Corneal cross-linking in 9 horses with ulcerative keratitis.
Abstract: Corneal ulcers are one of the most common eye problems in the horse and can cause varying degrees of visual impairment. Secondary infection and protease activity causing melting of the corneal stroma are always concerns in patients with corneal ulcers. Corneal collagen cross-linking (CXL), induced by illumination of the corneal stroma with ultraviolet light (UVA) after instillation of riboflavin (vitamin B2) eye drops, introduces crosslinks which stabilize melting corneas, and has been used to successfully treat infectious ulcerative keratitis in human patients. Therefore we decided to study if CXL can be performed in sedated, standing horses with ulcerative keratitis with or without stromal melting. Results: Nine horses, aged 1 month to 16 years (median 5 years) were treated with a combination of CXL and medical therapy. Two horses were diagnosed with mycotic, 5 with bacterial and 2 with aseptic ulcerative keratitis. A modified Dresden-protocol for CXL could readily be performed in all 9 horses after sedation. Stromal melting, diagnosed in 4 horses, stopped within 24 h. Eight of nine eyes became fluorescein negative in 13.5 days (median time; range 4-26 days) days after CXL. One horse developed a bacterial conjunctivitis the day after CXL, which was successfully treated with topical antibiotics. One horse with fungal ulcerative keratitis and severe uveitis was enucleated 4 days after treatment due to panophthalmitis. Conclusions: CXL can be performed in standing, sedated horses. We did not observe any deleterious effects attributed to riboflavin or UVA irradiation per se during the follow-up, neither in horses with infectious nor aseptic ulcerative keratitis. These data support that CXL can be performed in the standing horse, but further studies are required to compare CXL to conventional medical treatment in equine keratitis and to optimize the CXL protocol in this species.
Publication Date: 2013-06-26 PubMed ID: 23803176PubMed Central: PMC3703264DOI: 10.1186/1746-6148-9-128Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
- Journal Article
- Research Support
- Non-U.S. Gov't
Summary
This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.
The research was conducted on 9 horses with ulcerative keratitis, and the goal was to assess the effectiveness of a Corneal Collagen Cross-linking (CXL) treatment. The study found that this treatment was successful and safe for the majority of the horses.
Research Background
- This research was prompted by the need to find effective treatments for corneal ulcers, a common equine eye ailment. These ulcers can potentially cause visual impairment depending upon their severity.
- Secondary infections and protease activity, the latter of which can lead to melting of corneal stroma, are of major concern with corneal ulcers.
- The study utilized a method known as Corneal Collagen Cross-linking (CXL), which has been proven successful in treating human patients suffering from infectious ulcerative keratitis.
- The process involves using ultraviolet light to illuminate the corneal stroma after administering riboflavin (Vitamin B2) drops to the eye. These actions help in creating crosslinks that stabilize the melting corneas.
Research Process & Results
- The entire study was conducted on 9 horses that varied in age from 1 month to 16 years. These were treated using a combination of CXL and medical therapy.
- The horses were diagnosed with different forms of keratitis: mycotic (in two horses), bacterial (in five horses), and aseptic (in two horses).
- A modified version of the Dresden protocol for CXL was used on all subjects following sedation. Stromal melting, diagnosed in four horses, stopped within 24 hours.
- Outcomes were positive for the majority of the subjects, 8 out of the 9 horses, as they all became fluorescein negative in an average of 13.5 days post-treatment.
- One horse developed bacterial conjunctivitis the day after undergoing CXL treatment but was successfully cured with topical antibiotics. Another horse was enucleated four days after the treatment due to the development of panophthalmitis brought about by severe uveitis and fungal ulcerative keratitis.
Conclusions of the Research
- Based on the outcomes, it was concluded that the CXL treatment is safe and effective to be performed on sedated, standing horses.
- No harmful effects attributed to the riboflavin or UVA irradiation were recorded during the follow-up, suggesting safety for the horses with both infectious and aseptic keratitis.
- Despite these promising results, the authors recommend further studies to compare the effectiveness of CXL vs conventional medical treatments for equine keratitis. They also suggest conducting additional studies to optimize the CXL treatment protocol specifically for horses.
Cite This Article
APA
Hellander-Edman A, Makdoumi K, Mortensen J, Ekesten B.
(2013).
Corneal cross-linking in 9 horses with ulcerative keratitis.
BMC Vet Res, 9, 128.
https://doi.org/10.1186/1746-6148-9-128 Publication
Researcher Affiliations
- Department of Animal Environment & Health, Swedish University of Agricultural Sciences, PO Box 234, SE-532 24 Skara, Sweden. anna.hellander.edman@slu.se
MeSH Terms
- Animals
- Anti-Bacterial Agents / therapeutic use
- Cornea / pathology
- Corneal Ulcer / microbiology
- Corneal Ulcer / pathology
- Corneal Ulcer / radiotherapy
- Corneal Ulcer / veterinary
- Cross-Linking Reagents / therapeutic use
- Eye Infections, Bacterial / drug therapy
- Eye Infections, Bacterial / veterinary
- Female
- Horse Diseases / pathology
- Horse Diseases / radiotherapy
- Horses
- Male
- Riboflavin / therapeutic use
- Ultraviolet Therapy / methods
- Ultraviolet Therapy / veterinary
References
This article includes 49 references
Citations
This article has been cited 17 times.- 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.
