Veterinary Ophthalmology - 2022 - Anastassiadis - Corneal diamond burr debridement for superficial non‐healing corneal.pdf

Received: 9 July 2022 | Revised: 1 September 2022 DOI: 10.1111/vop.13026 | Accepted: 8 September 2022 ORIGINAL REPORT Corneal diamond burr debridement for superficial non-­healing corneal ulcers in cats Zoe Anastassiadis1 | Kellam David Bayley2 1 Veterinary Ophthalmic Referrals, Adelaide, South Aust...

Received: 9 July 2022 | Revised: 1 September 2022 DOI: 10.1111/vop.13026 | Accepted: 8 September 2022 ORIGINAL REPORT Corneal diamond burr debridement for superficial non-­healing corneal ulcers in cats Zoe Anastassiadis1 | Kellam David Bayley2 1 Veterinary Ophthalmic Referrals, Adelaide, South Australia, Australia 2 Pet Eye Care, Wellington, New Zealand Correspondence Zoe Anastassiadis, Veterinary Ophthalmic Referrals, Anzac Highway, Plympton, Adelaide 5038, Australia. Email: [email protected] | Robert A. Read1 Abstract Objective: To describe the clinical outcomes and efficacy of diamond burr debridement (DBD) treatment for corneal ulceration in cats. Procedure(s): Medical records of cats that received DBD at two private practices between 2015 and 2021 were retrospectively reviewed. DBD was performed using a battery-­powered, handheld motorized burr and a bandage contact lens was placed in 18/21 eyes. Corneal ulceration was considered resolved if the cornea was fluorescein negative with a stable epithelial surface. Recurrence was defined as return of corneal ulceration. Descriptive statistics and a Fisher's exact test were conducted on the study population. Results: Twenty-­one eyes from 20 cats with superficial corneal ulcers refractory to medical treatment underwent DBD. Domestic and Burmese were the most commonly encountered breeds and the median age of affected cats was 8.83 years (range 0.5–­20 years). Corneal ulceration was present for a median of 14 days prior to DBD. Healing was achieved in 81% of eyes; with four eyes failing to heal and requiring further intervention. Corneal sequestrum was reported in one case that failed to heal. Of the healed cases, three cases recurred (17.6%) at a mean of 116.3 days (range 79–­135 days). Burmese were overrepresented (p <.001) in cases that failed to heal or recurred (6/7 eyes; 85.7%). The median postoperative follow­up time was 93 days (range 6–­1613 days). Conclusions: Diamond burr debridement is a safe, non-­invasive treatment for corneal ulceration in cats but, compared with published results, it had a lower success rate than superficial lamellar keratectomy. KEYWORDS bandage contact lens, cat, corneal ulceration, diamond burr debridement, epithelial healing, recurrence 1 | I N T RO DU CT ION Corneal ulceration in cats is a common cause for presentation to a veterinary ophthalmologist.1,2 Many factors have been proposed to cause corneal insult: ulcerative keratitis secondary to feline herpesvirus (FHV-­1) infection, trauma, eyelid abnormalities, lagophthalmos, tear film abnormalities, breed predisposition, and neurological deficiencies.1–­6 Chronic corneal insult is thought necessary to initiate corneal sequestrum formation; however, the etiopathogenesis for sequestrum formation remains speculative.3 © 2022 American College of Veterinary Ophthalmologists. 476 | wileyonlinelibrary.com/journal/vop  Veterinary Ophthalmology. 2022;25:476–482. Iatrogenic corneal trauma associated with grid keratotomy (GK) has been found to also predispose to sequestrum formation.7 If complete healing of a corneal ulcer occurs, then the risk of progression to corneal sequestrum is unlikely but not guaranteed.3 The benefits of early surgical intervention for corneal ulceration are quick resolution of discomfort and possible prevention of involvement to the deeper corneal layers and corneal sequestrum formation.3,8 Various techniques have been described for the treatment of corneal ulceration across species including diamond burr debridement (DBD),9–­11 superficial lamellar keratectomy (SK),1 corneal or conjunctival grafting procedures,4 and cyanoacrylate glues.12,13 DBD is a treatment widely used in clinical settings because the technology is inexpensive, treatment is minimally invasive and the technique has a short learning curve.3,9 The proposed mechanism of action of DBD is enhanced epithelial adhesion due to the creation of micro-­erosions, altered