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Knickelbein KE, Lassaline ME. Approach to Immune-mediated Ocular Diseases. Vet Clin North Am Equine Pract 2024:S0749-0739(24)00029-4. [PMID: 38806348 DOI: 10.1016/j.cveq.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024] Open
Abstract
Immune-mediated ocular inflammation is a common clinical diagnosis reached for horses with keratitis and uveitis. This diagnosis is made as a diagnosis of exclusion following a thorough effort to rule out an underlying cause for the inflammation, most importantly infectious and neoplastic disease. Practically, response to ophthalmic and systemic anti-inflammatory or immunomodulatory medications is used to support a diagnosis of immune-mediated ocular inflammation; however, such medications are often contraindicated in the face of infection or neoplasia. This article will summarize our current understanding and approach to the diagnosis and management of immune-mediated keratitis and recurrent or insidious uveitis in horses.
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Affiliation(s)
- Kelly E Knickelbein
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, 930 Campus Road, Ithaca, NY 14853, USA.
| | - Mary E Lassaline
- Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, 3800 Spruce Street, Philadelphia, PA 19104, USA
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Smith HL, Berglund AK, Robertson JB, Schnabel LV, McMullen RJ, Gilger BC, Oh A. Effect of gentamicin on CD3+ T-lymphocyte proliferation for treatment of equine recurrent uveitis: An in vitro study. Vet Ophthalmol 2023. [PMID: 37116984 DOI: 10.1111/vop.13098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 04/30/2023]
Abstract
OBJECTIVE The objective of the study was to determine the effect of gentamicin on CD3+ T-lymphocyte proliferation and cell viability using an in vitro cell culture model as a means of investigating the mechanism of action of low-dose intravitreal gentamicin injection. ANIMALS STUDIED Three adult horses with no evidence of ophthalmic or systemic disease. PROCEDURE Peripheral blood lymphocytes were treated with gentamicin at concentrations 37.5 μg/mL, 112.5 μg/mL, 187 μg/mL, 375 μg/mL, or 750 μg/mL then stimulated to proliferate with concanavalin A (ConA). 4',6-diamidino-2-phenylindole (DAPI) and carboxyfluoroscein succinimidyl ester (CSFE) were used as markers of cell viability and cell proliferation, respectively. Following 5-day culture, live cell counts and CSFE fluorescent intensity data were collected via automated cell count and flow cytometry. The experimental design was duplicated using preservative-free gentamicin and a proprietary brand formulation. Statistical analysis was performed using two-way ANOVA with Tukey's multiple comparison test. RESULTS No statistically significant comparisons in CD3+ T-lymphocyte live cell counts and geometric mean fluorescent intensity of CSFE were identified between gentamicin concentrations or formulations. CONCLUSIONS Gentamicin had no effect on equine peripheral blood CD3+ T-lymphocyte cell viability and proliferation in concentrations ranging from "safe" to "retinotoxic" in relation to intravitreal injection volumes. Low-dose intravitreal gentamicin may not suppress the Th1- and Th17-mediated immune response.
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Affiliation(s)
- Hannah L Smith
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, North Carolina, Raleigh, USA
| | - Alix K Berglund
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, North Carolina, Raleigh, USA
- Comparative Medicine Institute, North Carolina State University, North Carolina, Raleigh, USA
| | - James B Robertson
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, North Carolina, Raleigh, USA
- Office of Research, College of Veterinary Medicine, North Carolina State University, North Carolina, Raleigh, USA
| | - Lauren V Schnabel
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, North Carolina, Raleigh, USA
- Comparative Medicine Institute, North Carolina State University, North Carolina, Raleigh, USA
| | - Richard J McMullen
- JT Vaughan Large Animal Teaching Hospital, College of Veterinary Medicine, Auburn University, Alabama, Auburn, USA
| | - Brian C Gilger
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, North Carolina, Raleigh, USA
| | - Annie Oh
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, North Carolina, Raleigh, USA
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Fischer BM, Brehm W, Reese S, McMullen RJ. Equine recurrent uveitis—A review. EQUINE VET EDUC 2022. [DOI: 10.1111/eve.13695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Britta M. Fischer
- Department of Clinical Sciences, College of Veterinary Medicine, JT Vaughan Large Animal Teaching Hospital Auburn University Auburn Alabama USA
- Department of Ophthalmology Clinic for Animals Hofheim Germany
| | - Walter Brehm
- Faculty of Veterinary Medicine, Department for Horses University of Leipzig Leipzig Germany
| | - Sven Reese
- Chair of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine LMU Munich Germany
| | - Richard J. McMullen
