Prognosis and impact of equine recurrent uveitis

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.

Ocular toxicity and distribution of subconjunctival and intravitreal rapamycin in horses

In vitro photosensitivity of rapamycin (RAPA) and ocular toxicity and distribution of intravitreal and subconjunctival RAPA was evaluated in normal horses. RAPA (2.5 mg, 5 mg, and 10 mg) was placed in 10 mL of PBS and maintained in a water bath at 37 degrees C, kept in the dark or subjected to room light, and sampled for up to 3 months for RAPA levels. Six normal adult horses received either 5 mg (n = 2) or 10 mg (n = 2) of RAPA intravitreally or 10 mg (n = 2) subconjunctivally. Ophthalmic exams and electroretinography (ERG) were performed prior to injection and on days 1, 7, 14, and 21 post-injection. Eyes were enucleated and samples were collected for RAPA concentrations and histopathology. No difference in light vs. dark RAPA concentrations was observed, suggesting a lack of RAPA phototoxicity. No evidence of ocular toxicity was noted on ophthalmic examination or histopathology. RAPA was not detected intraocularly 7 days post-injection in eyes receiving subconjunctival RAPA, but was detected in the vitreous at 21 days post-injection. Drug could be detected in both the aqueous and vitreous humor after intravitreal injection. Further study is needed to determine the efficacy of intravitreal RAPA.

Proteinases of the cornea and preocular tear film

Maintenance and repair of corneal stromal extracellular matrix (ECM) requires a tightly coordinated balance of ECM synthesis, degradation and remodeling in which proteolytic enzymes (proteinases) perform important functions. There are natural proteinase inhibitors present in preocular tear film (PTF) and cornea simultaneously with proteinases that prevent excessive degradation of normal healthy tissue. Disorders occur when there is an imbalance between proteinases and proteinase inhibitors in favor of the proteinases, causing pathologic degradation of stromal collagen and proteoglycans in the cornea. Two matrix metalloproteinases (MMPs), MMP-2 and MMP-9, are of major importance in terms of remodeling and degradation of the corneal stromal collagen. Immunohistochemical studies have shown different origins of MMP-2 and -9. MMP-2 is synthesized by corneal keratocytes and performs a surveillance function in the normal cornea, becoming locally activated to degrade collagen molecules that occasionally become damaged. Alternatively, MMP-9 may be produced by epithelial cells and polymorphonuclear neutrophils following corneal wounding. Because the cornea is in close contact with the preocular tear film (PTF), proteinases have been evaluated in the PTF. In damaged corneas, total proteolytic activity in the tear fluid was found to be significantly increased compared to normal eyes and contralateral eyes. Studies analyzing the proteolytic activity in serial PTF samples during corneal healing led to the following conclusions: ulcerative keratitis in animals is associated with initially high levels of tear film proteolytic activity, which decrease as ulcers heal; proteinase levels in melting ulcers remain elevated leading to rapid progression of the ulcers. The success of medical and surgical treatment of the corneal ulcers is reflected by the proteolytic activity in tears. In animals, successful treatment leads to a rapid reduction in tear film proteolytic activity that corresponds with the improvement in the clinical signs of corneal ulceration. The in vitro effects of various compounds on proteolytic activity in the tear fluid of animals with ulcerative keratitis have been evaluated and their important inhibitory effects have been confirmed. Because these various compounds utilize different mechanisms to inhibit various families of proteinases, a combination of these proteinase inhibitors may be beneficial.

Superficial, nonhealing corneal ulcers in horses: 23 cases (1989-2003)

OBJECTIVE

To characterize superficial, nonhealing corneal ulcers in the horse and to assess the affect of age, breed, sex, inciting cause of the ulcer, and treatment on healing time of these ulcers.

DESIGN

Retrospective study.

ANIMALS

Twenty-three horses with superficial, nonhealing corneal ulcerations.

PROCEDURE

Medical records from 1989 to 2003 of horses diagnosed with superficial, nonhealing corneal ulcers were reviewed. Signalment, duration of clinical signs, ophthalmic abnormalities, treatment and response to treatment were recorded. Horses were treated, in addition to medical therapy, using debridement, debridement and grid keratotomy, superficial keratectomy, and superficial keratectomy with conjunctival graft placement.

RESULTS

Mean age +/- SD of horses was 13.7 +/- 5.8 years. The mean time of presence of the corneal ulceration was 38.9 +/- 21.3 days. Mean time to complete re-epithelialization of the corneal ulcers after treatment was 20 +/- 14.7 days. Horses treated with debridement alone, grid keratotomy and superficial keratectomy healed in a mean time of 15.3 +/- 14.6 days, 16 +/- 12.6 days, and 22.8 +/- 6.7 days, respectively.

CONCLUSIONS AND CLINICAL RELEVANCE

Horses treated with a single debridement at initial evaluation healed in a significantly shorter time period than horses treated with grid keratotomy or superficial keratectomy. The latter two procedures may be beneficial in the treatment of nonhealing ulceration in horses, but the results of this study suggest that these procedures should only be performed following failure of the ulcer to heal after epithelial debridement.