corneal topography and a physical polishing effect that may induce the expression of extracellular matrix and reactive fibrosis.9–­11 The addition of a bandage contact lens (BCL) is proposed to facilitate healing by applying pressure to the corneal epithelium, protecting the migration of corneal epithelial cells against traction elicited by excursion of the eyelids (and nictitans), improved drug retention and corneal deturgescence control.9–­11 To the authors' knowledge, no papers have described DBD for the resolution of superficial corneal ulcers in cats. The purpose of this retrospective study was to report the clinical outcomes and efficacy of DBD as a potential treatment for corneal ulceration in a series of cats. 2 | M AT E R IALS AN D M ET H OD S Medical records of cats undergoing a DBD procedure at Veterinary Ophthalmic Referrals or Pet Eye Care with at least one follow-­up between 2016 and 2021 were retrospectively evaluated. Following record retrieval, each case was reviewed by one author (ZA) to ensure inclusion criteria were met with 20 cats (21 eyes) recruited. A diagnosis of superficial corneal ulceration was made if a non-­healing ulcer was recorded in the referral history, detection of a superficial corneal ulcer without stromal involvement, and the presence of nonadherent epithelium surrounding the ulcer that could be removed by gentle cotton tip debridement.4 An ECVO diplomate or resident performed all the examinations. Information extracted from the medical records included, age, gender, breed, eye(s) affected, duration of clinical signs, BCL placement, BCL retention, complications, date of recurrence and healing.    | 477 The ocular surface of affected eyes was aseptically prepared with a chlorhexidine gluconate 0.05% solution (1:100 dilution). The eyelids were held open manually or with a Barraquer eyelid speculum. Loose corneal epithelium was debrided with sterile cotton-­tipped applicators prior to DBD procedure. DBD was performed with an Algerbrush II battery operated handheld unit and a detachable diamond tipped burr (Algerbrush II, Alger Equipment Company). A 3.5 mm medium grit burr tip was applied with gentle pressure onto the surface of the ulcer bed using the side of the tip in a circular motion for approximately 1 min to remove nonadhered epithelial tissue. The DBD procedure was ceased once stable epithelium was encountered. Cases were classified as healed post-­treatment if there was no evidence of fluorescein stain uptake at the subsequent recheck examination(s). Cats in the case series for DBD were either sedated (2/21 eyes), anesthetized (9/21 eyes) or manually restrained (9/21 eyes) with topical proxymetacaine hydrochloride applied to the affected cornea (Alcaine 0.5%; Alcon). Most of the cases performed under general anesthesia had additional adnexal diseases that required surgical intervention. A BCL was placed post-­procedure in 18/21 eyes at the discretion of the veterinary ophthalmologist (14-­mm-­diameter PureVision bandage contact lens, Bausch and Lomb Incorporated). Most of the cats were already receiving topical antibiotic ointments at initial consultation prescribed from their primary care veterinarians (Table 1). Following DBD, these were changed to topical antibiotic drops due to majority of owners reporting difficulty and irritation with previous antibiotic ointment administration (Table 1). Postoperative medications included a combination of topical antibiotics (20/21 eyes) three times daily in the affected eye, systemic antibiotics in one cat that did not tolerate topical medications (doxycycline 5 mg/kg bid po), systemic analgesics (meloxicam 0.05 mg/kg sid po or buprenorphine 0.02 mg/kg bid buccally) and systemic antivirals (2/21 eyes; famciclovir 90 mg/kg bid po) with choice dependent on clinician preference (Table 1). 2.1 | Statistical analysis Descriptive statistics of the study population were assessed. A Fisher's exact test was performed to determine association with breeds within the study population. All analyses were performed in R statistical software version 4.0.3 (R Core Team R: A language and environmental for Statistical Computing, R Foundation for Statistical Computing) and p <.05 was considered statistically significant. 