咨询描述:医生你好,我家猫是加菲猫,今年12岁,因为疱疹病毒去年右眼得过一次角膜腐骨,经过3个多月的保守治疗滴眼药加吃药今年1月份痊愈。
保守治疗用药是:吃泛******** 125gm 一天两次,*****一天1ml. 眼药膏主要是********和****,根据病情每天3-5次不等.
到3月底出现了左眼出现同样的问题,并且范围比右眼大得多,在经过差不多快3个月保守治疗没有太大效果,医生说病毒潜入的越来越深,建议尽快手术,在7月18号进行了用自己的角膜移位手术,术后两周拆线,拆线一周后医生说可以停止吃泛昔洛韦药片和其他眼药,停药一周后,也就是刚刚复查检查眼中又出现了一块深褐色病变,目前继续吃药片和上********和另一种眼药膏********,希望可以把疱疹病毒再压下去
目前看医生的反应也不太好,表示从没见过这么快这么顽强的病变,而且泛昔洛韦这个药在这么吃下去是比较伤肾的,想问一下咱们这边医生有没有比较好的建议?照片里是最新的状态
问题大致一样,细节不同?
陈奕达
执业兽医师
根据您讲到的信息,我初步分析猫咪角膜问题,跟疱疹病毒有很大的关系。并且属于后遗症问题,这个方面除了给予抗病毒用药以外,没有其它太好的办法来帮助猫咪。
然后猫咪这种角膜腐骨症,可以除了您描述这些药物治疗以外,还可以配合一些宠物专用修复眼角膜用药,以及口服的广谱消炎用药,来帮助恢复,观察一下后续状态如何。
禁止猫咪抓挠刮蹭眼睛,不然会越来越严重,什么神药都没有用。(一直佩戴伊丽莎白圈)
如果考虑在家保守治疗,您可以告诉我,然后这边可以帮您开具一套用药,并且帮您计算好用法用量,供您采纳参考一下。
我想问的几个问题:
1,她这种情况是不是不适合再次手术了?在年纪这么大且短时间内已经做了两次全麻手术,而且据我现在的理解,她的疱疹病毒来势太凶做手术赶不上她病变的速度?
2,抗病毒药泛昔洛韦是不是以后都不能停了?这样下去是不是对她的肾功能损伤特别严重?她现在身体其他状况还好,有点早期肾病,有一个数值偏高,不过好在平常喜欢喝水,我有一个她手术前的血液报告放在下面供您评估
3,我有一个来自外行非常不成熟的想法:如果抗病毒药对她伤害比较大,而这个病只发在眼睛上,如果把她这只眼球摘掉呢?会影响到她的寿命吗或者病毒会发展到她身体其他地方吗?
不好意思问题比较多,主要是这一年多被这么病折磨的心力交瘁,国外医疗花费也巨大,而治疗了一通好像有回到原点.
另外我这边后续当然希望能保守治疗,请您开具一套用药,这样我可以回国时多买些回来用
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我再给您补充以下信息:
我这边猫猫是在国外的,其实在这次用自己的角膜移植手术之前6月12号还做了一次手术,当时是把病变刮下去之后补了羊膜组织,但是两周后羊膜组织都溶解了,中间出现了一个洞,角膜变得薄薄一层,医生说出现了排异反应随时有泄漏风险,就这样又观察了快两周羊膜根本长不上所以又做了一次用自己角膜移位的手术。
血检报告我做了翻译,重新上传了一下
为保护用户隐私不显示图片/视频
陈奕达
执业兽医师
您好,感谢您的等待,谢谢。回复不及时,还请您见谅🙏🙏🙏🙏🙏🙏。
1.猫咪现在的情况,确实暂时不太适合手术。因为两次手术间隔时间比较短。2.抗病毒用药不一定以后就停不了。这个需要看一下猫咪后续恢复状态,然后定制方案。用药对于猫咪来讲,确实有肝脏肾脏负荷,这个确实没有太好办法。3.可以考虑摘除眼球,因为久治不愈的情况下,我也会建议摘除眼球。一般不会影响寿命之类的。4.眼部疾病症状,个人认为是有病毒后遗症问题导致的。如果没有其它症状,那么一般不会再有其它问题了。5.猫咪sdma指标有一些高(这个指标,属于肾脏早期异常指标,说明猫咪肾脏有一些轻微损伤了),确实需要考虑肾脏有一些代谢异常问题,这个确实没有太好办法。不过指标暂时还没有特别高,以后可以定期检测体检即可。6.