Bartonella vinsonii subspecies berkhoffi as a possible cause of anterior uveitis and choroiditis in a dog

A 2-year old, neutered, female spaniel mixed breed was referred to the North Carolina State University Veterinary Teaching Hospital for evaluation of bilateral anterior uveitis. The dog was febrile and, in addition to anterior uveitis, multifocal hyporeflective lesions were present in the tapetal fundus of both eyes. The antibody titer for Bartonella vinsonii subspecies berkhoffi was positive (1 : 512). Aqueous paracentesis was performed for PCR in an attempt to detect B. vinsonii in the eye but was unsuccessful. The ocular manifestations of Bartonella infection in humans are currently expanding as more sensitive serologic and PCR techniques are being developed to identify Bartonella spp. In addition to optic neuritis and neuroretinitis, retinochoroidal lesions are one of the most common manifestations of B. henselae infection, and are frequently accompanied by vitreous or anterior segment inflammation. Diagnosis of a Bartonella infection in humans can be made on serology alone, in conjunction with ocular examination findings. The ultimate proof of B. vinsonii (berkhoffi) as a direct cause of ocular disease would be detection of the infectious agent in the eye. However, it is unknown at this time whether Bartonella causes ocular disease primarily, secondarily via an autoimmune reaction, or both. Due to the difficulties associated with culture of Bartonella spp. and the limitations of PCR, serology is currently the most useful tool for screening dogs for possible Bartonella spp. infection. In the case presented here, even though the PCR was negative, the clinical signs of anterior uveitis and choroiditis might reasonably be associated with B. vinsonii (berkhoffi) seroreactivity, which was repeatable on three separate occasions. Clinical improvement was also accompanied by a post-treatment decrease in B. vinsonii (berkhoffi) seroreactivity, potentially supporting resolution of Bartonella infection in this dog. This is the first reported case of a possible association between uveitis, choroiditis and Bartonella infection in the dog, without clinical manifestations of other organ or tissue involvement. Future studies based on PCR analysis of intraocular fluids may clarify the involvement of B. vinsonii (berkhoffi) in dogs with intraocular inflammatory disease. Furthermore, performing fluorescein angiography in dogs with elevated Bartonella titers may also prove useful in the identification and characterization of lesions.

The effect of topical administration of atropine sulfate on the normal equine pupil: influence of age, breed and gender

OBJECTIVES

The purpose of this study was to determine the influence of age, breed and gender on vertical pupil diameter (VPD) following a single dose of 1% atropine sulfate ophthalmic solution in the normal equine eye.

ANIMALS STUDIED

Thirty-two horses of various ages, breeds and genders were included. The horses had no history or clinical signs of ophthalmic disease. All horses studied had darkly pigmented irides.

PROCEDURES

Two milligrams of 1% atropine sulfate ophthalmic solution was topically administered as a single dose in the right eye of each horse on Day 0. The VPD (mm) was measured in both eyes using digital calipers prior to treatment and every 24 h after administration for 2 weeks (Days 1-14). Duration of effect on VPD was then calculated for treated and untreated eyes. Data were also analyzed for effect of age, breed and gender on mean VPD, maximum VPD and time to maximum VPD.

RESULTS

The VPD in the treated eye was significantly elevated compared to baseline measurements and compared to the untreated eye at all time points. Arabians had a greater mean VPD at Day 0 and on several days following treatment. Females had greater mean VPD compared to males on 5 out of 15 days.

CONCLUSIONS

Duration of mydriasis after administration of 1% atropine sulfate ophthalmic solution in the normal equine eye is greater than 14 days. Horses of the Arabian breed and female horses may be more sensitive to effects of cholinergic blockade in the eye.

Transpupillary diode laser retinopexy in dogs: ophthalmoscopic, fluorescein angiographic and histopathologic study

OBJECTIVE

To evaluate the ophthalmoscopic, fluorescein angiographic and light microscopic effects of diode laser retinopexy application in the tapetal and nontapetal fundus in the dog, and to ascertain appropriate laser power settings for production of photocoagulative lesions in these two regions.

ANIMALS STUDIED

Three adult female Beagle dogs.

PROCEDURES

Laser burns were applied to selected areas in the fundus with an indirect headset delivery system using settings varying from 100 to 200 milliWatts (mW) and from 100 to 600 milliSeconds (mS) with total delivered energy ranging between 15 and 100 milliJoules (mJ). The dogs were then monitored by ophthalmoscopic examination and fluorescein angiography at regular intervals for 7-28 days. Histopathologic studies were performed at 7, 14 and 28 days after laser application.

RESULTS

The diode laser produced ophthalmoscopically visible lesions in the nontapetal fundus with all laser settings used, and the appearance of these lesions corresponded to the energy levels used, and degree of pigment in the lased region. Gray-white colored lesions with minimal subsensory retinal edema were seen with settings as low as 100 mWatts/150 mSeconds. In the tapetal fundus, laser burns were more difficult to produce, less repeatable, and required higher energy levels. Laser burns appeared as bronze, dark green or black discolorations of the tapetum with varying degrees of subsensory retinal edema. Lesions were more reproducible and were achieved with lower settings in the tapetal area of the tapetal/nontapetal junction. Ophthalmoscopically, depigmentation and repigmentation of the RPE (nontapetal fundus) and degenerative changes in the overlying retina (tapetal fundus) developed in the laser burns over the 28-day study period. Fluorescein angiographic studies showed disruption of the blood-retinal barrier at the level of the RPE and fluorescein leakage into the subsensory retinal space was seen in most lesions at 24 h, was minimal at 3 days, and had resolved by 7 days. Histologically, grayish-white lesions in the nontapetal fundus, and bronze to small black lesions in the tapetal fundus were typically characterized by outer retinal necrosis and RPE migration. Gliosis was considered minimal, was confined to the retina, and no inflammatory cells were seen. Peripheral intense white lesions (nontapetum) and lesions with a black center (tapetal fundus) were characterized by more extensive panretinal and choroidal necrosis. Most of the nontapetal lesions and a few in the tapetal fundus showed the formation of a central retinal detachment.

CONCLUSIONS

The diode laser effectively produces lesions suitable for retinopexy in both the nontapetal, pigmented fundus and the tapetal fundus, although variably so in the latter region. Initial laser settings of 100-150 mW/200 mS for the pigmented fundus, and 150 mW/200-300 mS for the peripheral tapetal fundus are recommended, and the clinician should gradually increase time interval settings to achieve a grayish-white lesion in the nontapetum, and a bronze to slightly black lesion in the tapetal fundus. If possible, retinopexy should be applied to the peripheral tapetal area or tapetal/nontapetal junction.