14635224, 2022, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/vop.13026 by Robin Stanley - National Health And Medical Research Council , Wiley Online Library on [14/11/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License ANASTASSIADIS et al. 8 15 2 6 4 11 20 4 3 12 14 10 20 11 1 2 3 4 5 6 7 8 9 10 11 12 13 14 DSH DSH DMH DSH Burmese DSH DSH DMH Burmese Exotic shorthair Burmese Persian Burmese DLH Breed OD OS OS OD OD OD OD OD OS OD OD OD OS OS Eye Concurrent ocular disease Chloramphenicol drops, Meloxicam Doxycycline, Famciclovir Chloramphenicol drops, Neloxicam Chloramphenicol drops, Doxycycline Famciclovir, Polymyxin B sulfate + Bacitracin zinc + neomycin sulfate ointment Polymyxin B sulfate + Bacitracin zinc + neomycin sulfate ointment Meloxicam, Doxycycline, Famciclovir Meloxicam, ocular lubricate Polymyxin B sulfate + Bacitracin zinc + neomycin sulfate ointment, Benzapril, Aspirin Fusidic acid ointment, meloxicam Chloramphenicol drops, Famciclovir Meloxicam, Polymyxin B sulfate + Bacitracin zinc + Neomycin sulfate ointment Meloxicam, Framycetin sulfate drops Previous medication(s) from primary care veterinarian Chloramphenicol drops, Meloxicam, Famciclovir Chloramphenicol drops, Meloxicam Chloramphenicol drops, Meloxicam Chloramphenicol drops, Meloxicam Ofloxacin drops, Meloxicam Doxycycline, Meloxicam Chloramphenicol drops, Meloxicam Ofloxacin drops, Meloxicam 21 14 14 10 14 7 39 14 10 6 Ofloxacin drops, Famciclovir, Aspirin, Benzapril Chloramphenicol drops, Meloxicam N/A 7 N/A 21 Healing (days) Ofloxacin drops, Meloxicam Ofloxacin drops, Meloxicam Ofloxacin drops, Meloxicam Framycetin sulfate drops, Meloxicam Postoperative medication(s) 1613 343 239 851 93 7 139 191 163 6 8 805 53 21 Follow up (days) N N N N Y (79) N N Y (135) Y (135) N N/A N N/A N Ulcer recurrence (Y/N) and time (days) GA TA and restraint TA and restraint TA and restraint Sedation TA and restraint GA TA and restraint GA TA and restraint TA and restraint Sedation GA TA and restraint Anesthetic technique Recurrence and euthanasized due to chronic kidney disease Recurrence and required SK Recurrence and required SK Corneal sequestrum formation Complications    ANASTASSIADIS et al. 14635224, 2022, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/vop.13026 by Robin Stanley - National Health And Medical Research Council , Wiley Online Library on [14/11/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License Age (years) Patient data for eyes treated with DBD for corneal ulceration | Case no. TABLE 1 478 4 11 3 6 6 15 0.5 15 16 17 18 19 20 21 DSH DSH Russian Blue Russian Blue Russian Blue Burmese Burmese Breed OD OS OS OD OD OS OD Eye Eyelid agenesis Ectopic cilia Lower lid Entropion Lower lid entropion Lower lid entropion Concurrent ocular disease Polymyxin B sulfate + Bacitracin zinc + neomycin sulfate ointment, Gabapentin, Prednisolone 8 7 Olfoxacin drops, Buprenorphine buccally Olfoxacin drops, Meloxicam 9 9 7 N/A N/A Healing (days) Ofloxacin drops, Meloxicam Olfoxacin drops, Meloxicam Prednisolone acetate drops Prednisolone acetate drops Ofloxacin drops, Meloxicam Chloramphenicol drops, Meloxicam Chloramphenicol drops, Meloxicam Postoperative medication(s) Polymyxin B sulfate + Bacitracin zinc + neomycin sulfate ointment, triamcinolone acetonide injection Chloramphenicol drops Chloramphenicol drops, Buprenorphine buccally Previous medication(s) from primary care veterinarian 339 7 42 42 14 28 877 Follow up (days) N N N N N N/A N/A Ulcer recurrence (Y/N) and time (days) TA and restraint GA GA GA GA GA N/A Anesthetic technique Complications    | 479 14635224, 2022, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/vop.13026 by Robin Stanley - National Health And Medical Research Council , Wiley Online Library on [14/11/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License Abbreviations: DLH, domestic long hair; DMH, domestic medium hair; DSH, domestic shorthair; FS, female spayed; GA, general anaesthesia; MN, male neutered; N, no recurrence; N/A, insufficient data; OD, oculus dexter; OS, oculus sinister; SK, superficial keratectomy; TA, topical anaesthesia and restraint; Y, recurrence. Age (years) (Continued) Case no. TABLE 1 ANASTASSIADIS et al. | 3 | ANASTASSIADIS et al.    