Advances in feline ophthalmology

Feline glaucomas

Cats are usually presented at a very late stage in the course of glaucoma when the eye is already blind. Secondary glaucoma because of another underlying ocular lesion is the most common form of glaucoma in the cat and is frequently associated with chronic anterior uveitis or intraocular neoplasia. Chronic stages of glaucoma in the cat are characterized by buphthalmus, anterior lens luxation, and exposure keratitis secondary to the enlarged globe. Ophthalmoscopic signs of glaucomatous retinal degeneration are only noticed in very advanced stages. Treatment of glaucoma in cats is usually aimed to keep the eye comfortable and within a normal intraocular pressure range. However, many antiglaucoma medications that are successfully used in humans and dogs are not very well tolerated by cats and, therefore, the selection of recommended drugs is limited in this species.

Feline corneal sequestra: a review of 64 cases (80 eyes) from 1993 to 2000

Feline corneal sequestrum is a common condition of the feline cornea. The purpose of this study was to provide a detailed description of the clinical features of the condition including the response to different management options and to assess the rate of recurrence. The medical records of 64 cases (80 eyes) of feline corneal sequestra that presented to the Animal Health Trust from 1993 to 2000 were reviewed. Fifty-two cases were reviewed retrospectively; 12 cases were assessed prospectively between April and September 2000 as part of a separate study. The Persian was the most frequently encountered breed and the mean age of affected cats was 5.6 years. At initial presentation, sequestra were unilateral in 58 cats and bilateral in 6 cats, 5 of which were Persians. Ocular discomfort and ocular discharge were common presenting signs, occurring in 42 and 36 eyes, respectively. Seventy-four eyes were managed surgically with keratectomy only (n = 44) or keratectomy followed by a graft procedure (n = 30). Sequestra recurred in 16 eyes in the study. There was no significant difference in the rate of recurrence between eyes that received a graft procedure (n = 5) and eyes that did not (n = 11) (P = 0.56). Complications following transection of conjunctival pedicle grafts were observed. Brown to black discoloration of noncorneal tissue and therapeutic biomaterials was observed, including discoloration of both viable and apparently nonviable grafted conjunctival tissue, small intestinal submucosa graft material and bandage contact lenses.

Bilateral proliferative keratitis in a Domestic Long-haired cat

A 9-year-old, female spayed, Domestic Long-haired cat was presented with bilateral, progressive, pink-white corneal opacities. The referring veterinarian had diagnosed feline herpesvirus-1 (FHV-1) keratitis though diagnostics for FHV-1 had not been performed and treatment with antibiotics and antivirals did not improve the condition. Histopathology showed neutrophils, plasma cells and lymphocytes, but no eosinophils or mast cells. Routine diagnostics did not find an underlying cause, but Southern blot analysis for FHV-1 was positive. The cat responded to topical corticosteroids and cyclosporine when used consistently.

The feline glaucomas: 82 cases (1995-1999)

OBJECTIVE

To describe signalment, ophthalmic abnormalities, and response to treatment in cats with glaucoma.

DESIGN

Retrospective study.

ANIMALS

Eighty-two cats with 93 glaucomatous eyes. CRITERIA FOR INCLUSION: Medical records of all cats with glaucoma presented to the ophthalmology services at two referral specialty hospitals between 1995 and 1999 were reviewed. Cats were included if intraocular pressure (IOP) > 25 mmHg, if buphthalmos was present, or if a shallow anterior chamber was present and IOP > or = 5 mm Hg higher than the contralateral normal eye.