Use of an intravitreal sustained-release cyclosporine delivery device for treatment of equine recurrent uveitis

OBJECTIVE

To evaluate the use of an intravitreal sustained-release cyclosporine (CsA) delivery device for treatment of horses with naturally occurring recurrent uveitis.

ANIMALS

16 horses with recurrent uveitis.

PROCEDURES

Horses with frequent recurrent episodes of uveitis or with disease that was progressing despite appropriate medication were selected for this study. Additional inclusion criteria included adequate retinal function as determined by use of electroretinography, lack of severe cataract formation, and no vision-threatening ocular complications (eg, retinal detachment, severe retinal degeneration, and posterior synechia). Sustained-release CsA delivery devices (4 microg of CsA/d) were implanted into the vitreous through a sclerotomy at the pars plana. Reexaminations were performed 1, 3, 6, and 12 months after implantation, then continued annually. Ophthalmic changes, number of recurrent episodes of uveitis, and vision were recorded.

RESULTS

The rate of recurrent episodes after device implantation (0.36 episodes/y) was less than prior to surgery (75 episodes/y). In addition, only 3 horses developed episodes of recurrent uveitis after surgery. Vision was detected in 14 of 16 affected eyes at a mean follow-up time of 13.8 months (range, 6 to 24 months).

CONCLUSIONS AND CLINICAL RELEVANCE

This intravitreal sustained-release CsA delivery device may be a safe and important tool for long-term treatment of horses with chronic recurrent uveitis.

Acute vision loss after general anesthesia in a cat

A 6-year-old, male castrated, domestic shorthair cat presented with a 2-week history of blindness following general anesthesia. Behavioral changes, lethargy, inappetence and neurological deficits were also noted. Ophthalmic evaluation revealed blindness, normal pupillary light response and dazzle response, but no other abnormalities. Serodiagnostic testing for common infectious agents was negative and a cerebrospinal fluid analysis was normal. History and postmortem examination following euthanasia revealed cerebrocortical necrosis most consistent with anesthesia related hypoxia.

Effect of an intravitreal cyclosporine implant on experimental uveitis in horses

The purpose of this study was to determine the effects of an intravitreal device releasing cyclosporine A (CsA) on recurrent inflammatory episodes in experimental uveitis. Nine normal horses were immunized peripherally with H37RA-mTB antigen twice, and then received 25 microg of H37RA-mTB antigen intravitreally in the right eye and an equal volume of balanced salt solution intravitreally in the left eye. Two weeks later, the animals randomly received either a CsA or a polymer implant (without CsA) in both eyes 1 week following implantation of the devices, 25 microg of H37RA-mTB antigen was reinjected into the right eye of each animal. Clinical signs of ophthalmic inflammation were graded following injections and implantation. The animals from each group were euthanized at 3, 14, and 28 days following the second injection. Aqueous and vitreous humor protein concentrations were measured. The presence, number, and type (CD4, 5 and 8) of infiltrating inflammatory cells and amount of tissue destruction were determined. Total RNA was isolated and quantitative reverse transcriptase-polymerase chain reaction was performed for equine specific interleukin (IL) 2 and 4, interferon-gamma (IFN gamma) and beta-actin. In addition, aqueous and vitreous humor and peripheral blood were collected at the termination of the experiments and analyzed for CsA concentration by HPLC. Within 4h of the first intravitreal H37RA-mTB antigen injection, each animal developed epiphora, blepharospasm, mild corneal edema, aqueous flare, myosis, and vitreous opacity. The severity of signs peaked 48 to 72 h after injection and subsequently decreased back to normal within 14 days. Following the second injection, clinical signs in the eyes with the CsA device were less severe and significantly shorter in duration than signs with the polymer only implant eyes. Aqueous and vitreous humor protein levels, infiltrating cell numbers, total number of T-lymphocytes, and levels of IL-2 and IFN gamma-mRNA were significantly less in eyes with the CsA implant compared to eyes with the polymer only. CsA implants did not completely eliminate the development of a second ('recurrent') experimental inflammatory episode in these horses. However, the duration and severity of inflammation, cellular infiltration, tissue destruction, and pro-inflammatory cytokines RNA transcript levels were significantly less in those eyes implanted with the CsA device.

Ocular lesions associated with systemic hypertension in cats: 69 cases (1985-1998)

OBJECTIVE

To characterize clinical and clinicopathologic findings, response to treatment, and causes of systemic hypertension in cats with hypertensive retinopathy.

DESIGN

Retrospective study.

ANIMALS

69 cats with hypertensive retinopathy.

PROCEDURE

Medical records from cats with systemic hypertension and hypertensive retinopathy were reviewed.

RESULTS

Most cats (68.1%) were referred because of vision loss; retinal detachment, hemorrhage, edema, and degeneration were common findings. Cardiac abnormalities were detected in 37 cats, and neurologic signs were detected in 20 cats. Hypertension was diagnosed concurrently with chronic renal failure (n = 22), hyperthyroidism (5), diabetes mellitus (2), and hyperaldosteronism (1). A clearly identifiable cause for hypertension was not detected in 38 cats; 26 of these cats had mild azotemia, and 12 did not have renal abnormalities. Amlodipine decreased blood pressure in 31 of 32 cats and improved ocular signs in 18 of 26 cats.