R E S U LTS Twenty-­one eyes from 20 cats with superficial corneal ulcers refractory to medical treatment underwent DBD. From initial ophthalmic examination, the duration of the corneal ulceration ranged from 7 to 365 days, with a median of 14 days. The mean age of cats at the time of DBD was 8.3 years (range 0.5 months–­20 years). The study population included 14 female neutered and six male neutered cats. Five breeds were represented: six Burmese, two Russian Blue, one Exotic Shorthair, one Persian and 10 Domestic short, medium or long hair cats. Based on the presenting clinical history, corneal ulceration was unilateral in 19 cats and bilateral in one cat. Additional ocular findings were present in some eyes, with 3/21 eyes having lower lid entropion, 1/21 eyes having ectopic cilia, and 1/21 eyes having previously undergone surgery for eyelid agenesis. Various topical and systemic antibiotic treatments had been prescribed by the referring veterinarian (Table 1). Nineteen percent (4/21) of the cats had previously received systemic antiviral therapy (famciclovir), although the dose rates were largely unknown. Polymerase chain reaction (PCR) testing for FHV-­ 1, feline Calicivirus, Chlamydophilia felis, or Mycoplasma spp. was not performed in any case. Data regarding whether the PCR testing was offered and declined or not offered was not accessible from the medical records. Study population and results are summarized in Table 1. Following DBD, epithelial healing was observed in a median time of 10 days and ranged from 6 to 39 days (Figure 1). DBD was successful in healing 17/21 eyes (81%) for the duration of the follow-­ up period. Cases were followed for a median duration of 93 days (range 6–­ 1613 days). The BCL retention rate was 5/15 eyes (33.3%) at time of 1st recheck at a median of 9 days (range 6–­35 days) with data not available for all cases. The total number of eyes that failed to heal following DBD was 4/21 eyes (19%) with one developing a corneal sequestrum. All of the eyes that failed to heal subsequently had a SK performed with complete resolution of the ulceration achieved. Among the series of cats, three eyes (17.6%) that had healed following DBD then suffered a later recurrence of ulceration during the study period, at a mean of 116 days (range 79–­135 days). Of the 3/17 recurrent ulceration eyes, two had a SK with subsequent complete healing and one was euthanized due to decline in health from chronic kidney disease. Burmese cats were overrepresented (p <.001) in cases that failed to heal or recurred (6/7 eyes; 85.7%). 4 F I G U R E 1 Case no. 5 (A) Prior to DBD with axial corneal erosion and (B) Following DBD with complete healing and good corneal clarity. | DISC USSION A fast and effective treatment method for corneal ulceration that expedites corneal healing will logically discourage corneal sequestrum formation, given the causative association.3 Morgan et al.8 (1994) found that time to healing of corneal ulceration was significantly shorter following surgical intervention (3.8 weeks) compared with medical therapy alone (11.2 weeks). Epithelial healing following DBD in this series of cats was observed at a mean time of 12.8 days (range 6–­39 days). The healing timeframe was shorter than reported for the other techniques by Jegou and Tromeur (2014) and La Croix et al (2001) with mean healing times of 22.1 days for SK and 42 days for superficial debridement and GK techniques, respectively.1,7 However, as daily monitoring was not performed, the time to achieve healing reported in this study and previous literature may not accurately reflect the time interval from surgical intervention to healing.1,7 In this case series, DBD was successful in achieving complete healing in 81% of eyes (17/21 eyes). This was comparable to the previous literature, with Jegou and Tromeur (2014) achieving resolution following SK in 85% of eyes within 4 weeks and complete resolution in all their cases within 52 days when supplemented with medical treatment and placement of a BCL in one case.1 Although the etiology of corneal ulceration may differ, 14635224, 2022, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/vop.13026 by Robin Stanley - National Health And Medical Research Council , Wiley Online Library on [14/11/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 480 DBD in dogs for the treatment of spontaneous chronic corneal epithelial defects (SCCEDs) had similar success rates at final recheck ranging from 74% to 100%, albeit with higher case numbers.9,10 The four eyes that did not heal in our study population required additional surgical