Outcome of surgical treatment of severe keratomalacia in dogs and cats with a 360-degree conjunctival graft: 12 cases (2017-2024).

360-degree conjunctival grafts effectively preserve globes and vision in over 80% of severe keratomalacia cases.

This retrospective case series evaluated the outcomes of 360-degree conjunctival grafts combined with temporary tarsorrhaphy in 12 dogs and cats (10 dogs, 2 cats) presenting with severe keratomalacia affecting more than 50% of the corneal surface. Four cases had concurrent corneal perforation, two with iris prolapse. The tarsorrhaphy was maintained for a median of 20 days post-operatively. Globe preservation was achieved in 83.3% (10/12) of cases, with 70% (7/10) of preserved globes retaining visual function. Among visual eyes, corneal clarity was graded as minimal opacity in 57.1%, moderate in 28.6%, and severe in 14.3%. Notably, three of four perforated eyes were successfully salvaged, with two retaining vision, demonstrating the technique's utility even in advanced cases. Short-term complications occurred frequently and included graft and/or tarsorrhaphy dehiscence (5/12), granulation tissue formation (3/12), panuveitis (1/12), and persistence of keratomalacia (2/12), with the latter two requiring enucleation. Long-term complications in retained globes included corneal fibrosis (90%), pigmentation (80%), and neovascularisation (60%). Despite these sequelae, the majority of visual eyes maintained minimal corneal opacity at final follow-up. The authors conclude that the 360-degree conjunctival graft is an accessible and effective surgical technique for managing severe keratomalacia, offering favorable rates of globe preservation and vision retention, including in eyes with corneal perforation.

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