CONCLUSIONS AND CLINICAL RELEVANCE

Retinal lesions, caused predominantly by choroidal injury, are common in cats with hypertension. Primary hypertension in cats may be more common than currently recognized. Hypertension should be considered in older cats with acute onset of blindness; retinal edema, hemorrhage, or detachment; cardiac disease; or neurologic abnormalities. Cats with hypertension-induced ocular disease should be evaluated for renal failure, hyperthyroidism, diabetes mellitus, and cardiac abnormalities. Blood pressure measurements and funduscopic evaluations should be performed routinely in cats at risk for hypertension (preexisting renal disease, hyperthyroidism, and age > 10 years). Amlodipine is an effective antihypertensive agent in cats.

Acute renal failure in four cats treated with paromomycin

Acute renal failure was diagnosed in 4 cats receiving paromomycin orally for treatment of infectious enteritis. All 4 cats responded to fluid therapy and recovered normal or near-normal renal function; however, 3 of the cats subsequently became deaf and developed cataracts. Toxicoses were attributed to a combination of an excessive dosage of paromomycin and absorption of the drug across injured intestinal mucosal epithelium. Pharmacokinetic studies are needed to further define the disposition of paromomycin after oral administration to cats.

Characterization of T-lymphocytes in the anterior uvea of eyes with chronic equine recurrent uveitis

Equine recurrent uveitis (ERU), a chronic, recurrent inflammation primarily of the anterior uveal tract, is the most common cause of blindness in horses. Recently, T-lymphocytes have been found to be the most numerous cell type to infiltrate the anterior uveal of horses with ERU. In the present study, we characterized the T-lymphocyte population in the anterior uveal tract of eyes of horses with chronic ERU by evaluating the microscopic appearance (histopathologic features), the T-lymphocyte subsets, and the relative levels and amounts of T-lymphocyte cytokine mRNA in the anterior uvea. Seven inflamed eyes (from six horses with chronic ERU) and 5 normal eyes (from five horses with nonocular problems) were studied. After clinical examination, the eyes were removed, ocular fluids were aspirated, and anterior uveal tissues (iris and ciliary body) were processed for histologic and molecular (RNA isolation) analyses. Histologic examination by hematoxylin and eosin (H and E) staining and immunohistochemistry evaluating T-lymphocyte subsets (anti-CD4, CD8, CD5) were performed for each sample. RNA samples were analyzed for levels of messenger (m) RNA specific for interleukin (IL)-2, 4, and interferon-gamma (IFNgamma) by quantitative reverse transcriptase polymerase chain reaction (QRT-PCR). Eyes with ERU exhibited characteristic clinical signs, including corneal edema, aqueous flare, posterior synechia, corpora nigra degeneration, and cataract formation. Histologically, infiltration of the uveal tract with lymphocytes, plasma cells, and macrophages was most evident in the ciliary body and base of the iris. Loss of tissue structure (destruction) was most evident in the ciliary processes. Infiltrating lymphocytes were predominantly CD4+ T-cells (e.g. 48% CD4+ and 18% CD8+ in the ciliary body stroma), as determined by immunohistochemistry. Few inflammatory cells were observed in the normal eyes. The QRT-PCR results revealed increased transcription of IL-2 and IFNgamma and low IL-4 mRNA expression in eyes with chronic ERU compared to normal eyes, demonstrating a Thelper (Th) 1-like inflammatory response in eyes with ERU.

Low-dose oral administration of interferon-alpha for the treatment of immune-mediated keratoconjunctivitis sicca in dogs

This preliminary study was designed to evaluate the effectiveness and dosage of oral use of interferon-alpha (IFN-alpha) in the treatment of naturally occurring, immune-mediated, canine keratoconjunctivitis sicca (KCS). Dogs with chronic immune-mediated KCS were selected from the two clinic populations. All medication, except topical artificial tears, was discontinued at least 2 weeks prior to beginning the clinical trial. IFN-alpha was administered orally once daily to the dogs by their owners as the sole therapy for the KCS. Examinations of the dogs were performed every 2 weeks for the duration of the trial (12 weeks). Each dog was given either two or three separate, escalating doses (20, 40, 80 IU of the IFN-alpha. A favorable response was observed in 55% (11/20) of all dogs treated. Clinical findings of those dogs that responded included increased wetting of the eyes, decreased mucus discharge, and fewer signs of discomfort. There was a nearly significant difference (p = 0.08) in pretreatment mean Schirmer's tear test (STT) between the dogs that responded (6.4 +/- SEM 0.62 mm/min) and those that did not respond (4.7 +/- SEM 0.69 mm/min) to the orally administered IFN-alpha. Seven of 11 dogs with favorable outcomes had an increased STT of at least 5 mm/min after treatment with oral IFN-alpha and the group had a post-treatment STT (10.5 +/- SEM 1.4 mm/min) significantly greater than baseline (p = 0.0004). The post-treatment STT of the dogs that did respond was significantly greater (p < 0.01) than the post-treatment mean STT of dogs that did not respond. All dogs that responded did so with the 20 or 40 IU dose of IFN-alpha. No side effects were noted and all dogs tolerated the treatment well.

Normal variation in, and effect of 2% pilocarpine on, intraocular pressure and pupil size in female horses

OBJECTIVE

To determine normal variation in, and effect of 2% pilocarpine hydrochloride on, intraocular pressure (IOP) and pupil size in female horses during a specified period.

ANIMALS

10 female horses with normotensive eyes.

PROCEDURE

IOP and horizontal and vertical pupil size were measured on a single day between 8 AM and 8 PM at hours 0, 0.5, 1, 2, 4, 6, 8, 10, and 12. Measurements were repeated after single- dose application of 2% pilocarpine to both eyes. IOP and pupil size were measured at 8 AM and noon in a 5-day experiment of twice-daily application of 2% pilocarpine.

