A 32 year old African Grey Parrot was referred to Myvets Hospital for cataract diagnosis and assessment. Ophthalmic examination revealed normal ocular palpebral reflexes, eye movements, corneal scarring was present, hyper mature cataract in right eye, unilateral blindness. Phacoemulsification technique of lens was done to remove the cataract under general anaesthesia. Patient was given meloxicam injection before surgery and general anaesthesia, Polymixin B eye drops for 7 days and was discharged within 6 hours after the surgery. After recovery from anaesthesia bird was normal and activity was normal. Post operative care is crucial to success of the surgery
Cataract is an increase in density and opacity and if not treated it leads to complete blindness. It is less common in African Grey Parrot and Macaws; surgical removal is the only option to remove the opacity and to regain the visibility.
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ETIOLOGY
SYMPTOMS
History of the patient was taken and physical examination was performed to check the visibility. Cataract was confirmed which caused opacity of the lens, the only way of regaining the sight was to remove the opacity surgically under general anaesthesia.
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OPTHALMIC EXAMINATION
General examination of the bird was done followed by ocular examination without the use of sedatives and anaesthesia as the later might interfere with the ocular reflexes and lacrimation. Examination of the anterior segment and periocular structures by otoscope and ophthalmoscope was done to check the injury or damage to cornea. Palpebral reflexes were checked which was normal in left eye .Traumatic cataract was diagnosed due to trauma and led to retinal degeneration and damage to cornea which lead to unilateral blindness in the African Grey Parrot.
CATARACT SURGERY
Precautions and extra care was taken for the cataract surgery to minimise the risk associated with anaesthesia. Surgery was performed with butraphanol, Kappa agonist opiods which is a short acting medicine and provides analgesia pain relief up to 2 hours at Myvets Hospital along with 2mg/kg Midazolam, 2 mg/kg Butraphanol and 0.05 to 1 mg / kg Anexate
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Pulse Oxymeter was placed to know the oxygen level in the blood during the procedure. Anaesthetic induction, African Grey Parrot was sedated prior to induction with gas anaesthesia to make him calm and quiet and to reduce the anaesthetic time. He was intubated to receive 100 % oxygen and ventilation to airways was monitored continuously. To support the cardiovascular system intravenous catheter was placed for fluids, antibiotics, analgesics. Fluids are extremely important in avian surgery as birds tend to lose fluids during anaesthesia through evaporation from tissues. To regulate the body temperature of the bird heat mat was placed as birds have higher body temperature as compare to mammals and have larger surface area compared to body weight.
Trauma and senile lenticular degeneration have been speculated as causes for cataract formation in African Grey parrots. In canaries, cataracts are inherited, and surgical removal has been recommended. The avian eye is large, conforms closely to the orbit and has limited mobility. Sclera ossicles help support the eye and prevent collapse during surgery.
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In this African Grey Parrot, matured cataracts were present in the one of the eyes, which is common over the age of 35 years. In many cases, the cataracts remained immature for several years without completely obstructing the vision. This bird with rapidly developing cataracts frequently became blind due to phacolytic uvetitis. Lens removal was performed because of visual impairment.
For lens removal in these African Grey Parrot, no attempt was made to dilate pupil preoperatively. The African grey parrot lens is approximate 5mm in diameter, which is too small for phacoemulsification instrumentation, and the cataracts were removed using standards surgical technique. In the immediate post-operative period, the eye were treated with a topical steroid-antibiotics ointment followed by weekly subconjunctival injections of triamcinolone for up to a total treatment period of four weeks. Haemorrhages, synechiae of the iris and sologhing of the corneal epithelium were reported complications, however post operative inflammation was minimal.
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Surgical Procedure:
The phacoemulsification tip required a 3mm incision at the limbus or or perilimbus at approximately the 10 and 3 o’clock position. A scalpel blade or a von graefe cataract knife was used to make these incisions. Prior to making the second incision, a 22G needle connected to an IV set is inserted through the first incision.
The depth of the anterior chamber is maintained using a continuous infusion of this solution while the second incision is made.
A cystotome or 27G needle with a bent tip was inserted through the second the second incision and used to create a tear in the anterior lens capsule at its periphery. The anterior capsule is not removed in order to help contain the fragments of lens material. After the capsulotoy is created, the needle is removed and the phacoemulsification tip is inserted through the second incision, through the capsulotoy incision and under the anterior capsule.
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The tip was hollow and was used to aspirate materials. Incision was closed with 8-0 polyglactin absorbable suture with simple interrupted patterns. Te first incision is loosed while the infusion needle is maintained. Some fluid is lost during closure of the second incision but the depth of the anterior chambers is re-established within a few minutes. The lateral canthotomy is closed using 5-0 polyglactin absorbable suture in a simple interrupted pattern. At present lens replacement devices are not commercially available in a appropriate size for avian patients.
POSTOPERATIVE CARE:
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MADHURITA GUPTA, PRESIDENT
MYVETS CHARITABLE TRUST & RESEARCH CENTRE
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DR.YUVRAJ KAGINKAR , AVIAN EXPERT
MYVETS VETERINARY HOSPITAL
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Title photo: MyVet
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