Diamond burr debridement for a non-healing corneal ulcer?

[WMM201]

Hello Everyone,

My cat Mumu is continuing her journey as an unsighted cat. She had a recheck with the ophthalmologist today, and her superficial corneal ulcer in her right eye is still not healing (healed in the left eye) after superficial debridement with a cotton swab last week, serum eye drops, Ofloxacin, and constant applications of Optixcare eye lubricant. The ophthalmologist said a bandage contact lens wouldn't help her after I asked about it ( neely had said it helped her cat heal) and said that diamond burr debridement would be what she would do next to promote some inflammation healing response. If that didn't work, she would do a surgical keratectomy under general anesthesia. Mumu right now doesn't seem to be in major discomfort with her drops and gabapentin (also for arthritis), so I decided to hold off on procedures to do some thinking after her glaucoma surgery ended up losing Mumu's vision.

Doing some research, it seems that diamond burr debridement can potentially cause more problems in cats and some ophthalmologists don't really like it for superficial corneal ulcers. I was also surprised that the bandage contact lens was dismissed immediately by the ophthalmologist today. Does anyone have any experience with this procedure on their cats' superficial corneal ulcers, or can share what worked for their cats' healing? The earliest I can get Mumu to another ophthalmologist isn't until July 14. I'm going to try to call more places, but all the practices around are booked out for months.

Another strange thing is that the ophthalmologist today (who did her glaucoma surgery) said that Mumu has a strong light response in her right eye, but not her left, but both retinas are still attached and eyes aren't inflamed. In her opinion, there is no reason why Mumu can't see unless there is a problem with her optic nerve. She wanted to do an electroretinogram test, but Mumu already had a long day at the vet for her bloodwork and I didn't think she had any more patience. I'm still not sure if I want to do this test, because I don't know if it would actually make a difference in terms of whether Mumu can see. It seems more to find out why she can't see having recovered mostly from the surgery as expected (except for the corneal ulcer in the right eye).

Does anyone have any thoughts or suggestions? I wish ophthalmologists weren't so booked out and I could get another opinion on this sooner than 7 weeks from now!


Diana

 

[neely]

I'm sorry Mumu had such a rough day, poor baby. Since you are in Michigan, are you within driving distance of the University of Michigan? It's my understanding they have an excellent reputation and veterinary school. Or maybe you could arrange a telehealth video chat with them.

 

[WMM201]

neely Thanks so much for your kind thoughts for Mumu! In fact, two weekends ago, I had taken Mumu to their ophthalmology department for an emergency consultation. That was when her surgical complications first set in and she lost her vision. They diagnosed corneal ulcers in her eyes at that time and it's the right eye that still hasn't healed. I asked if I could transfer her care to them, and they said they are fully booked for months and that I should work with her current ophthalmologist. But I think I might try to call them again, just to see if there is any hope of them looking at her before July 14 or even close to her 3 week recheck.

 

[neely]

I asked if I could transfer her care to them, and they said they are fully booked for months and that I should work with her current ophthalmologist. But I think I might try to call them again, just to see if there is any hope of them looking at her before July 14 or even close to her 3 week recheck.

Can you ask if they have a wait list should anyone decide to cancel their appointment? That way you could possibly get in sooner. If they tell you they don't have a wait list I would suggest calling to check on a regular basis. Good luck!

 

[WMM201]

Can you ask if they have a wait list should anyone decide to cancel their appointment? That way you could possibly get in sooner. If they tell you they don't have a wait list I would suggest calling to check on a regular basis. Good luck!

neely I am so glad I called Michigan State today! I spoke with the doctor who saw her as an emergency patient last time, and she already seemed surprised by the recommendation for diamond burr debridement and the dismissal of the contact lens option over the phone. She was able to fit me in for next week so they can examine Mumu and get a second opinion on treatment for her corneal ulcer and overall eye situation. I feel so much better now that I know Mumu can have another perspective on her case that seems more attuned to cats (vs dogs) and that she doesn't have to wait 3 weeks with this corneal ulcer! Thank you for giving me that nudge!!

 

[neely]

Thank you for giving me that nudge!!