RESULTS

Variation in IOP and pupil size was not significant between 8 AM and 8 PM. Change in IOP or pupil size after a single dose of 2% pilocarpine also was not significant. In the multiple-dose experiment, the IOP at noon on the fifth day was significantly higher than the IOP in the morning on the first and second days. The IOP in the morning on the fifth day was significantly higher than the IOP in the morning and at noon on the first and second days. The IOP at noon on the fourth day was significantly higher than the morning IOP on the first and second days and at noon on the first day. The decrease in vertical pupil size was significant.

CONCLUSIONS

Between 8 AM and 8 PM, variation in IOP and pupil size in normotensive eyes of horses is not significant. Two percent pilocarpine does not significantly change IOP between 8 AM and 8 PM in clinically normal horses after a single dose or multiple twice-daily applications. After multiple twice-daily applications, a trend toward an increase in IOP was seen, and the decrease in vertical pupil size was significant.

Experimental implantation of posterior chamber prototype intraocular lenses for the feline eye

OBJECTIVE

To measure postoperative anterior chamber depth (ACD), corneal curvature, and refractive state of feline eyes after lens removal and implantation of a prosthetic intraocular lens (IOL) and determine appropriate IOL use in cats.

ANIMALS

8 clinically normal adult cats.

PROCEDURE

A-scan ultrasonic biometry, keratometry, and streak retinoscopy were performed on both eyes of each cat before and after lens removal and implantation of a prosthetic IOL. Three diopter (D) IOL strengths were used: 48, 51, and 60 D. Measurements were recorded for 12 weeks after surgery.

RESULTS

IOL were well tolerated by cats, with no serious complications attributable to implantation or presence of the IOL. The ACD was significantly greater after (8.30 mm) than before (4.97 mm) surgery; however, it became slightly more shallow during the 4 weeks after surgery, suggesting that the IOL shifted anteriorly in the eye. Significant difference in corneal curvature was not detected before or after surgery among eyes with various IOL. Twelve weeks after surgery, eyes with 48-, 51-, and 60-D IOL had mean +/- SD refractive state of +2.1 +/- 0.49, +0.42 +/- 0.20, and -2.6 +/- 0.78 D, respectively. Linear regression analysis of refractive state on IOL power for all eyes at 12 weeks after surgery predicted that +52.8-D IOL was necessary to best approximate emmetropia in these cats.

CONCLUSION AND CLINICAL RELEVANCE

IOL of substantially higher diopter strength than that needed in dogs was required to achieve emmetropia after lens extraction in cats. A 52- to 53-D IOL is required to correct feline eyes to near emmetropia after lens removal.

Retinal degeneration associated with vitamin E deficiency in hunting dogs

A group of Walker Hounds and Beagles that were fed a diet of table scraps were examined because of slow, progressive loss of vision. Clinical and microscopic features of the disease were correlated to the dogs' micronutrient status. Sensory retinal degeneration, predominantly in the central tapetal fundus, was found in all dogs, and severity of changes varied with age of the dog. Plasma, serum, and tissue concentrations of vitamin E were low in affected dogs (10 to 40% of control values). Lipofuscin accumulation was found on microscopic examination in retinal pigment epithelium, smooth muscle cells of the intestinal tract, and neurons of the CNS. Findings were consistent with nutritional vitamin E deficiency and oxidative injury to photoreceptors of the retina. Changes in these dogs were similar to those described for central progressive retinal atrophy and equine lower motor neuron disease, suggesting these diseases may share a common pathogenesis to vitamin E deficiency.

Keratometry, ultrasonic biometry, and prediction of intraocular lens power in the feline eye

OBJECTIVE

To determine ocular dimensions (using A-scan ultrasound biometry) and corneal curvature (using keratometry) in the feline eye and to calculate the appropriate dioptric power for a prototype posterior chamber intraocular lens (IOL) necessary to achieve emmetropia in the eyes of cats undergoing lens extraction.

ANIMALS

25 clinically normal adult mixed-breed cats and 10 eyes from 10 clinically normal adult mixed-breed cat cadavers.

PROCEDURE

A-scan ultrasonic biometry was performed on both eyes of each live cat. Cats were tranquilized, and keratometry was performed on each eye. Biometry was performed on the cadaver eyes. Five of the cadaver eyes had the lens extracted and an IOL, designed for use in dogs, was implanted. Biometry was repeated to estimate postoperative IOL position. Using 3 theoretical IOL formulas, data from biometry, keratometry, and postoperative IOL position were used to predict IOL strength required to achieve emmetropia after lens extraction in cats.

RESULTS

Mean axial length of eyes in live cats was 20.91 +/- 0.53 mm. Mean preoperative anterior chamber depth (ACD) was 5.07 +/- 0.36 mm, and mean lens thickness was 7.77 +/- 0.23 mm. Predicted postoperative ACD was calculated to be 10.84 mm. Measured postoperative ACD in the 5 cadaver eyes was 8.28 mm. Required IOL strength calculated, using the predicted postoperative ACD, was 73 to 76 diopters. The required IOL strength calculated, using the measured postoperative ACD, was 53 to 55 diopters.

CONCLUSIONS AND CLINICAL RELEVANCE

An IOL of substantially higher diopter strength than that needed in dogs is required to achieve emmetropia after lens extraction in average cats; an IOL strength of approximately 53 to 55 diopters will likely be required.

Phacoemulsification. Technology and fundamentals

The number one rule of phacoemulsification and aspiration cataract surgery is to know your machine. This chapter is designed to help the surgeon who is currently using phacoemulsification, or those who wish to understand more about technique, learn the basics and technology of the various types of phacoemulsification machines. Fluidics, pump design, handpiece mechanics, phacoemulsification needles, and fundamentals of phacoemulsification of cataracts will be reviewed.