感谢医生回复,
如果摘除这只眼球您的意思是应该不会发病身体其他部位,但是不是另一只右睛还是有机率也会复发?目前从今年1月份右眼痊愈后没有再复发也没有在右眼球上再发现病毒.
我的理解是,就目前情况我应该给她重新配带上伊丽莎白圈,再继续用药保守治疗,如果后继有好转再根据情况看用什么药,如果情况越来越糟就再考虑摘除眼球。那如果情况一直不好,您建议大概我应该等多久要考虑摘除眼球呢?
陈奕达
执业兽医师
您好,实在抱歉,今天手术有点多,回复不及时,还请您见谅🙏🙏🙏🙏🙏🙏🙏。
另外一支眼睛确实有可能会发病,不过跟是否摘除眼球没有太大关系。
您理解的正确。
如果保守治疗一个月之后,猫咪越来越严重,建议考虑摘除眼球。
麻烦您这么多手术还帮忙回复,那麻烦您开具一套药吧,我买完最近让我国内的朋友带过来。
另外刚才看您说的建议也吃点消炎药,我问过这边医生为什么不给吃的消炎药,她说因为吃的消炎药对眼睛的位置传达的并不精确没有必要,当然国外一直对抗生素管的很严。她手术期间也吃了一周的消炎药,不是阿莫西林我查了一下是比较强效的消炎药,但反应比较大,吃完一会就容易吐。
所以您这边觉得还是应该平常吃消炎药的吗?我之前就从国内带了一些宠物版的********粉末和**,****也还有
为保护用户隐私不显示图片/视频
陈奕达
执业兽医师
您好,图片上的这个可以使用。(可以配合下述处方内的用药,共同帮助猫咪)
口服广谱消炎用药,是控制炎症,对眼睛还是有效果的。
然后这边根据宝贝的情况,我给宝贝开个处方。供您采纳一下,以备您不时之需。
药物具体用法用量已经帮您计算妥当,您可以点击查看详情按钮,进入处方页面查看。
处方里面的
1.********,宠物专用广谱消炎杀菌滴眼液。
2.****,宠物专用修复角膜滴眼液。
(使用多种滴眼液情况下,需要每个滴眼液之间,间隔10-20分钟以上用药)
您可以根据需求自行选择购买。
谢谢医生,您这两个眼药水,尤其是********还可以我目前一直用的眼药膏同时用嘛?(****每天5次,*** 2%每天3次),还是我应该避开单独用呢?另外********我应该给她每天用量多少呢?猫猫重2.3公斤,这边药是2克每小袋
为保护用户隐私不显示图片/视频
陈奕达
执业兽医师
您好,实在是抱歉😂😂😂,回复不及时,还请您见谅🙏🙏🙏🙏🙏。
使用我处方内的滴眼液之后,可以使用图片上的********,进行配合治疗。其它的药膏可以暂时停止使用了。(效果重复了)
****,您可以按照说明给予猫咪服用。或者按照每公斤10毫克,一天两次口服。
陈奕达
执业兽医师
非常感谢您对蘑菇宠医的信任,如果您对我的解答满意,请您给我点亮五星哦!祝您的爱宠早日康复!
后续宝贝有其它问题,您可以到“蘑菇宠医”官方微信公众号找到我的医生继续向我提问
希望我的建议可以帮到您,如果爱宠平时有什么养护小问题也可以通过蘑菇宠医小程序搜索了解哦~“
为保护用户隐私不显示图片/视频
陈奕达
执业兽医师
考虑宝贝目前遇到的问题,后期您可以随时或者每间隔5-7天联系我一次,我会根据宝贝的病情变化和恢复情况,给予全程养护指导。同时可以购买专用服务包,更加优惠
谢谢医生,用药明白了,最后一个问题,********好像需要冷藏,但我拖朋友带回来途中肯定没发冷藏,请问途中一天时间不冷藏会有问题吗?如果不行的话有替代的吗,比如sentrx这种保护眼角膜凝露我这里有。其他我没有问题了,非常感谢医生的建议,保守治疗中我肯定还得再麻烦咨询您🙏
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陈奕达
执业兽医师
您好,可以使用专门的保温箱,进行冷藏保温即可。
可以使用宠物专用透明质酸钠滴眼液,每天8-10次,每次1-2滴,替代干细胞滴眼液。
您图片上的这个药物我也没有使用过,所以不太好帮您评估这个药物。可以尝试使用一下,试试看效果如何。
医生建议及处方根据当前病情给出,仅适用于本次问诊
蘑菇宠医处方笺
用法用量需根据患宠的年龄、体重等信息开具,此处方暂不展示
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