Low-dose intravitreal injection of 4 mg preservative-free gentamicin and superficial lamellar keratectomy combined with modified Gundersen grafts to control chronic heterochromic iridocyclitis and secondary keratitis in horses.
Abstract: To describe a combined treatment approach for heterochromic iridocyclitis and secondary keratitis (HIK) in horses. Methods: A total of 15 horses (16 eyes). Methods: Sixteen eyes from 15 horses (mean age 14.1 years, range 6-26 years) received low-dose (4 mg) intravitreal preservative-free gentamicin injection (IVGI) and modified Gundersen grafts with standing sedation and local anesthesia following a clinical diagnosis of HIK. Additional therapies of suprachoroidal triamcinolone (8 mg) injection, episcleral bromfenac implants, and suprachoroidal cyclosporine implants were performed in individual cases. Leptospira titers were also reported when available. Results: The most frequent ophthalmic findings were pigmented keratic precipitates (n = 15/16 eyes, 94%), corneal edema (n = 14/16 eyes, 88%), and pigmented cells suspended in the anterior chamber (n = 7/16 eyes, 44%). Postoperative treatment generally consisted of topical and systemic NSAIDs, topical antibiotics, and a topical mydriatic agent. Complications included persistent corneal edema (7/16, 44%), corneal ulceration (6/16, 38%), graft failure requiring revision (2/16, 13%), stromal abscess (1/16, 6%), surgery site infection (1/16, 6%), and suspected retinal degeneration following IVGI (1/16, 6%). One case was enucleated 6 months after treatment (1/16, 6%). Of the 12 eyes with at least 3 months of post-treatment follow-up, 10 were comfortable and visual with static or improved symptoms of HIK. Conclusions: This multimodal treatment approach aims to address both the anterior uveitis and endothelial decompensation frequently seen in horses with HIK. The surgery can be performed under standing sedation. Continued evaluation and long-term follow-up is necessary in all horses with HIK.
© 2024 American College of Veterinary Ophthalmologists.
Publication Date: 2024-08-06 PubMed ID: 39108032DOI: 10.1111/vop.13264Google 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
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.
This research paper explores a combined treatment method for heterochromic iridocyclitis and secondary keratitis (HIK) in horses. This method uses a low-dose intravitreal preservative-free gentamicin injection and modified Gundersen grafts as treatments.
Methodology
- 16 eyes from 15 horses of varying age groups were the subjects of this study.
- After a clinical diagnosis of HIK, the horses received a low-dose (4 mg) intravitreal preservative-free gentamicin injection and modified Gundersen grafts. This procedure was done using standing sedation and local anesthesia.
- Supplemental treatments such as suprachoroidal triamcinolone injection, episcleral bromfenac implants, and suprachoroidal cyclosporine implants were also used in individual cases. Additionally, when available, Leptospira titers were also reported.
Results
- Out of the 16 eyes, the most common findings were pigmented keratic precipitates, corneal edema, and pigmented cells suspended in the anterior chamber.
- Postoperative treatment mostly included topical and systemic NSAIDs, topical antibiotics, and a topical mydriatic agent.
- Some complications were faced, such as persistent corneal edema, corneal ulceration, graft failure requiring revision, stromal abscess, surgery site infection, and suspected retinal degeneration following the gentamicin injection.
- One case had to be removed (enucleated) six months after treatment.
- However, of the 12 eyes with at least three months post-treatment follow-up, 10 were comfortable and still had sight, with static or improved symptoms of HIK.
Conclusion
- The combined treatment approach aims to simultaneously address both the anterior uveitis and the endothelial decompensation often seen in horses with HIK.
- These procedures can be performed under standing sedation, making the process easier.
- However, the study emphasizes that continued evaluation and long-term follow-up are necessary for all treated horses with HIK.
Cite This Article
APA
Charnock LN, McMullen RJ.
(2024).
Low-dose intravitreal injection of 4 mg preservative-free gentamicin and superficial lamellar keratectomy combined with modified Gundersen grafts to control chronic heterochromic iridocyclitis and secondary keratitis in horses.
Vet Ophthalmol, 28(2), 386-402.
https://doi.org/10.1111/vop.13264 Publication
Researcher Affiliations
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama, USA.
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, USA.
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama, USA.
- Equine Clinic Munich Riem, Munich, Germany.
MeSH Terms
- Animals
- Horses
- Horse Diseases / surgery
- Horse Diseases / therapy
- Horse Diseases / drug therapy
- Keratitis / veterinary
- Keratitis / therapy
- Keratitis / surgery
- Keratitis / drug therapy
- Anti-Bacterial Agents / administration & dosage
- Anti-Bacterial Agents / therapeutic use
- Male
- Female
- Gentamicins / administration & dosage
- Gentamicins / therapeutic use
- Iridocyclitis / veterinary
- Iridocyclitis / surgery
- Iridocyclitis / therapy
- Iridocyclitis / drug therapy
- Corneal Transplantation / veterinary
- Corneal Transplantation / methods
- Intravitreal Injections / veterinary
- Keratectomy / veterinary
- Keratectomy / methods
References
This article includes 25 references
- Pinto NI, McMullen RJ Jr, Linder KE, Cullen JM, Gilger BC. Clinical, histopathological and immunohistochemical characterization of a novel equine ocular disorder: heterochromic iridocyclitis with secondary keratitis in adult horses.. Vet Ophthalmol 2015;18:443‐456.