- Department of Clinical Sciences, College of Veterinary Medicine, JT Vaughan Large Animal Teaching Hospital Auburn University Auburn Alabama USA
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Wollanke B, Gerhards H, Ackermann K. Infectious Uveitis in Horses and New Insights in Its Leptospiral Biofilm-Related Pathogenesis. Microorganisms 2022; 10:387. [PMID: 35208842 PMCID: PMC8875353 DOI: 10.3390/microorganisms10020387] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 12/17/2022] Open
Abstract
Uveitis is a sight-threatening eye disease in equids known worldwide that leads to considerable pain and suffering. By far the most common type of uveitis in Germany and neighboring countries is classical equine recurrent uveitis (ERU), which is caused by chronic intraocular leptospiral infection and is the main cause of infectious uveitis in horses. Other infectious causes are extremely rare and are usually clinically distinguishable from ERU. ERU can be treated very effectively by vitreous cavity lavage (vitrectomy). For proper indications of this demanding surgery, it is necessary to differentiate ERU from other types of uveitis in which vitrectomy is not helpful. This can be conducted on the basis of anamnesis in combination with ophthalmologic findings and by aqueous humor examination. During vitrectomy, vitreous material is obtained. These vitreous samples have historically been used for numerous etiologic studies. In this way, a chronic intraocular leptospiral infection has been shown to be the cause of typical ERU and, among other findings, ERU has also been recognized as a biofilm infection, providing new insights into the pathogenesis of ERU and explaining some thus far unexplainable phenomena of ERU. ERU may not only have transmissible aspects to some types of uveitis in humans but may also serve as a model for a spontaneously occurring biofilm infection. Vitreous material obtained during therapeutically indicated vitrectomy can be used for further studies on in vivo biofilm formation, biofilm composition and possible therapeutic approaches.
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Affiliation(s)
- Bettina Wollanke
- Equine Clinic, Ludwig-Maximilians-University, 80539 Munich, Germany; (H.G.); (K.A.)
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Fischer BM, McMullen RJ, Reese S, Brehm W. Intravitreal injection of low-dose gentamicin for the treatment of recurrent or persistent uveitis in horses: Preliminary results. BMC Vet Res 2019; 15:29. [PMID: 30651102 PMCID: PMC6335700 DOI: 10.1186/s12917-018-1722-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/29/2018] [Indexed: 12/03/2022] Open
Abstract
Background Despite appropriate medical therapy, many horses with equine recurrent uveitis continue to suffer from recurrent bouts of inflammation. Surgical intervention via the pars plana vitrectomy or suprachoroidal cyclosporine implant placement may control and/or prevent recurrences, however, these procedures may be contraindicated, unavailable, or declined by an owner. Thus, an effective adjunctive treatment option may help to improve the clinical outcomes in those situations. There are several anecdotal reports on the use of intravitreal gentamicin injections, but to date, no data evaluating the complication rate and/or treatment effect following this treatment have been published. Thus, the aim of this prospective study was to describe the intravitreal gentamicin injection technique, describe the associated peri-injection (within 24 h) and post-injection (30 to 780 days) complications, and to report the effects of the injection on the clinical signs of uveitis. Additionally, evaluation of the systemic and ocular Leptospira-status, and its effect on the treatment outcome was performed. A total of 86 horses of various ages, breeds, and gender presenting with recurrent or persistent uveitis were treated via intravitreal injection of 4 mg of undiluted gentamicin (0.04 ml, Genta 100, 100 mg/ml in 35 horses) or preservative-free gentamicin (0.05 ml, 80 mg/ml in 52 horses) under sedation and local anesthesia. All 86 horses were observed for immediate peri-injection and post-injection complications. Response to therapy was evaluated in 59 of the 86 horses (follow-up: 30 to 780 days). Results Peri-injection complications consisted of subconjunctival (26/86; 30.2%) or intracameral hemorrhage (4/86; 4.7%); both of which completely resolved within 5 days. Post-injection complications consisted of cataract formation/maturation (5/59 horses, 8.5%) and diffuse retinal degeneration (3/59 eyes 5.1%). The majority of horses 52/59 (88.1%) with a minimum follow-up period of 30 days were controlled (absence of recurrent or persistent inflammation) at their last recheck examination. Recurrent inflammation was documented in 5/59 (8.5%) horses and persistent inflammation was diagnosed in 2/59 (3.4%) horses. Conclusions Intravitreal injection of low-dose gentamicin shows promise at controlling different types and stages of uveitis. The ability of intravitreal injections of low-dose gentamicin (4 mg) to control persistent and recurrent inflammation warrants further investigation.