You're entirely welcome. I know the feeling when you want to help your cat and will go to great lengths to get the best medical care for them. I sincerely hope the visit with the doctor from MI State goes well for Mumu. I can't wait to hear what the vet recommends.

 

[WMM201]

You're entirely welcome. I know the feeling when you want to help your cat and will go to great lengths to get the best medical care for them. I sincerely hope the visit with the doctor from MI State goes well for Mumu. I can't wait to hear what the vet recommends.

neely Today's second opinion appointment was such a pleasant change from the frustration from the previous ophthalmologist. The MSU vet was much more responsive to my questions and offered therapies that seemed to take into account my cat rather than what has worked for other patients--mostly dogs. And Mumu apparently was very good for her eye exam as well as her contact lens placement in the right eye. I hope this contact lens will help that corneal ulcer heal, or at least make it more comfortable while it takes its sweet time. She also has inflammation in both eyes that her other ophthalmologist didn't find 5 days ago. Now, it's more drops, more times a day until this corneal ulcer heals in one eye and the inflammation dies down in both eyes. But at least this gave me some hope beyond a procedure that I knew was probably not right for me cat.

 

[neely]

And Mumu apparently was very good for her eye exam as well as her contact lens placement in the right eye.

So glad you saw the MSU vet and had a good experience. Sometimes you have to go with your gut feeling and get a second opinion. I'm also glad Mumu was able to get a contact lens like one of our previous cats and hope it works as well for her as it did for our guy. Very important that the second vet caught the inflammation in both eyes which the ophthalmologist missed. Fingers and paws crossed for Mumu and you. Thanks much for the update!

 

[WMM201]

An update in case this is useful: We had our ophthalmologist recheck at the vet school medical center today and unfortunately Mumu's corneal ulcer in her right eye hasn't healed up, but it is smaller. However, less positive development is that her left eye now has developed corneal ulcers after being healed up. She doesn't blink enough or close her eyes all the way often when she is sleeping. This is because she is now blind and the laser cytocoagulation surgery for her glaucoma have desensitized her corneas and so she apparently is now doubly predisposed to these exposure ulcers. She had been on anti-inflammation eyedrops in the left eye, which probably didn't help with the ulcers, either. But it's important to get her inflammation under control in her eyes or she will be painful. So now she has bandage contact lenses in both eyes and is still on eyedrops, with just one dose of the anti-inflammatory drops to split the difference between allowing healing and controlling the uveitis.

The ophthalmologist said that it's only one month out from her lens removal and laser glaucoma surgery, so Mumu could be still healing, but slowly because she is old. I sure hope that's the case. I know the corneal ulcers take forever to heal, but having the left eye get another ulcer is discouraging. It makes me once again just feel so bad that I chose surgery for Mumu to begin with just trusting one ophthalmologist's opinion (that I kind of was hesitant about).

Today's specialist said that there is a procedure to basically close up the eyelids a little, I think permanently? that would make Mumu's eyes a little smaller and therefore help her corneas be less exposed. Has anyone out there ever heard of this or had this done on their kitties? Or have dealt with these recurring exposure ulcers in their cats?

 

[fionasmom]

Feline Eyelid Agenesis

This might be the surgery you are describing....might be. If it is, there are numerous sites which discuss it. MSPCA vet who wrote the article has a phone number.

 

[neely]

The ophthalmologist said that it's only one month out from her lens removal and laser glaucoma surgery, so Mumu could be still healing, but slowly because she is old.

I like to be optimistic and sincerely hope Mumu is still healing as the specialty ophthalmologist suggested. Regarding choosing surgery and trusting the opinion of the first vet, try not to blame yourself. We all do this but you had no way of knowing whether it would help Mumu or not so you did what you felt was best for her at the time. Thankfully you sought a second opinion from a more knowledgeable specialist and that is what counts. Sending special thoughts to your sweet girl and you.

 

[Margot Lane]

Thank you for posting this thread…just so heartwarming to see what lengths you are going to help your Mumu. Astonishing what science can do these days. I am sure this thread will be helping other kitties in future whose owners maybe didn’t know this option even existed! Heal up, Mumu!