intervention, with SK resulting in complete healing in all remaining cases. The risk of corneal sequestrum formation following DBD in this case series was low with only one case (4.8%) recorded. La Croix et al.7 (2001) found 31% of eyes developed corneal sequestrum following GK compared with 10% developing a sequestrum in the area of the non-­healing ulcer following superficial debridement treatment. However, it is possible for corneal pigmentation to remain static for several years prior to progressing to a corneal sequestrum.4 For this reason, an extended follow-­up period would have been beneficial in this retrospective study.4 Corneal ulceration in this series recurred in 17.6% (3/17 eyes) of eyes that had healed following DBD, with a median follow-­up time period of 93 days (range 6–­1613 days). This recurrence rate is similar to that reported with SK surgery, where 21.9% of cases suffered recurrent ulceration at a mean period of 6.9 months after surgery.1 However, the length of follow-­up period in both series may not accurately reflect the rate of recurrence with some cases lost to follow-­up as surgical treatment is often curative, and re-­examination is not usually feasible or recommended.4 Three cats in the dataset had concurrent adnexal disease with DBD performed at the same time as surgical correction. These eyes were included in the case series as in the authors' clinical experience some eyes fail to resolve with cotton tip debridement alone, even if the mechanical irritation is corrected. Therefore, the aim of the DBD procedure in these cases was to expedite healing; reducing time of discomfort, necessity of secondary procedures and the possibility of corneal sequestrum formation. Cats in this study are similar in age to previous reports,1,6,7 unilateral disease presentation is consistent with previous reports1 and the breeds documented are similar to those previously described in the literature.1,7 Brachycephalic cat breeds are considered predisposed to corneal ulceration and are likely overrepresented due to conformation abnormalities in addition due to reduced corneal sensitivity.2 In this study, Burmese cats were overrepresented (p <.001) in cases that failed to heal or recurred (6/7 eyes; 85.7%). The reason for this overrepresentation in our study population is likely multifactorial: reduced corneal sensitivity, lagophthalmos, and prominent eyes.1–­3,6 Schirmer tear testing and tear film break up testing were not routinely performed, but given the role of tear film stability it is possible this also contributed to corneal ulcer presentation.3 Based on the overrepresentation of Burmese cats, we suspect case selection is    | 481 important in achieving a successful outcome, and therefore, DBD should be used in caution on Burmese cats. On assessment of the cases that fail to heal; no further trends were detected in the duration of clinical signs, BCL placement or retention, age, medications, or concurrent ocular conditions. Bandage contact len's were used in 18/21 eyes (85.7%) with an overall lens retention rate of 33.3% (5/15 eyes), with data not available for all cases. The retention rate is low compared with rates published in the canine literature ranging from 62% to 95%.9,11,14 The reason for the low BCL retention rate is largely unknown but could be multifactorial: poor fit, lack of E-­collar use by the owners and increased mobility of the feline nictitans membrane.3,8 The three eyes that did not receive a BCL had complete healing of the corneal ulceration and had no recurrence within the study period. Future studies into the use of BCL in cats including whether their use impacts healing and comfort are necessary as these factors could not be determined with the data from this case series. No cats in this case series developed postoperative infections. The use of prophylactic topical ofloxacin in some eyes was based on individual clinician concerns about Pseudomonas aeruginosa keratitis with BCL use as seen in people.15 Further research into the effects of BCL use in alternating conjunctival commensals and role in keratitis is warranted in our veterinary ophthalmology patients. Limitations in this study due to its retrospective nature and the inability to control patient or procedural variables included: lack of control group, no PCR testing for infectious diseases, variable times of assessment and some incomplete medical records. The presence of PCR testing in future studies may enable associations to be established between infectious diseases and outcomes in DBD cases. These specific patient outcomes may provide support for combination therapy (medical and mechanical intervention) and benefits of performing PCR testing in this specific cohort of patients. It is also possible that recurrence in corneal ulceration may have occurred without a more extensive follow-­ up period. Future prospective studies could address many of these limitations as well as corroborating data analysis. 