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Affiliation(s)
- Britta M Fischer
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, JT Vaughan Large Animal Teaching Hospital, 1500 Wire Road, Auburn, AL, 36849-5540, USA
| | - Richard J McMullen
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, JT Vaughan Large Animal Teaching Hospital, 1500 Wire Road, Auburn, AL, 36849-5540, USA.
| | - Sven Reese
- Chair of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, LMU, Munich, Germany
| | - Walter Brehm
- Faculty of Veterinary Medicine, University of Leipzig, Department for Horses, Leipzig, Germany
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McMullen RJ, Fischer BM. Medical and Surgical Management of Equine Recurrent Uveitis. Vet Clin North Am Equine Pract 2017; 33:465-481. [PMID: 28985983 DOI: 10.1016/j.cveq.2017.07.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Equine recurrent uveitis (ERU) is characterized by recurrent bouts of inflammation interrupted by periods of quiescence that vary in duration. There is little consensus on the clinical manifestations, the underlying causes, or the management. The 3 commonly recognized syndromes of ERU (classic, insidious, and posterior) do not accurately separate the clinical manifestations of disease into distinct categories. An accurate diagnosis and early intervention are essential to minimizing the effects of disease and preserving vision. There are multiple medical and surgical options for controlling ERU as long as the disease is recognized early and targeted treatment is initiated immediately.
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Affiliation(s)
- Richard Joseph McMullen
- Department of Clinical Sciences, Auburn University, Auburn University College of Veterinary Medicine, JT Vaughan Large Animal Teaching Hospital, 1500 Wire Road, Auburn, AL 36849-5540, USA.
| | - Britta Maria Fischer
- Large Animal Internal Medicine, Auburn University, Auburn University College of Veterinary Medicine, JT Vaughan Large Animal Teaching Hospital, 1500 Wire Road, Auburn, AL 36849-5540, USA
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Werners AH. Treatment of endotoxaemia and septicaemia in the equine patient. J Vet Pharmacol Ther 2016; 40:1-15. [PMID: 27452161 DOI: 10.1111/jvp.12329] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 05/02/2016] [Indexed: 12/27/2022]
Abstract
Endotoxins, constituents of the cell wall of gram-positive and gram-negative bacteria, regularly result in severe illness and death in horses. In endotoxaemia, these constituents are present in the systemic circulation; in septicaemia, whole microbes invade normally sterile parts of the body. Interaction of these endotoxins with pathogen recognition receptors leads to an inflammatory response that cannot always be sufficiently contained and hence needs direct treatment. Over the last decennia, our understanding of the pathophysiology of endotoxaemia and septicaemia has significantly increased. Based on improved understanding of the interaction between receptors and endotoxins as well as the subsequent downstream signalling pathways, new therapeutic targets have been identified in laboratory animal species and humans. Important species differences in the recognition of endotoxins and pathogens by their receptors as well as the inflammatory response to receptor activation hamper extrapolation of this information to the horse (and other species). Historically, horses with endotoxaemia and septicaemia have been treated mainly symptomatically and supportively. Based on the identified therapeutic targets, this review describes the current knowledge of the treatment for endotoxaemia and septicaemia in the horse with reference to the findings in other animal species and humans.
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Affiliation(s)
- A H Werners
- Department of Anatomy, Physiology and Pharmacology, School of Veterinary Medicine, St. George's University, True Blue Campus, St. George's, Grenada, West-Indies
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Allbaugh RA. Equine recurrent uveitis: A review of clinical assessment and management. EQUINE VET EDUC 2016. [DOI: 10.1111/eve.12548] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- R. A. Allbaugh
- Department of Veterinary Clinical Sciences; Iowa State University College of Veterinary Medicine; Ames USA
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Gerding JC, Gilger BC. Prognosis and impact of equine recurrent uveitis. Equine Vet J 2015; 48:290-8. [PMID: 25891653 DOI: 10.1111/evj.12451] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 04/07/2015] [Indexed: 11/30/2022]
Abstract
REASONS FOR PERFORMING STUDY Equine recurrent uveitis (ERU) is a leading cause of vision loss in horses. OBJECTIVES To assess the prognosis and impact of ERU on affected horses and their owners by evaluating the signalment, treatment and outcome (including the loss of use, vision assessment and economic loss). STUDY DESIGN Retrospective impact study. METHODS Medical records of horses presenting to the North Carolina State University Veterinary Health Complex (NCSU-VHC) with ERU between 1999 and 2014 were reviewed. Signalment, clinical signs, ophthalmic examination findings, treatments and outcomes were evaluated. Owner questionnaires were completed regarding vision, job/role, monetary value, diagnostic and treatment costs, concurrent illness and outcomes. RESULTS Records of 224 horses (338 eyes) with ERU were reviewed. There was an overrepresentation of Appaloosas (54; 24.1%), Hanoverians (11; 4.9%) and other Warmbloods (13; 5.8%). Ninety-six eyes (28.4%) were diagnosed as blind and 38 eyes (11.2%) with glaucoma on initial evaluation. Leptospirosis titres of serum and/or aqueous humour were obtained in 88 horses and were positive in 40 horses (45.5%), with L. pomona being the most frequently isolated serovar. Globe loss at the NCSU-VHC occurred in 41 ERU eyes (12.1% of total). Owner questionnaires were evaluated in 194 horses (86.6%) and 91 horses (46.9%) were reported blind in the affected eye(s). Fifty-seven horses (29.4%) did not return to their previous role, while 61 (31.4%) performed at a reduced level. Equine recurrent uveitis decreased the monetary value of 164 horses. Twenty-nine horses (14.9%) were euthanised and 37 (19.1%) underwent change in ownership as a direct result of ERU. CONCLUSIONS The impact of ERU is attributed to the high frequency of blindness, globe loss and loss of function. Euthanasia and change of ownership are common sequelae to the progressive nature of ERU. These factors, along with financial costs of the disease, have a significant impact on affected horses and their owners.