 

[WMM201]

neely and Margot Lane , thank you both so much for these kind and supportive words. They mean a lot to me! I am definitely trying to look forward instead of backward. Despite my own conflicted feelings about Mumu's eyes and how they got this way, I am happy to report that Mumu is adjusting well and, with these bandage contact lenses in, not in discomfort. For the first time since her surgery and all the problems that happened since, we went out for a harness walk today, and boy did Mumu love it. She remembers her route and it was almost like she could see in her mind. If Mumu is determined to live her best life, then I have to just support her and stop moping. neely , thank you so much for responding about the contact lens and the prompt to call Michigan State. I truly believe they have helped Mumu immeasurably. Margot Lane , you are always ao understanding!

 

[WMM201]

Feline Eyelid Agenesis

This might be the surgery you are describing....might be. If it is, there are numerous sites which discuss it. MSPCA vet who wrote the article has a phone number.

Hi fionasmom , thanks for looking it up! I did a bit more digging around online and I think the one the specialist was talking about is a temporary tarsorraphy. She said they suture the corners of the eyelids closed to reduce the amount of exposure of the cornea and it still allows monitoring and medications. If this would really help Mumu's eyes heal I would consider it, but this seems like something that needs to be done under general anesthesia (how else can they make sure the cat won't move during the procedure in such a delicate area?). Mumu has some other systemic things happening that makes me hesitant to put her under anesthesia unless absolutely necessary. I really hope her eyes are at least healing slowly at her recheck in a month as we buy her some more time to get healthier and stronger for any kind of procedures. I will definitely update with more information. I hope Mumu's experience can be helpful to any other cat parents out there facing eye issues. It really seems like more attention is given to dog eye health than to cats.

 

[WMM201]

Also, the specialist recommended GenTeal Severe gel or Refresh Celluvisc drops for Mumu because I said she doesn't really like the Optixcare gel. I got the Refresh drops (had a coupon ) and they come in single use vials that give 6 drops. I think Mumu does prefer these because it's less volume of substance going in her eye. I wonder if it lasts as long or longer than Optixcare, especially since it's normally used by people with severe dry eyes. Anyway, if anyone's eyes (kitty or human) could use heavy duty drops, you could try these!

 

[fionasmom]

I understand your concern about anesthesia. In the elderly (humans), the eyelids sometimes do not adhere to the eye as they should which allows for a similar problem such as Mumu is having. The happened to one of my aunts who was in long term care and, at age 99, no one was going to give her anesthesia. They did maintain her eyes with continual use of drops.

 

[WMM201]

I understand your concern about anesthesia. In the elderly (humans), the eyelids sometimes do not adhere to the eye as they should which allows for a similar problem such as Mumu is having. The happened to one of my aunts who was in long term care and, at age 99, no one was going to give her anesthesia. They did maintain her eyes with continual use of drops.

I hope your aunt was comfortable with her eyes and overall, fionasmom . I wonder if Mumu is closer to 99 in cat years. I sure hope the drops will be enough. Even though I was giving Mumu Optixcare every couple of hours for the past week and a half, she still developed the corneal ulcers. I won't be able to maintain the frequency of drops after the summer, but maybe by then her corneas will be healthier. I really hope the human drops I just switched to have more staying power for her. Thank goodness for those contact lenses in right now!

 

[WMM201]

Continuing to update this for anyone interested in kitty eye problems. It's been 3 weeks since Mumu got contact lenses put in both eyes for corneal ulcers. She'd been getting her eye drops and seeming comfortable, but frustratingly not really closing her eyes fully. Two days ago, I noticed some more opaque spots on both of her eyes, and I didn't know if it's the contact lenses or a problem with her actual corneas. This morning, her left eye seemed really uncomfortable for the first time since this whole ordeal started: Mumu was squinting some and holding the left eye closed after her morning eye meds. So I called the vet school ophthalmology department where Mumu was due for recheck in 7 days from today and sent some photos. They had me come in today with her, and poor Mumu lost both her contact lenses and her corneal ulcers have not healed at all. It's really disheartening news especially since she seems uncomfortable for the first time. Unfortunately, because of her kidney disease and hypothyroidism, Mumu is slow to heal especially where there not blood vessels, like the front of her corneas. So, we're switching from Ofloxacin drops to terramycin ointment, stopping the Diclofenac antiinflammatory drops, and adding a lubricating ointment especially for overnight. Hopefully, the ulcers stay uninfected and can heal with the heavier ointments and eye lubricants.