Surgical treatment of dacryocystitis caused by cystic dilatation of the nasolacrimal system in three dogs

A 4-year-old castrated male Golden Retriever was referred for evaluation of intermittent purulent discharge from the right eye of 4-months' duration. A radiolucent area in the maxillary bone was detected on examination of skull radiographs. Dacryocystorhinography revealed pooling of contrast material in the radiolucent area. A rhinotomy was performed, and a large opening between the cystic structure of the nasolacrimal system and the nasal cavity was created. Epiphora resolved after surgery and had not recurred by 9 months after surgery. Two other dogs had cystic structures of the nasolacrimal system and were treated surgically to allow drainage into the nasal cavity.

Neodymium:yttrium-aluminum-garnet laser treatment of cystic granula iridica in horses: eight cases (1988-1996)

OBJECTIVE

To determine clinical features of cystic granula iridica in horses and outcome of horses treated with an ophthalmic neodymium:yttrium-aluminum-garnet (Nd:YAG) laser.

DESIGN

Retrospective study.

ANIMALS

8 horses.

PROCEDURE

An ophthalmic Nd:YAG laser was used to deflate cysts in all horses.

RESULTS

Horses were examined because of visual impairment (n = 5), decreased jumping performance (2), or head shaking (1). Clinical signs associated with cysts resolved in all horses after treatment. Short- and long-term complications did not develop, and cysts did not recur.

CLINICAL IMPLICATIONS

Cystic granula iridica may cause vision impairment in horses. Treatment with an ophthalmic Nd:YAG laser appears to be safe and effective.

Eosinophilic keratoconjunctivitis in seven horses

Eosinophilic keratoconjunctivitis was diagnosed in 7 horses at The Ohio State University between 1976 and 1994. All horses had moderate-to-severe blepharospasm, chemosis, and conjunctival hyperemia; epiphora; and extensive yellow-to-white caseous mucoid discharge. Corneal ulcers associated with this disease were perilimbal and extended centrally. All ulcers were covered with a white necrotic plaque firmly attached to the underlying cornea. Other ophthalmic abnormalities were not detected. Corneal scrapings examined cytologically contained numerous eosinophils interspersed between epithelial cells, few mast cells, and neutrophils. Microbial organism were not seen. Bacterial and fungal cultures were negative for ocular pathogens. The initial diagnosis of eosinophilic keratoconjunctivitis was made on the basis of clinical and cytologic findings. In 5 horses, the condition completely resolved after topical treatment with corticosteroid (0.05% dexamethasone) and triple antibiotic ointments. However, the duration of treatment was prolonged, with a mean treatment time of 64 days (range, 45 to 106 days). All corneal ulcers remained superficial, and despite the prolonged duration of treatment, none of the horses developed secondary bacterial or fungal keratitis. One horse underwent superficial keratectomy and had the shortest resolution time (14 days).

Penetrating keratoplasty for treatment of recurrent squamous cell carcinoma of the cornea in a horse

Squamous cell carcinoma involving the cornea and conjunctiva of the left eye in a 14-year-old horse was treated by superficial keratectomy in combination with beta-radiation and radiofrequency hyperthermia. The tumor recurred 4 months later in the central cornea at the edge of the previous keratectomy site. Penetrating keratoplasty was performed in an effort to remove the tumor and retain a visual eye. The eye was visual 13 months after surgery. Mild fibrosis and vascularization were observed in the area of the penetrating keratoplasty.

Intraocular silicone prosthesis implantation in eyes of dogs and a cat with intraocular neoplasia: nine cases (1983-1994)

OBJECTIVE

To determine the outcome of implantation of an intraocular silicone prosthesis (ISP) in the eyes of dogs and cats with intraocular neoplasia.

DESIGN

Retrospective case series.

ANIMALS

Eight dogs and 1 cat with histologically confirmed intraocular neoplasia.

PROCEDURE

Signalment, clinical signs before and after surgery, results of microscopic examination of eviscerated intraocular tissues, follow-up information, and necropsy findings, if available, were recorded for each animal.

RESULTS

Five dogs and 1 cat had primary intraocular neoplasms. Two of the dogs developed regrowth of the neoplasm around the ISP 6 to 24 months after implantation, and the eyes were enucleated. The cat developed signs compatible with systemic metastasis 4 years after surgery and was euthanatized. Three dogs had multicentric or metastatic neoplasia involving the eye. Two of these dogs were euthanatized because of their systemic disease 1.5 to 7 months after ISP implantation. The third dog is alive without evidence of regrowth 3 years after surgery.

CLINICAL IMPLICATION

Intraocular neoplasia is not an absolute contraindication to ISP implantation.

Cellular immunity in dogs with keratoconjunctivitis sicca before and after treatment with topical 2% cyclosporine

Peripheral cellular immunity of ten dogs with keratoconjunctivitis sicca (KCS) that had not been treated with topical corticosteroids or cyclosporine was evaluated (by use of in vitro lymphocyte proliferation assays and CD4+/CD8+ lymphocyte subset analysis) before and after 1 and 3 months of treatment with topical ocular 2% cyclosporine (CsA). In vitro lymphocyte proliferation and CD4+/CD8+ lymphocyte subset analysis was done in eight normal dogs at the 0, 1 and 3 month time periods to use for comparison. There was no significant difference in lymphocyte proliferation or numbers of CD4+ or CD8+ lymphocytes in dogs with KCS and normal dogs prior to CsA treatment. However, by 1 month's time, lymphocyte proliferation had decreased in the CsA-treated Dogs with KCS, and by 3 months there was a significant difference (P < 0.0001) from the normal dogs. These results suggest that dogs with KCS may not have altered peripheral cellular immunity and that use of topical 2% cyclosporine for treatment of KCS causes a suppression of lymphocyte proliferation after 1 to 3 months of use.