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Affiliation(s)
- J C Gerding
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, USA
| | - B C Gilger
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, USA
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Malalana F, Stylianides A, McGowan C. Equine recurrent uveitis: Human and equine perspectives. Vet J 2015; 206:22-9. [PMID: 26188862 DOI: 10.1016/j.tvjl.2015.06.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 06/22/2015] [Accepted: 06/30/2015] [Indexed: 12/31/2022]
Abstract
Equine recurrent uveitis (ERU) is a spontaneous disease characterised by repeated episodes of intraocular inflammation. The epidemiology of ERU has not been fully elucidated, but the condition appears to be much more common in horses than is recurrent uveitis in humans, especially in certain breeds and geographical regions. Both humans and horses show a similarly altered immune response and a marked autoimmune response as the primary disease pathophysiology. However, an inciting cause is not always clear. Potential inciting factors in horses include microbial agents such as Leptospira spp. Microbial factors and genetic predisposition to the disease may provide clues as to why the horse appears so susceptible to this disease. The aim of this review is to discuss the immunology and genetics of ERU, compare the disease in horses with autoimmune anterior uveitis in humans, and discuss potential reasons for the increased prevalence in the horse.
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Affiliation(s)
- Fernando Malalana
- The Philip Leverhulme Equine Hospital, The University of Liverpool, Leahurst Campus, Neston, Wirral, CH64 7TE, UK.
| | - Amira Stylianides
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK
| | - Catherine McGowan
- Department of Musculoskeletal Biology, Institute of Ageing and Chronic disease, The University of Liverpool, Leahurst Campus, Neston, Wirral, CH64 7TE, UK
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de Linde Henriksen M, Brooks DE. Standing ophthalmic surgeries in horses. Vet Clin North Am Equine Pract 2014; 30:91-110. [PMID: 24680208 DOI: 10.1016/j.cveq.2013.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Standing ophthalmic surgery without general anesthesia allows for several routine ophthalmic procedures including eyelid lacerations and enucleations to be performed in the horse, but does contain increased risk of causing tissue damage arising from the inability to eliminate eye and head movements. Heavy sedation and local nerve blocks of the involved motor and sensory nerves are essential in achieving a good outcome from ophthalmic surgery in the nonanesthetized horse. The inability to use an operating microscope in standing surgery in horses prevents performing precise corneal and intraocular microsurgeries.
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Affiliation(s)
- Michala de Linde Henriksen
- Comparative Ophthalmology Service, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, 1352 Boyd Avenue, Saint Paul, MN 55108, USA.
| | - Dennis E Brooks
- Comparative Ophthalmology Service, Departments of Large and Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, 2015 Southeast 16th Avenue, Gainesville, FL 32608, USA
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Quantification of triamcinolone acetonide in ocular tissues after intravitreal injection to rabbit using liquid chromatography–tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2011; 879:548-52. [DOI: 10.1016/j.jchromb.2011.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 01/10/2011] [Accepted: 01/10/2011] [Indexed: 11/23/2022]
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Torriglia A, Valamanesh F, Behar-Cohen F. On the retinal toxicity of intraocular glucocorticoids. Biochem Pharmacol 2010; 80:1878-86. [DOI: 10.1016/j.bcp.2010.07.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 07/06/2010] [Accepted: 07/08/2010] [Indexed: 10/24/2022]
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