RESULTS

Mean +/- SD age was 9.2 +/- 4.4 years. Thirty-one cats were female; 51 were male. Breeds included 69 domestic and 13 pure-bred cats. One eye was affected in 71 cats; both eyes in 11 cats. The most common presenting complaints and ophthalmic abnormalities were cataract, corneal edema, mydriasis, buphthalmos, cloudy eye, and blindness. Mean intraocular pressure in the affected eye was 36.4 +/- 14.7 mmHg. The glaucomas were believed to be secondary in 81 eyes, primary in five eyes, and undetermined in seven eyes. The goal of medical therapy was to maintain IOP in a comfortable range we presumed to be < 30 mm Hg in blind eyes, and to maintain IOP below 25 mmHg to preserve vision in visual eyes. Intraocular pressure was maintained in a comfortable range or normal range in 58% of all eyes using medical therapy alone. Surgery was performed in nine eyes after medical management failed. Sixty-seven eyes were blind, 21 were visual, and five had decreased vision at initial presentation. With treatment, vision was retained in nine eyes, deteriorated in five eyes, and was lost in three eyes.

CONCLUSIONS

The glaucomas were most frequently secondary in cats and resulted in blindness prior to presentation in the majority of eyes in our study. Medical management controlled IOP in more than half of the eyes, and maintained vision in almost half of visual eyes.

Nonhealing corneal ulcers in cats: 29 cases (1991-1999)

OBJECTIVE

To compare mean healing times after debridement, debridement with grid keratotomy, and superficial keratectomy in cats with nonhealing corneal ulcers.

DESIGN

Retrospective study.

ANIMALS

29 cats with 36 nonhealing corneal ulcers.

PROCEDURE

Medical records of cats with nonhealing corneal ulcers were reviewed. Signalment, duration of clinical signs, ophthalmic abnormalities, and response to various treatment protocols were recorded.

RESULTS

Mean age of affected cats was 7 years, 8 months. Affected breeds included domestic shorthair (17 cats), Persian (9), Himalayan (2), and Siamese (1). Clinical signs were evident for approximately 2 weeks prior to referral. Both eyes were affected in 4 cats. Mean healing time of ulcers treated with superficial debridement was 30 days. Mean healing time of ulcers treated with superficial debridement and grid keratotomy was 42 days. Superficial keratectomy was performed on 2 eyes and resulted in a healing time of 2 weeks. Formation of a corneal sequestrum was evident in 2 of 21 eyes treated with superficial debridement. Formation of a corneal sequestrum was evident in 4 of 13 eyes treated with superficial debridement and grid keratotomy.

CONCLUSIONS AND CLINICAL RELEVANCE

Brachycephalic cats appear to be predisposed to developing nonhealing corneal ulcers. The combination of superficial debridement and grid keratotomy did not decrease mean healing time of nonhealing ulcers, compared with superficial debridement alone. Grid keratotomy may predispose cats with corneal ulcers to develop a corneal sequestrum.

Canine and feline primary ocular bacterial infections

Bacterial infections are frequently associated with diseases of the eyelids, cornea, and conjunctiva. Animals sustaining KCS commonly have bacterial infections of the external eye owing to a lack of antimicrobial properties present in the normal tearfilm. Infection can occur in the nasolacrimal duct or lacrimal sac, which is referred to as dacryocystitis. Severe corneal ulcers are frequently infected with bacteria, especially Pseudomonas sp. Three new topical ophthalmic antibiotics have recently become commercially available: ciprofloxacin, norfloxacin, and ofloxacin.

The causes of glaucoma in cats

The cause of glaucoma in 131 enucleated eyes from 128 cats was determined in a retrospective histologic study. Obliteration of the ciliary cleft by diffuse iridal melanoma (38 eyes), or other neoplasms (14 eyes), or by the presence of idiopathic lymphocytic-plasmacytic anterior uveitis (53 eyes) were the most frequent lesions likely to explain the development of glaucoma. Secondary changes of inner retinal atrophy, optic disc cupping, scleral thinning with megaglobus, and atrophy of ciliary processes were similar to those described in dogs and human beings with chronic glaucoma. In light of the duration and severity of the glaucoma, the degree of inner retinal atrophy was often less than expected. Diffuse corneal edema and breaks in Descemet's membrane, changes typical of glaucoma in other species, were rarely detected. Eyes with chronic uveitis and glaucoma had collapsed ciliary clefts, iridoscleral adhesions, and posterior displacement of the iris. We were unable to determine whether these changes were consequences of the uveitis and thus responsible for the development of glaucoma, or if they were merely the result of the chronic glaucoma itself.