Uveal malignant melanoma in a duck

An adult male Muscovy (Cairina moschata) X Peking (Anas platyrhynchos) duck had a primary malignant uveal melanoma with periocular extension involving the left eye. The periocular mass displaced the globe 1.5 cm laterally. Thoracic metastasis of the ocular neoplasm infiltrated the pectoral muscles, rib cage, and cranial lung lobe on the left side, causing diminished voluntary motion of the left wing. The left orbit was exenterated, but tumor regrowth was evident within 2 weeks. This case was unusual because melanocytic neoplasms are rare in birds.

Traumatic ocular proptoses in dogs and cats: 84 cases (1980-1993)

Eighteen eyes of 66 dogs were visual on reevaluation of traumatic proptosis. Twenty-one eyes were enucleated, and 4 dogs were euthanatized. In 18 cats, no eyes regained vision after traumatic proptosis: 12 cats had the affected eye enucleated, 2 had an eye that was considered blind, and 4 cats were euthanatized. Affected eyes of 45 dogs and 2 cats underwent surgical replacement and temporary tarsorrhaphy. Favorable prognostic indicators for eyes undergoing surgical replacement included proptosis in a brachycephalic dog, positive direct or consensual pupillary light response, normal findings on posterior segment examination, and a proptosed eye that had vision on initial examination. Unfavorable prognostic indicators included proptosis in a nonbrachycephalic dog, proptosis in cats, hyphema, no visible pupil, facial fractures, optic nerve damage, and avulsion of 3 or more extraocular muscles.

Effect of auriculopalpebral nerve block and intravenous administration of xylazine on intraocular pressure and corneal thickness in horses

Intraocular pressure (IOP) was measured, using applanation tonometry, in both eyes of 20 horses after topical application of 0.5% proparacaine to the cornea. Ultrasonic pachymetry was used to measure central, mid-peripheral, and peripheral corneal thickness (CT) in all 4 quadrants of both eyes of 25 horses. All measurements were repeated after auriculopalpebral nerve block, sedation by IV administration of xylazine, or combination of nerve block and sedation. Mean IOP after topical anesthesia of the cornea was 20.6 +/- 4.7 mm of Hg for the left eye and 20.35 +/- 3.7 mm of Hg for the right eye. Mean central CT was 793.2 +/- 42.3 microns. The peripheral part of the cornea was significantly (P < 0.05) thicker, on average, than the central part of the cornea. Auriculopalpebral nerve block had no significant effect on IOP or CT. Intravenous administration of xylazine resulted in a significant (P < 0.05) decrease in IOP, but had no effect on CT.

Histological findings in corneal stromal abscesses of 11 horses: correlation with cultures and cytology

Histopathology was compared to culture results and cytology from horses with corneal stromal abscess at the Auburn University and the Ohio State University Veterinary Teaching Hospitals. Significant bacteria were not isolated in culture or seen on histopathology in any of the horses. Although most bacteria infecting equine corneas can be isolated with blood and MacConkey's agars, failure to detect bacterial growth may not rule out infection because anaerobic or intracellular bacteria would not be isolated. The inability to visualise bacterial organisms on histological sections did not rule out their presence in the tissue, because there is often destruction of bacteria by neutrophils, macrophages and antibiotic therapy greatly reducing their numbers. Fungal keratitis was diagnosed by histopathology in 4 of 11 eyes (36%) and keratitis with no aetiological agent in 7 of 11 eyes (64%). Nine of 11 horses (82%) had a prominent neutrophilic stromal infiltrate and 2 (18%) had a predominantly pyogranulomatous reaction. Two of the 4 lesions that showed histological evidence of fungal infection were positive for identifiable fungi on culture and cytology. Fungal cultures of the other 2 cases with histological evidence of mycotic keratitis were negative or grew unidentifiable fungi which were considered pathogenic because, on histopathological sections, fungal hyphae were found deep in the corneal stroma surrounded by an inflammatory reaction. In 3 of 6 cases where fungi were recovered on culture, they were considered contaminants based on lack of evidence of organisms in histopathological sections. Histopathology and the use of special stains were important in the interpretation of culture and cytology results.

Concomitant brainstem axonal dystrophy and necrotizing myopathy in vitamin E-deficient rats

The purpose of this study was to simultaneously evaluate in rats the effects of vitamin E depletion on tissue alpha-tocopherol (alpha-T) concentrations, electrophysiologic measurements and histopathology. Rats (21-day-old male Wistar) were fed either vitamin E-deficient or supplemented (control) diets (n = 6/group) for 10, 16, and 61 weeks. At these times, electrophysiologic tests (electromyography, spinal and somatosensory evoked potentials, and motor nerve conduction velocity) were performed, the rats were killed and alpha-T concentrations of adipose tissue, sciatic nerve, and cervical and lumbar spinal cord were measured along with histopathologic evaluation of skeletal muscles and the nervous system. By 61 weeks, depletion of alpha-T from adipose tissue and peripheral nerve was more severe (< 1% of controls) than from cervical and lumbar spinal cord (15 and 8% of controls, respectively). Electrophysiologic tests were normal at all times. Histopathologic evaluation at 61 weeks revealed normal peripheral nerve structure, but necrosis of type 1 muscle fibers and increased numbers of spheroids in the gracile and cuneate nuclei. Our results confirm that low alpha-T concentrations in tissues precede histologic changes in peripheral nerves and skeletal muscle. Furthermore, pathologic changes associated with vitamin E deficiency occur independently in muscle and nervous tissue of rats.

