Why we perform a graft
These grafts are used to provide a blood supply and support to deep corneal ulcerations, feline sequestra, and other corneal disorders, to allow corneal healing.
1. Conjunctival pedicle grafts
This involves making a flap of conjunctiva (the clear/pinky tissue overlying the white of the eye) and stitching this onto the cornea. The benefit of this graft is that it provides immediate blood supply to the healing cornea, and it is quicker and easier to perform, it is also less risky in the face of infection. But downsides are that it lacks in physical tectonic support (a bit like trying to build a house without scaffolding) and that it can affect vision more so than other types of grafts.
The conjunctival graft leaves a flap of pink-coloured tissue across the cornea. Sometimes this can interfere with vision if it covers the central cornea. The sutures we use will dissolve within 4-6 weeks. We will sometimes recommend a sedation to cut the graft, 6 weeks after the procedure. This will leave a circular section of conjunctival tissue on the cornea and is usually smaller than the original ulcer.
Here is an example of a conjunctival flap:
2. Corneoconjunctival transposition/CCT
This is a technically more challenging and involves making a flap from a section of both cornea and conjunctiva, and moving it down into where the defect is. The benefit is that for defects involving the central cornea, it preserves the visual function and clarity of the cornea. It is also a very stable graft and immediately provides support AND blood supply to the damaged area of cornea. It cannot be done in all cases and depends upon the health of the cornea.
This is what a CCT can look like after surgery:
3. Graft Aftercare
You will be given pain relief, oral antibiotics and antibiotic eye drops. Usually the antibiotic drops are 4x daily initially but will reduce to 3x daily after 1 week, then 2x daily after 3 weeks. The drops must be continued 2x daily until 6 weeks post-operatively while the sutures dissolve.
We usually recommend regular check ups during the 6 week healing period to ensure all is going well.
4. Longterm
A graft is for life. Most dogs need no further treatment after a graft as long as there are no other underlying conditions. However some dogs, (especially pugs!) love to put down pigment onto their corneas and sometimes need to stay on long-term treatment for this. This will just involve eye drops twice daily.
