination before the operation were treated in the process, and no complications mentioned in the literature were encountered during the postoperative follow-up period in the cases evaluated using the Morgan pocket surgical technique.
In cases where the Morgan pocket technique is applied in dogs, recurrence may occur due to inadequate grasping of episcleral or subconjunctival tissue during suture placement, inadequate restraint of the dog, or exposure to trauma in the postoperative period (Premont et al., 2012). In a study by Rezaei et al. (2019), no recurrence was encountered. In the studies reported by Yaygıngül et al. (2019) (26 dogs) and Sağlıyan and Günay (2018) (13 dogs), recurrence was reported in a single case because the elizabethan collar was not used. Similarly, in the present study, only one of 39 dogs experienced recurrence because an elizabethan collar was not used. It is crucial to use an elizabethan collar to prevent trauma-induced recurrence in this surgical procedure.
CONCLUSION
In conclusion, it was observed that the Morgan pocket technique yielded clinically successful results in cases of third eyelid prolapse observed in Turkish Shepherd dogs and other dog breeds. Since there is not enough data on Turkish Shepherd dogs, it is anticipated that the use and outcomes of this technique will contribute to the literature. A limitation of this study is that the Schirmer test could not be performed in all dogs for six months and longer postoperatively.
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ZABEL, A. Surgical treatment of cherry eye. Banfield Pet Hospital, California, Oregon, Washington and Northern Nevada, 2015. Available in:http://www. banfield.com/getmedia/eaf2d896-6b4e-49ee-9126 ec30ab4682c5/3_4-Surgical-treatment-of-cherry-eye Accessed in: 15 Jan. 2015.
» http://www. banfield.com/getmedia/eaf2d896-6b4e-49ee-9126 ec30ab4682c5/3_4-Surgical-treatment-of-cherry-eye
Publication Dates
-
Publication in this collection
28 Apr 2025 -
Date of issue
May-Jun 2025
History
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Received
03 June 2024 -
Accepted
04 Oct 2024
