• Lendectomy, also known as intracapsular lens extraction (ICLE), is the term used for removal of the lens and its capsule via a large perilimbal corneal incision. The technique is used for the treatment of anterior lens luxation, and in some cases prophylactically for the treatment of lens subluxation (the condition immediately preceding lens luxation, where the lens remainsin situbut becomes increasingly unstable).
• In dogs, lens luxation Lens: luxation is usually hereditary and bilateral. There is a strong breed predisposition in the Lancashire heeler and terrier breeds. It is also seen in the border collie.

Uses

• To remove an anteriorly luxated lens, and in some cases prophylactically to remove a subluxated lens. Not recommended for the treatment of posterior lens luxation due to the high risk of retinal detachment Retina: detachment.

Advantages

• Surgical removal of an anteriorly luxated lens is the only treatment available that may successfully restore vision and prevent secondary complications such as glaucoma Glaucoma: due to lens luxation and blindness Blindness.

Disadvantages

• Difficult surgical technique: magnification, correct microsurgical instrumentation and microsurgical experience are essential. Referral to a specialist ophthalmologist is recommended.
• Post-operative complications may be severe, including wound breakdown, corneal ulceration Ulcerative keratitis , bacterial infection, anterior uveitis Uveitis , secondary glaucoma, retinal detachment Retina: detachment , blindness.
• Even in surgically successful cases, post-operative vision is reduced due to hyperopia (long-sightedness) caused by the absence of a lens.
• In dogs, the condition is usually bilateral, so monitoring and/or surgery of the contralateral eye may be required.

Alternative techniques

• Phacoemulsification Phacoemulsification can sometimes be employed in cases of lens subluxation, and has a more successful surgical outcome. Referral to a specialist ophthalmologist is recommended.
• Enucleation may be required in advanced cases of chronic anterior lens luxation with secondary glaucoma.
• For posterior lens luxation, regular monitoring and/or treatment with anti-glaucoma medication is advised.

Time required

Preparation

• Sterile preparation of peri-ocular skin and flushing of conjunctival sac and ocular surface with dilute povidone-iodine solution (0.2%) Povidone-iodine.
• Lateral canthotomy Eyelid: lateral canthotomy may be required prior to corneal incision.

Procedure

• 30-40 minutes for an experienced surgeon.
• Removal of lens via a large (170°) perilimbal corneal incision, followed by vitrectomy and closure of the corneal wound.

Decision taking

Risk assessment

• In dogs, lens luxation is usually hereditary and bilateral. Careful examination of the contralateral eye should be performed, and bilateral surgery may be required.
• Owner and patient compliance is vital. The corneal wound is fragile in the post-operative period and the patient must be kept calm and quiet for a period of days. The patient will require frequent post-operative medications. Regular post-operative re-examinations are recommended.