- Usseglio N, Andrés JL, Marchal JA, Moroni L, Nieto D. Photochemical corneal cross-linking: Evaluating the potential of a hand-held biopen. Mater Today Bio 2025 Apr;31:101512.
- Marchegiani A, Gialletti R, Cassarani MP, Cerquetella M, Attili AR, Lombardo G, Lombardo M, Spaterna A, Arcelli R. Riboflavin/UV-A corneal phototherapy as stand-alone management of ulcerative keratitis in dogs. Vet Med (Praha) 2022 Apr;67(4):190-198.
- Shukla AK, Kowalska ME, Arteaga K, Crasta M, Dixon C, Famose F, Hartnack S, Pot SA. Evaluation of photoactivated chromophore for keratitis-corneal cross-linking (PACK-CXL) in feline infectious keratitis-patient demographics, treatment protocols, risk factors, and treatment outcome: a retrospective study. Vet Ophthalmol 2025 Mar;28(2):330-340.
- Neri S, Mascolini MV, Peruffo A, Todros S, Zuin M, Cordaro L, Martines E, Contiero B, Carniel EL, Iacopetti I, Patruno M, Fontanella CG, Perazzi A. How does atmospheric pressure cold helium plasma affect the biomechanical behaviour on alkali-lesioned corneas?. BMC Vet Res 2024 Apr 24;20(1):153.
- Kowalska ME, Shukla AK, Arteaga K, Crasta M, Dixon C, Famose F, Hartnack S, Pot SA. Evaluation of risk factors for treatment failure in canine patients undergoing photoactivated chromophore for keratitis - corneal cross-linking (PACK-CXL): a retrospective study using additive bayesian network analysis. BMC Vet Res 2023 Nov 2;19(1):227.
- 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.
- Suter A, Schmitt S, Hübschke E, Kowalska M, Hartnack S, Pot S. The bactericidal effect of two photoactivated chromophore for keratitis-corneal crosslinking protocols (standard vs. accelerated) on bacterial isolates associated with infectious keratitis in companion animals. BMC Vet Res 2022 Aug 17;18(1):317.
- Fontanella CG, Carniel EL, Corain L, Peruffo A, Iacopetti I, Pavan PG, Todros S, Perazzi A. Mechanical behaviour of healthy versus alkali-lesioned corneas by a porcine organ culture model. BMC Vet Res 2021 Oct 28;17(1):340.
- Mezzadri V, Crotti A, Nardi S, Barsotti G. Surgical treatment of canine and feline descemetoceles, deep and perforated corneal ulcers with autologous buccal mucous membrane grafts. Vet Ophthalmol 2021 Nov;24(6):599-609.
- Foote BC, Smith JS, Bowden AC, Allbaugh RA, Sebbag L. Case Report: Successful Management of Refractory Keratomycosis in an Alpaca Using Penetrating Keratoplasty and Combination Antifungal Therapy (Caspofungin 0.5% and Terbinafine 1%). Front Vet Sci 2021;8:644074.
- Lores M, Rakestraw P, De Rijck M, Yarbrough T. Use of autologous fascia lata graft to repair a complex corneal ulcer in a mare. Ir Vet J 2020;73:7.
- 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).
- Casola C, Pot SA, Lavaud A, Voelter K. Corneal cross-linking as a treatment for corneal dystrophy with secondary bacterial infection in a Friesian horse. Clin Case Rep 2020 Apr;8(4):709-715.
- Tabibian D, Mazzotta C, Hafezi F. PACK-CXL: Corneal cross-linking in infectious keratitis. Eye Vis (Lond) 2016;3:11.
- Tabibian D, Richoz O, Hafezi F. PACK-CXL: Corneal Cross-linking for Treatment of Infectious Keratitis. J Ophthalmic Vis Res 2015 Jan-Mar;10(1):77-80.
- O'Brart DP. Corneal collagen cross-linking: a review. J Optom 2014 Jul-Sep;7(3):113-24.
Use Nutrition Calculator
Check if your horse's diet meets their nutrition requirements with our easy-to-use tool Check your horse's diet with our easy-to-use tool
Talk to a Nutritionist
Discuss your horse's feeding plan with our experts over a free phone consultation Discuss your horse's diet over a phone consultation
Submit Diet Evaluation
Get a customized feeding plan for your horse formulated by our equine nutritionists Get a custom feeding plan formulated by our nutritionists
