Enucleation in equids with and without the use of an orbital suture meshwork implant: a retrospective study of 37 cases.
Authors: Maninchedda U, Nottrott K, Gangl M
Journal: The Veterinary record
Summary
# Editorial Summary: Orbital Meshwork Implants in Equine Enucleation Transpalpebral enucleation represents a common procedure for end-stage ocular disease in horses, yet the optimal technique for managing the resulting orbital defect remains debated. Maninchedda and colleagues retrospectively evaluated 37 horses undergoing enucleation between 2006 and 2013, comparing traditional closure (n=11) against transpalpebral enucleation with non-absorbable sutured meshwork prosthesis implantation (n=26) to determine whether the prosthetic approach reduced postoperative complications, scarring, and cosmetic concerns. Infection, discharge and wound dehiscence occurred at similar rates in both groups, and pre-existing infection or inflammation—rather than implant presence—was the primary risk factor for postoperative complications; notably, one horse required meshwork removal due to chronic fistula formation. Counter to the investigators' hypothesis, implanted meshwork horses more frequently developed a sunken orbital appearance, with 26% of owners actively dissatisfied with cosmetics and a further 44% willing to pursue alternative techniques if they did not increase morbidity or cost. Whilst meshwork implants appear surgically safe, practitioners should counsel owners that implantation does not guarantee cosmetic superiority and may paradoxically worsen orbital contour; refinement of prosthetic design or alternative reconstructive approaches warrant investigation for clients prioritising post-operative appearance alongside functional outcomes.
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Practical Takeaways
- •Transpalpebral enucleation with or without meshwork implant carries similar postoperative complication rates; pre-existing infection/inflammation is a significant risk factor regardless of technique used
- •Meshwork implants prevent severe orbital collapse but commonly result in owner dissatisfaction due to sunken-in appearance; counseling on cosmetic expectations is essential before surgery
- •Consider alternative prosthetic or reconstructive techniques for clients prioritizing cosmetic outcome, as current meshwork methods show limited cosmetic success despite safety
Key Findings
- •No significant difference in postoperative complications (infection, discharge, dehiscence) between enucleation with meshwork implant (n=26) versus without (n=11)
- •Meshwork implant had to be removed in 1 horse (3.8%) due to chronic fistula development
- •Most owners satisfied with scarring outcomes, but 70% of owners with meshwork implants reported poor cosmetic appearance with sunken-in orbit
- •70% of owners desired improved cosmetic results, with 44% willing to try alternative techniques if safety and cost were not compromised