Modified lateral orbitotomy for removal of orbital neoplasms in two dogs

A simplified lateral orbitotomy is described that decreases surgical time and lessens tissue dissection, yet maintains the exposure to the orbit provided by other orbitotomy techniques. The approach involves cutting the orbital ligament, incising the temporalis aponeurosis from the dorsal zygomatic arch, making parallel zygomatic arch osteotomies, and reflecting the zygomatic arch ventrally. Closure of the wound involves wiring the zygomatic arch back into place. This orbitotomy procedure provides excellent exposure for removal or biopsy of orbital masses. The use of this technique for surgical excision of orbital masses in two dogs, one with an adenoma of the third eyelid gland and one with an orbital fibrosarcoma, and their subsequent management is described.

Scanning electron microscopy of intraocular lenses that had been implanted in dogs

Scanning electron microscopy was used to evaluate changes on the surfaces of polymethylmethacrylate (PMMA), silicone, and polyhydroxyethylmethacrylate (HEMA) intraocular lenses (IOL) that had been implanted in the anterior chambers of the right eyes of 15 dogs. Five dogs received PMMA IOL; 5 dogs received silicone IOL; and 5 dogs received HEMA IOL. Twenty-eight days after surgery, the IOL were removed and processed for scanning electron microscopy. Nonimplanted IOL of each type were processed identically for comparison. Implanted PMMA IOL had significantly more debris and macrophages on their surfaces than did silicone IOL or HEMA IOL. Silicone IOL had significantly less fibrin deposition than did PMMA or HEMA IOL. Silicone IOL had surface defects attributable to handling by surgical instruments. Implanted HEMA IOL had multiple pits that appeared to be caused by biodegradation.

Clinicopathologic findings after experimental implantation of synthetic intraocular lenses in dogs

Clinical findings indicate that canine eyes tolerate implantation of polymethylmethacrylate (PMMA) intraocular lenses (IOL) well, although inflammation and ocular damage attributable to the implants is not known. The use of silicone or polyhydroxyethylmethacrylate (HEMA) IOL has not been reported in dogs. In this study, 15 conditioned, mixed-breed dogs were allotted to 3 groups: 5 received PMMA IOL; 5 received silicone IOL; and 5 received HEMA IOL. The IOL optic was inserted into the anterior chamber of the right eye and anchored to the cornea. An identical surgical procedure was done on the left eye, except that no lens optic was inserted. Clinical examination and measurement of corneal thickness were done immediately prior to and after surgery. Aqueous humor samples were collected at the time of surgery and 28 days after surgery. Only mild and transient inflammation was observed in IOL-implanted eyes. On several postoperative days, it was found that PMMA IOL induced significantly greater corneal thickness, aqueous flare, anterior uveal irritation, and corneal edema than did other IOL. Significantly more anterior uveal irritation and increased aqueous humor protein concentration was observed with HEMA IOL than with PMMA or silicone IOL. Silicone IOL induced significantly less fibrin deposition than did PMMA or HEMA IOL.

Corneal thickness measured by ultrasonic pachymetry in cats

Ultrasonic pachymetry was used to measure central, superior peripheral, and temporal peripheral corneal thickness of 35 cats (70 eyes) with normal corneas, anterior chambers, and intraocular pressures. Mean central corneal thickness for both eyes in 3 locations for 35 cats was 578 +/- 64 microns. Significant differences did not exist between central and peripheral corneal thickness. Corneal thickness increased significantly (P < 0.0001) with age up to 100 months. There was no significant difference in corneal thickness with regard to sex of the cats when adjusted for age.

Diagnosis and treatment of lens diseases

The lens represents a unique tissue in light of its embryologic development, retention of old cells and nuclear make-up, transparent nature, immune privileged status, and metabolic restrictions. Disorders of malformation and malposition occur, but cataract development is the most common and significant problem for owners and animals. Technologic and pharmacologic advances have allowed surgical removal of equine cataracts to become an acceptable alternative, capable of returning a visually impaired horse to a functional status. Uveal inflammation represents the greatest threat to successful surgical cataract removal. Veterinarians should consult with those versed in ophthalmology for assistance in diagnosis, prognosis, peroperative treatment, surgical intervention, and follow-up on lens disorders.

Orbital neoplasms in cats: 21 cases (1974-1990)

Squamous cell carcinoma was the most common neoplasm found in a review of case records of 21 cats with histopathologically confirmed orbital neoplasms. Other neoplasms found were lymphosarcoma, undifferentiated carcinoma, malignant melanoma, adenocarcinoma, fibrosarcoma, chondroma, and hemangiosarcoma. Three (14%) neoplasms were primary, 15 (71%) were secondary, invading the orbit from adjacent tissues, and 3 (14%) were a manifestation of multicentric disease. The most common clinical sign was exophthalmia, followed by chronic epiphora, enophthalmia, and strabismus. Mean survival time after diagnosis was 1.9 months. Ten cats were euthanatized at the time of diagnosis because of extensive disease. Mean survival time of the other 11 cats was 4.3 months. Skull radiography was helpful in diagnosing orbital neoplasms in 8 of 11 cats that had invasion of the orbit by adjacent neoplasms.

Canine corneal thickness measured by ultrasonic pachymetry

Ultrasonic pachymetry was used to measure central, superior peripheral, and temporal peripheral corneal thicknesses of 75 dogs (150 eyes) with normal corneas, anterior chambers, and intraocular pressure. Mean corneal thickness averaged over the 2 eyes, 3 locations, and 75 dogs was 562 +/- 6.2 microns. The peripheral cornea was thicker on average than the central cornea by 49.43 +/- 8.45 microns and this difference increased with age at 6.97 +/- 1.3 microns/month of age. Mean corneal thickness changed with age (14.23 +/- 2.26 microns/month), and weight (1.83 +/- 0.38 microns/kg). Females had significantly thinner corneas (22.43 +/- 11.03 microns than males) after adjusting for age and weight.