And adding insult to injury for poor Mumu, she had some loose stools in the morning before we found out we had to go on a 70 miles drive. She had another loose stool accident in the exam room and we had to clean her with some wipes I brought. Then she got a bum and tail bath when we got home. The handheld showerhead I installed after her last diarrhea accident has really come in useful, I will say that. Mumu was a trouper, as always. I just wish she didn't have so many setbacks and issues. We go back next week for a recheck and I just hope things don't get worse in the meantime. I have stopped hoping for things to get better.

Also funny (not really) is that I had to postpone my own eye exam that was today for Mumu's appointment and her recheck is on the earliest day I could reschedule my appointment. Let's hope the timing works out as I optimistically planned!

 

[fionasmom]

Are retrying the contacts a possibility? I am in no way suggesting that you should if they are clearly not going to work, but I don't have any personal experience with them. The correct eye drop may do some good, hopefully, along with the lubricating ointment. You really have left no options unexplored and I hope that something will help.

I have certainly had cat "accidents" in the carrier in the car. It just makes everything so much more stressful. Mumu is clearly a very sweet girl to accept all of this in some sort of stride.

Not funny about the conflicting appointments, but it is sort of a Murphy's Law sort of thing. The universe is only letting one of you see the doctor that day.

Please keep us posted.

 

[WMM201]

Are retrying the contacts a possibility? I am in no way suggesting that you should if they are clearly not going to work, but I don't have any personal experience with them. The correct eye drop may do some good, hopefully, along with the lubricating ointment. You really have left no options unexplored and I hope that something will help.

I have certainly had cat "accidents" in the carrier in the car. It just makes everything so much more stressful. Mumu is clearly a very sweet girl to accept all of this in some sort of stride.

Not funny about the conflicting appointments, but it is sort of a Murphy's Law sort of thing. The universe is only letting one of you see the doctor that day.

Please keep us posted.

fionasmom indeed, kitty eyes won out over human eyes yesterday. The ophthalmologist didn't want to put in contact lenses again in favor of thicker ointment antibiotics and lubricants that hopefully will keep the eyes protected also. The ointments would be so thick that the lenses would slide off her eye. I hope that these ointments can keep her eyes moisturized more effectively, enough for her ulcers to improve at least. Mumu's left eye seems to be bothering her more. It's got a slightly high eye pressure, but we can't put her on a stronger pressure control eyedrop because the last time she was on them (dorzolamide) she had a terrible systemic reaction and needed to be hospitalized (she also was massively constipated and due to her lethargy, it's almost no wonder). Once we stopped the drops, she got better right away. Poor Mumu's body reaction is not really allowing the more effective drugs to be used. I gave her more gabapentin even though she had a lot for sedation yesterday because I am afraid she might be in pain. She's been sleeping and not walking around much since then and seems a little weak in the back legs.

I also wonder if there is something going on in the left ear. There is a lot of dark brown gunk in there, similar to what had been in her right ear right around when her lens luxated in early May. The cat clinic vet prescribed 7 days of Animax in the right ear, and since then the right ear looks clean and much better. I tried using Zymox Otic solution in Mumu's left ear for 3 days so far, it hasn't seemed to help yet. After the Zymox treatment today is also when Mumu started sleeping a lot and not moving around. I don't know if she is reacting to that or the gabapentin. I think I got too much Zymox in there because she shook and twitched her head a little. I cleaned out her ear some and so much brown stuff came off on the tissue. I wonder if there is still too much Zymox in there making her dizzy or something. I think I will call the cat clinic on Tuesday to ask if maybe I can use the Animax I have left from May in her left ear.

My poor baby Mumu is so patient and tolerant and is dealing with so much. I just hope she is comfortable. Seeing her do nothing but sleep today is sad but she did have a very stressful day yesterday and some unpleasant ear treatment today so maybe she just wants to rest. I hope I am helping her and not hurting her. It makes me so sad.