5 | CONC LUSION Diamond burr debridement is a safe, non-­invasive treatment for corneal ulceration in cats but compared with published results it had a lower success rate than superficial lamellar keratectomy. CONFLICT OF INTEREST None. 14635224, 2022, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/vop.13026 by Robin Stanley - National Health And Medical Research Council , Wiley Online Library on [14/11/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License ANASTASSIADIS et al. |    ORCID Zoe Anastassiadis https://orcid. org/0000-0002-7018-7005 Kellam David Bayley https://orcid. org/0000-0003-3113-213X REFERENCES 1. Jejou JP, Tromeur F. Superficial keratectomy for chronic corneal ulcers refractory to medical treatment in 36 cats. Vet Ophthalmol. 2015;18:335-­340. 2. Blocker T, Van der Woerdt A. A comparison of corneal sensitivity between brachycephalic and domestic short-­haired cats. Vet Ophthalmol. 2001;4:127-­130. 3. Glaze MB, Maggs DJ, Plummer CE. Feline ophthalmology. In: Gelatt KN, ed. Veterinary Ophthalmology. 6th ed. John Wiley & Sons; 2021:1665-­1729. 4. Featherstone HJ, Sansom J. Feline corneal sequestra: a review of 64 cases (80 eyes) from 1993 to 2000. Vet Ophthalmol. 2004;7:213-­227. 5. Yang VY, Labelle AL, Breaux CB. A bidirectional corneoconjunctival transposition for the treatment of feline corneal sequestrum. Vet Ophthalmol. 2019;22:192-­195. 6. Multari D, Perazzi A, Contiero B, Carobbi B, Bertoldi M, Iacopetti I. Corneal sequestra in cats: 175 eyes from 172 cases (2000–­2016). J Small Animl Pract. 2021;62(6):462-­267. 7. La Croix NC, van der Woerdt A, Olivero DK. Non healing corneal ulcers in cats: 29 cases (1991–­1999). J Am Vet Med Assoc. 2001;218:733-­735. 8. Morgan RV, Abrams KL. A comparison of six different therapies for persistent corneal erosions in dogs and cats. Vet Comp Ophthalmol. 1994;4:38-­43. ANASTASSIADIS et al. 9. Gosling AA, Labelle AL, Breaux CB. Management of spontaneous chronic corneal epithelial defects (SCCEDs) in dogs with diamond burr debridement and placement of a bandage contact lens. Vet Ophthalmol. 2013;16(2):83-­88. 10. Hung JH, Leidreiter K, White JS, Bernays ME. Clinical characteristics and treatment of spontaneous chronic corneal epithelial defects (SCCEDs) with diamond burr debridement. Vet Ophthalmol. 2020;23:764-­769. 11. Dees D, Fritz K, Wagner L, Paglia D, Knollinger AM, Madsen R. Effect of bandage contact lens wear and postoperative medical therapies on corneal healing rate after diamond burr debridement in dogs. Vet Ophthalmol. 2016;20(5):382-­389. 12. Rodriguez EN, Townsend WM, Stiles J. Double drape tectonic patch with cyanoacrylate glue for surgical repair of corneal defects: 8 cases. Vet Ophthalmol. 2021;24:419-­424. 13. Pumphrey SA, Desai SJ, Pizzirani S. Use of cyanoacrylate adhesive in the surgical management of feline corneal sequestrum: 16 cases (2011–­2018). Vet Ophthalmol. 2019;22:859-­863. 14. Wooff PJ, Norma JC. Effect of corneal contact lens wear in healing time and comfort post LGK for treatment of SCCEDs in boxers. Vet Ophthalmol. 2015;18:364-­370. 15. Khan M, Stapleton F, Duncan M, Wilcox P. Susceptibility of contact lens-­related Pseudomonas aeruginosa keratitis isolates to multipurpose disinfecting solutions, disinfectants and antibiotics. Transl Visc Sci Technol. 2020;9(5):1-­13. How to cite this article: Anastassiadis Z, Bayley KD, Read RA. Corneal diamond burr debridement for superficial non-­healing corneal ulcers in cats. Vet Ophthalmol. 2022;25:476-482. doi: 10.1111/vop.13026 14635224, 2022, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/vop.13026 by Robin Stanley - National Health And Medical Research Council , Wiley Online Library on [14/11/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 482