We are pleased that you have selected Michigan State University to provide cataract surgery for your pet. Please carefully read our surgery information below, as it is important to us that you clearly understand all information presented. Please feel free to discuss any questions you have with the clinician at any time.

Cataract surgery is typically performed when vision is significantly impaired (i.e. blindness occurs). The two most common forms of cataracts in dogs are:

1. breed-related, suspected to be caused by inherited genetic defects, and
2. changes in lens metabolism caused by diabetes mellitus.

Surgery can be performed in one or both eyes. There is an ideal "stage" of cataracts that improves the chance of a favorable outcome–the cataract is dense enough to cause vision problems, but is not too advanced. Should the cataracts be very advanced, the lens starts to shrink and scar, or the lens may even break open. This can result in additional risk of surgical complications due to increasing inflammation in the eye, and also reduces the chance of being able to place a prosthetic lens into the eye. A minimum of 10-14 days of topical medications is recommended prior to surgery to control any inflammation within the eyes. Please continue all prescribed medication prior to surgery. If refills are needed before your recheck appointment, please call your clinician, resident, or tech.

The long-term success rates reported in dogs following uncomplicated cataract surgery range from 85-90%. Successful surgery is defined as a visual animal with normal intraocular pressure for at least one year following surgery. Complications can occur the day of surgery, days, weeks, months, or years later. Potential complications include:

• glaucoma
• retinal detachment
• progressive scarring/opacification of the lens capsule that remains in the eye resulting in poor vision in the longer-term
• poor vision immediately after surgery
• incision breakdown
• infection inside the eye, corneal infection causing ulceration, and possible wound breakdown

Complications, although rare, can occasionally result in loss of vision and/or ocular discomfort. In most cases, complications can be managed either medically or with additional surgical procedures. In very small numbers of cases, these complications cannot be controlled, and the eye may need to be removed.

The expected success rate may be different (and possibly poorer) for your dog, depending on the pre-surgery ocular examination findings, such as pre-existing inflammation (uveitis) and glaucoma. We will discuss this in detail if we feel that your dog has additional risk-factors for a poorer expected outcome following surgery.

Before surgery, we recommend the following to improve the chances of an excellent surgical outcome:

• diabetes should be well controlled (fructosamine, glucose curve, usually performed in advance with your regular veterinarian)
• any ear or skin infection is controlled/medicated (with your regular veterinarian)
• dental cleaning and control of severe dental disease (gum disease, accumulation of tartar, teeth that need removed - with your regular veterinarian)
• a urinalysis (with possibly a urine culture for diabetics) to rule out urinary tract disease
• control of any high fat content in the blood (hypertriglyceridemia), if indicated

We will generally perform screening bloodwork (CBC, chemistry, triglycerides) and a urinalysis prior to surgery, but if these are performed with your regular veterinarian, they may not need to be repeated, provided you bring the results with you or ask your veterinarian to fax us the results.

If you have not done so already, please tell us if your dog is on any of the following medications:

• insulin for diabetes
• immunomodulating drugs, including steroids, azathioprine, cyclosporine, etc.
• pain medications (carprofen or similar, tramadol, etc.)
• any other medications or supplements

Please bring all medications and special diets with you for the next appointment if you are anticipating leaving your dog for surgery. We also recommend purchasing a harness and bringing it with you at the time of surgery. This will reduce the amount of pressure that is placed on the neck, which can cause an unexpected elevation of intraocular pressure.

We will provide you with an itemized estimate for surgery that includes the preoperative workup (examination, electroretinography, ocular ultrasound, bloodwork), the surgery (anesthesia, surgical procedure, lens implants), hospitalization, medications to return home with after surgery (but not all medications required long-term), and two recheck appointments following surgery. It is important to note the estimate does not include costs for any potential complications that could occur.

When you return for your recheck appointment, we will examine the eyes and arrange an ocular ultrasound and electroretinography test to ensure the eyes are healthy for surgery. Bloodwork will also be performed. We may choose to examine the drainage angle of the eye (gonioscopy).

If all the tests are passed, your dog will be a good surgical candidate and surgery will proceed the following day. Your dog will stay in the hospital the night after surgery as well so that we can monitor the pressure within the eye. If all goes well, your dog will be discharged the following day – the minimum stay in the hospital will be two nights.

• Evidence of retinal disease (including but not restricted to progressive retinal atrophy, complete retinal detachment)
• High intraocular pressure (glaucoma) prior to surgery
• Significant scarring of the cornea or inside the eye limiting the view of the lens during surgery
• Evidence of systemic illness (including but not restricted to elevated temperature, lethargy, vomiting, diarrhea)
• Bloodwork abnormalities (including, but not restricted to uncontrolled endocrine diseases, anemia, elevated triglyceride levels, elevated white cell counts)

Some of the success following cataract surgery is dependent on the administration of medications postoperatively. We will provide you with full medication instructions following surgery, and it will be important to follow the instructions listed.

• Eye medication application–minimum of two different drops (antibiotic, steroid, and non-steroidal, and possibly anti-glaucoma medications, applied five minutes apart), four times daily will be required following surgery. Sometimes more medications are required in certain circumstances. The frequency of these medications will taper slowly, depending on the response. Usually after the first month after surgery, we can taper the frequency. Some dogs stay on some topical medication for life. Medications will need to continue at the prescribed frequency until the next recheck examination. If you run out of medication, please refill medications at MSU or call us so that we can send a prescription for the medications to your local pharmacy.
• Oral medication: anti-inflammatory medications and possibly antibiotics for approximately 10-14 days postoperatively.
• A protective Elizabethan collar must be worn at all times for approximately four weeks following surgery.This collar prevents rubbing of the eyes, which could break the tiny sutures holding the eye closed after surgery and cause vision-threatening complications. Your dog can still eat, drink, and sleep with the collar on.
• The use of a harness for leash walks rather than a collar around the neck.
• Keeping your dog quiet for approximately four weeks following surgery. There should be no running, jumping up and down off of furniture, chasing of balls, or “killing” of toys. Walks outside should be on a leash only.
• Standard postoperative rechecks are at one week postoperatively, one month postoperatively, three months postoperatively, and six monthly thereafter. If your dog has any complications, it may be necessary to return to us more frequently. We see recheck appointments Monday-Friday 10 a.m. through 11 a.m.