Corneal cross-linking (CXL)-A clinical study to evaluate CXL as a treatment in comparison with medical treatment for ulcerative keratitis in horses.
Abstract: Compare CXL treatment with medical treatment alone in horses with stromal, ulcerative keratitis. Methods: 24 horses (24 eyes) with stromal, ulcerative keratitis were included. Methods: 12 horses were initially treated with CXL, and 12 horses were given conventional medical treatment. Topical medical treatment was added to horses in the CXL group if necessary. Parameters including cytology, microbial growth, time to fluorescein negativity, and time to inhibition of stromal melting were evaluated. Results: After the first day of treatments, a decrease in inflammatory signs and pain from the eye was observed in both groups. Stromal melting ceased within 24 hours regardless of treatment. CXL treatment alone was sufficient in 3 horses with noninfectious, superficial stromal ulcerations. Clinical signs of impaired wound healing were seen after 3-14 days in corneas with suspected or proven bacterial infection treated with CXL only, most likely because of insufficient elimination of bacteria deeper in the corneal stroma or because of re-infection from bacteria in the conjunctiva. The average decrease in stromal ulcer area per day after onset of treatment was almost identical between the groups, and no significant difference in time to fluorescein negativity was found. Conclusions: We consider CXL a possible useful adjunct treatment of corneal stromal ulcers in horses, especially for melting ulcers and as a potential alternative to prophylactic antibiotic treatment for noninfected stromal ulcers. However, CXL should not be used alone for infected or suspected infected stromal ulcers, because topical antibiotics were required in all horses with proven infectious keratitis.
© 2019 American College of Veterinary Ophthalmologists.
Publication Date: 2019-04-23 PubMed ID: 31012258DOI: 10.1111/vop.12662Google Scholar: Lookup
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- Clinical Trial
- Veterinary
- Comparative Study
- Journal Article
Summary
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This research studied the effectiveness of Corneal Cross-Linking (CXL) as a treatment method compared to conventional medical treatment for corneal ulcers in horses. The findings suggest, while CXL is potentially useful as an additional treatment option, it should not be used alone for infected corneal ulcers.
Study Methodology
- The study included 24 horses with corneal ulcers, split between two treatment groups: 12 received CXL treatment, and 12 were administered conventional medical treatment.
- Additional medical treatment was provided to the horses in the CXL group as and when required.
- Evaluation was based on various parameters including cytology, microbial growth, time to achieve fluorescein negativity, and time taken to inhibit stromal melting (corneal ulceration).
Results
- Both treatments resulted in reduced inflammation and eye pain from the first day onwards.
- Stromal melting ceased within 24 hours in all cases, irrespective of the treatment method used.
- Three horses with non-infectious superficial corneal ulcers recovered with CXL treatment alone.
- However, cases with suspected or proven bacterial infection showed signs of impaired wound healing after CXL-only treatment due to potential insufficient elimination of bacteria deeper in the corneal tissues or re-infection from surrounding conjunctiva bacteria.
- The average daily reduction in the area of the corneal ulcer and time to achieve fluorescein negativity (point indicating healing) was not significantly different in each group.
Conclusions
- CXL has potential as an adjunct treatment for stromal corneal ulcers in horses, and possibly as an alternative to prophylactic antibiotics for non-infected ulcers.
- However, CXL should not be used on its own in cases of corneal ulcers suspected or proven to be infectious as it appears all such cases required topical antibiotics for treatment success.
Cite This Article
APA
Hellander Edman A, Ström L, Ekesten B.
(2019).
Corneal cross-linking (CXL)-A clinical study to evaluate CXL as a treatment in comparison with medical treatment for ulcerative keratitis in horses.
Vet Ophthalmol, 22(4), 552-562.
https://doi.org/10.1111/vop.12662 Publication
Researcher Affiliations
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden.
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden.
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden.
MeSH Terms
- Animals
- Female
- Male
- Combined Modality Therapy / veterinary
- Corneal Ulcer / drug therapy
- Corneal Ulcer / radiotherapy
- Corneal Ulcer / veterinary
- Cross-Linking Reagents / therapeutic use
- Horse Diseases / drug therapy
- Horse Diseases / radiotherapy
- Horse Diseases / therapy
- Horses
- Photosensitizing Agents / therapeutic use
- Riboflavin / therapeutic use
- Ultraviolet Therapy / veterinary
- Wound Healing
Grant Funding
- H1147043 / Swedish-Norwegian Foundation for Equine Research
Citations
This article has been cited 4 times.- Stolle LM, Oltmanns H, Meißner J, Heun F, Schieder AK, Wolff HT, Ohnesorge B, Busse C. Polyhexanide, Povidone-Iodine, and Hypochlorous Acid Show High In Vitro Antimicrobial Efficacy Against Pathogens Commonly Associated With Equine Infectious Keratitis. Vet Ophthalmol 2026 Jan;29(1):e70141.
- Marchegiani A, Bazzano M, Cassarani MP, Arcelli R, Orzalesi C, Lombardo G, Lombardo M, Spaterna A, Gialletti R. Efficacy of riboflavin/UV-A corneal phototherapy as stand-alone treatment for ulcerative keratitis in horses. Vet Med (Praha) 2021 Aug;66(8):321-329.
- Lazareva Y, Rayisyan M, Mironova E. Features of the clinical picture of keratitis in horses with different forms of the course of the disease. Open Vet J 2022 Nov-Dec;12(6):830-838.
- Perazzi A, Gomiero C, Corain L, Iacopetti I, Grisan E, Lombardo M, Lombardo G, Salvalaio G, Contin R, Patruno M, Martinello T, Peruffo A. An Assay System to Evaluate Riboflavin/UV-A Corneal Phototherapy Efficacy in a Porcine Corneal Organ Culture Model. Animals (Basel) 2020 Apr 23;10(4).
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