- Sun Y, Ji Y. A literature review on Fuchs uveitis syndrome: an update.. Surv Ophthalmol 2020;65(2):133‐143.
- Goldberg MF, Erozan YS, Duke JR, Frost JK. Cytopathologic and histopathologic aspects of Fuch's Heterochromic Iridocyclitis.. Arch Ophthalmol 1965;74(5):604‐609.
- Datoo O'Keefe GA, Rao NA. Vogt‐Koyanagi‐Harada disease.. Surv Ophthalmol 2017;62(1):1‐25.
- Rao NA. Pathology of Vogt–Koyanagi–Harada disease.. Int Ophthalmol 2007;27:81‐85.
- Fischer BM, McMullen RJ Jr, 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(1):29.
- Pinard CL, Piètrement E, Macieira S, Tremblay D. Abstracts: 36th Annual Meeting of the American College of Veterinary Ophthalmologists, Nashville, TN, USA, October 12–15, 2005.. Vet Ophthalmol 2005;8:437‐450.
- Launois T, González Hilarión LM, Barbe F. Use of intravitreal injection of gentamicin in 71 horses with equine recurrent uveitis.. J Equine Vet 2019;77:93‐97.
- Kleinpeter A, Göpfert A, Köhler E, Brehm W. Intravitreale Low‐Dose‐Gentamicininjektion zur Behandlung ERU‐erkrankter Pferde. Intravitreal injection of low‐dose gentamicin for the treatment of ERU‐affected horses.. Tierarztl Prax Ausg G Grosstiere Nutztiere 2019;47(1):25‐34.
- Morén S, Kallberg M, Strom L. Equine uveitis: outcome and adverse effects after one or two intravitreal low‐dose gentamicin injections.. Equine Vet J 2024;14056.
- Smith HL, Berglund AK, Robertson JB. Effect of gentamicin on CD3+ T‐lymphocyte proliferation for treatment of equine recurrent uveitis: an in vitro study.. Vet Ophthalmol 2023;26(4):347‐354.
- Horikawa T, Thomasy SM, Stanley AA. Superficial keratectomy and conjunctival advancement hood flap (SKCAHF) for the management of bullous keratopathy: validation in dogs with spontaneous disease.. Cornea 2016;35(10):1295‐1304.
- Giannikaki S, Escanilla N, Sturgess K, Lowe RC. A modified technique of keratoleptynsis (“letter‐box”) for treatment of canine corneal edema associated with endothelial dysfunction.. Vet Ophthalmol 2020;23(6):930‐942.
- Scherrer NM, Lassaline M, Miller WW. Corneal edema in four horses treated with a superficial keratectomy and Gundersen inlay flap.. Vet Ophthalmol 2017;20:65‐72.
- McMullen RJ, Fischer BM. Medical and surgical management of equine recurrent uveitis.. Vet Clin North Am Equine Pract 2017;33(3):465‐481.
- Gagnon NA, Hartley C, Gilger BC. Efficacy and safety of suprachoroidal triamcinolone injection in horses with poorly responsive equine recurrent uveitis.. Vet Ophthalmol 2021;24:308‐312.
- Chen M, Li X, Liu J, Han Y, Cheng L. Safety and pharmacodynamics of suprachoroidal injection of triamcinolone acetonide as a controlled ocular drug release model.. J Control Release 2015;203:109‐117.
- Gilger BC, Wilkie DA, Clode AB. Long‐term outcome after implantation of a suprachoroidal cyclosporine drug delivery device in horses with recurrent uveitis.. Vet Ophthalmol 2010;13(5):294‐300.
- Michau TM, Gilger BC, Maggio F, Davidson MG. Use of thermokeratoplasty for treatment of ulcerative keratitis and bullous keratopathy secondary to corneal endothelial disease in dogs: 13 cases (1994‐2001).. J Am Vet Med Assoc 2003;222(5):607‐612.
- Bentley E, Murphy CJ. Thermal cautery of the cornea for treatment of spontaneous chronic corneal epithelial defects in dogs and horses.. J Am Vet Med Assoc 2004;224(2):250‐253.
- Gilger BC. Diseases of the uvea, uveitis, and recurrent uveitis.. .
- Malalana F, Blundell RJ, Pinchbeck GL, Mcgowan CM. The role of Leptospira spp. in horses affected with recurrent uveitis in the UK.. Equine Vet J 2017;49(6):706‐709.
- Gilger BC, Salmon JH, Yi NY. Role of bacteria in the pathogenesis of recurrent uveitis in horses from the southeastern United States.. Am J Vet Res 2008;69(10):1329‐1335.
- Sauvage AC, Monclin SJ, Elansary M, Hansen P, Grauwels MF. Detection of intraocular Leptospira spp. by real‐time polymerase chain reaction in horses with recurrent uveitis in Belgium.. Equine Vet J 2019;51(3):299‐303.
- Voelter K, Vial Z, Pot SA, Spiess BM. Leptospiral antibody prevalence and surgical treatment outcome in horses with equine recurrent uveitis (ERU) in Switzerland.. Vet Ophthalmol 2020;23(4):648‐658.
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
