Clinical features and outcomes of horses presenting with presumed equine immune mediated keratitis to two veterinary hospitals in the United Kingdom and Finland: 94 cases (2009-2021).
Abstract: There is limited literature regarding equine immune mediated keratitis (IMMK) in Europe. North America-based publications describe minimal blepharospasm, rare corneal ulceration and no uveitis; clinical impression suggests these are seen in Europe. Objective: Assess the prevalence of blepharospasm, corneal ulceration and uveitis and their impact on outcome in horses diagnosed with IMMK in Europe (UK and Finland). Methods: Retrospective case series. Methods: Clinical records of 94 horses with IMMK were evaluated. The UK and Finland populations were comparable; therefore, descriptive statistics were performed on combined data on subtypes of IMMK and clinical features. Odds ratios (OR) and confidence intervals (CI) were calculated for impact of blepharospasm, ulceration or presence of uveitis on the outcome of enucleation and treatment duration. Results: IMMK subtype was classified as 10/94 (10.6%) epithelial, 50/94 (53.2%) anterior stromal, 14/94 (14.9%) mid-stromal, 4/94 (4.25%) endothelial and 16/94 (17.0%) unrecorded. After excluding three horses with incidental corneal ulceration, blepharospasm was documented in 34/91 (37.4%), corneal ulceration in 26/91 (28.6%), and signs of uveitis in 23/91 (25.3%) horses. Increased odds of enucleation were significantly associated with the presence of blepharospasm (OR 5.5, 95% CI 1.6-19.4, p = 0.008) and signs of uveitis (OR 8.9, 95% CI 2.6-30.8, p < 0.001), but not corneal ulceration. The presence of blepharospasm, corneal ulceration or uveitis did not significantly alter the odds of ongoing medication. Conclusions: Data were collected over a wide timeframe; the diagnosis was mainly made without histopathology; a broad definition of uveitis was used and there was a bias towards complicated cases being retained for follow-up. Conclusions: The clinical features of IMMK were similar between two European countries but differed to USA descriptions. Blepharospasm, corneal ulceration and signs of uveitis can occur with IMMK; presence of blepharospasm and uveitis increase the odds of enucleation.
© 2024 The Author(s). Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.
Publication Date: 2024-08-26 PubMed ID: 39183684DOI: 10.1111/evj.14213Google Scholar: Lookup
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Summary
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This research study analyzes the prevalence and impacts of certain clinical features – blepharospasm, corneal ulceration, and uveitis – in horses diagnosed with immune mediated keratitis (IMMK) in the UK and Finland. The results show that these conditions can occur, and blepharospasm and uveitis are significantly associated with increased chances of enucleation, or eye removal.
Research Objective and Methodology
- The main objective of this research was to understand the prevalence of blepharospasm (eyelid twitching), corneal ulceration, and uveitis (ocular inflammation) in horses diagnosed with immune mediated keratitis (IMMK) in Europe, specifically in the UK and Finland.
- The study used a retrospective case series approach where the researchers evaluated the clinical records of 94 horses with IMMK, dating from between 2009 to 2021.
- Due to similarities between the UK and Finland equine populations, their data were combined for statistical analysis.
- The effects of these clinical features on the need for enucleation (eye removal) and the duration of treatment were assessed.
Key Findings
- The types of IMMK were classified based on the horses’ clinical records, and the classifications were roughly balanced across the populations, with the largest portion of cases being anterior stromal (over half) and a small number being unrecorded.
- After excluding incidental corneal ulceration, it was found that blepharospasm was documented in over a third of the horses, corneal ulceration in just under a third, and uveitis signs were noted in a quarter of the cases.
- Important statistical correlations were found, revealing a significant association of the presence of the blepharospasm and uveitis signs, with increased risk for enucleation. However, corneal ulceration was not significantly related to enucleation likelihood.
- None of these clinical features significantly altered the odds of ongoing medication.
Conclusions
- Despite the lengthy collection timeframe, lack of histopathological diagnostics in most diagnoses, use of a broad definition of uveitis, and potential bias towards complicated cases, the results revealed similar clinical features between the two European countries. These findings were, however, different from descriptions previously reported in the USA.
- The study concluded that blepharospasm, corneal ulceration and uveitis can indeed occur in European horses with IMMK, and presence of blepharospasm and uveitis increased the odds for enucleation.
Cite This Article
APA
Preston JF, Mustikka MP, Priestnall SL, Dunkel B, Fischer MC.
(2024).
Clinical features and outcomes of horses presenting with presumed equine immune mediated keratitis to two veterinary hospitals in the United Kingdom and Finland: 94 cases (2009-2021).
Equine Vet J.
https://doi.org/10.1111/evj.14213 Publication
Researcher Affiliations
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK.
- Department of Equine and Small Animal Medicine, University of Helsinki, Helsinki, Finland.
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK.
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK.
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK.
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