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Septic Endophthalmitis Following Suprachoroidal Cyclosporine Implant Placement in Two Horses With Equine Recurrent Uveitis.
Abstract: This article presents the clinical and histopathological findings from two horses that developed severe postoperative complications following suprachoroidal procedures routinely employed in the management of equine recurrent uveitis (ERU). Case 1 was a 5-year-old warmblood stallion that initially received a unilateral suprachoroidal triamcinolone injection, followed later by bilateral suprachoroidal cyclosporine implant (CSI) placement. At 9 weeks postoperatively, the right eye (which had undergone both procedures) developed secondary glaucoma necessitating enucleation. Case 2 was a 14-year-old Appaloosa mare that presented 9 days postoperatively with suspected bilateral CSI rejection. Due to poor visual prognosis, the horse was euthanized. Histopathologic examination of all three affected globes demonstrated findings consistent with severe, suppurative endophthalmitis of bacterial etiology.
Copyright © 2026 Milena Sanchez-Garcia et al. Case Reports in Veterinary Medicine published by John Wiley & Sons Ltd.
Publication Date: 2026-03-27 PubMed ID: 42454166PubMed Central: PMC13367127DOI: 10.1155/crve/7378792Google 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
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Severe postoperative eye infections occurred in two horses after placing suprachoroidal cyclosporine implants used to treat equine recurrent uveitis. These infections led to serious complications including secondary glaucoma and necessitated eye removal or euthanasia.
Background
- Equine recurrent uveitis (ERU) is a common inflammatory eye disease in horses causing repeated episodes of uveitis and potential vision loss.
- Suprachoroidal procedures, including injections or implant placements of steroids or immunosuppressants like cyclosporine, are used to manage inflammation in ERU.
- These interventions aim to deliver medication directly to the eye’s posterior segment, reducing inflammation and preserving vision.
Objective and Cases
- The study focused on two clinical cases involving horses that underwent suprachoroidal procedure treatments for ERU.
- Case 1: A 5-year-old warmblood stallion initially received a unilateral suprachoroidal triamcinolone injection, then later bilateral suprachoroidal cyclosporine implant (CSI) placements.
- Case 1 Outcome: Nine weeks after surgery, the stallion developed secondary glaucoma in the right eye (which had both procedures), leading to surgical removal (enucleation) of that eye.
- Case 2: A 14-year-old Appaloosa mare presented with suspected bilateral rejection of CSIs nine days postoperatively.
- Case 2 Outcome: Because of a poor visual prognosis and severe clinical signs, the mare was euthanized.
Clinical Findings
- Both horses developed severe postoperative complications, raising concerns about safety and risks associated with suprachoroidal implant placement.
- The complications included signs pointing toward infection and inflammation severe enough to cause eye damage or loss of vision.
- Secondary glaucoma developed in case 1, which is increased intraocular pressure damaging the optic nerve.
- In case 2, rejection of the implant suggested an immune or infectious reaction leading to rapid decline in eye condition.
Histopathological Findings
- Microscopic examination of the affected eyes (globes) revealed severe suppurative endophthalmitis.
- Endophthalmitis is an inflammatory condition inside the eye, often caused by bacterial infection.
- “Suppurative” indicates a pus-forming, acute inflammation consistent with bacterial infection.
- The findings confirmed bacterial etiology, highlighting infection as the primary cause of the postoperative complications.
Implications and Conclusions
- The study raises important safety concerns regarding the use of suprachoroidal cyclosporine implants in horses with ERU.
- Although the implants aim to reduce inflammation, they can potentially introduce or exacerbate intraocular infections.
- Clinicians should monitor closely for signs of infection or implant rejection after such procedures.
- Prompt recognition and treatment of endophthalmitis are critical to prevent permanent vision loss or necessitating eye removal.
- Future research may be needed to better understand infection risk factors and improve procedural safety in treating equine recurrent uveitis.
Cite This Article
APA
Sanchez-Garcia M, Chalder R, Blacklock B, Hartley C, Scurrell E, Neto R, Sutton D, McMullen RJ.
(2026).
Septic Endophthalmitis Following Suprachoroidal Cyclosporine Implant Placement in Two Horses With Equine Recurrent Uveitis.
Case Rep Vet Med, 2026, 7378792.
https://doi.org/10.1155/crve/7378792 Publication
Researcher Affiliations
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama, USA, auburn.edu.
- The Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Midlothian, UK, ed.ac.uk.
- The Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Midlothian, UK, ed.ac.uk.
- The Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Midlothian, UK, ed.ac.uk.
- Cytopath Ltd., Ledbury, Herefordshire, UK.
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, Alabama, USA, auburn.edu.
- Weipers Centre Equine Hospital, University of Glasgow, Glasgow, UK, gla.ac.uk.
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama, USA, auburn.edu.
Conflict of Interest Statement
The authors declare no conflicts of interest.
References
This article includes 25 references
- Fischer BM, Brehm W, Reese S, McMullen RJ. Equine Recurrent Uveitis—A Review. Equine Veterinary Education (2023) 35, no. 5, 254–264.
- Gilger BC. Equine Recurrent Uveitis: The Viewpoint From the USA. Equine Veterinary Journal (2010) 42, no. S37, 57–61.
- Spiess BM. Equine Recurrent Uveitis: The European Viewpoint. Equine Veterinary Journal (2010) 42, no. S37, 50–56.
- Werry H, Gerhards H. The Surgical Therapy of Equine Recurrent uveitis. Tierarztliche Praxis (1992) 20, no. 2, 178–186.
- Gilger BC, Salmon JH, Wilkie DA, Cruysberg LPJ, Kim J, Hayat M, Kim H, Kim S, Yuan P, Lee SS, Harrington SM, Murray PR, Edelhauser HF, Csaky KG, Robinson MR. A novel Bioerodible Deep Scleral Lamellar Cyclosporine Implant for Uveitis. Investigative Ophthalmology & Visual Science (2006) 47, no. 6, 2596–2605.
- Fischer BM, McMullen RJ, Reese S, Brehm W. Intravitreal Injection of Low-Dose Gentamicin for the Treatment of Recurrent or Persistent Uveitis in Horses: Preliminary Results. BMC Veterinary Research (2019) 15, no. 1.
- Launois T, González Hilarión LM, Barbe F, Leurquin C, Bihin B, Hontoir F, Dugdale A, Vandeweerd JM. Use of Intravitreal Injection of Gentamicin in 71 Horses With Equine Recurrent Uveitis. Journal of Equine Veterinary Science (2019) 77, 93–97.
- Kleinpeter A, Göpfert A, Köhler E, Brehm W. Intravitreal Injection of Low-Dose Gentamicin for the Treatment of ERU-Affected Horses. Tierarztliche Praxis (2019) 47, no. 1, 25–34.
- Gagnon NA, Hartley C, Gilger BC. Efficacy and Safety of Suprachoroidal Triamcinolone Injection in Horses With Poorly Responsive Equine Recurrent Uveitis. Veterinary ophthalmology (2021) 24, no. 3, 308–312.
- Emami-Naeini P, Yiu G. Medical and Surgical Applications for the Suprachoroidal Space. International Ophthalmology Clinics (2019) 59, no. 1, 195–207.
- Gilger BC, Malok E, Cutter KV, Stewart T, Horohov DW, Allen JB. Characterization of T-lymphocytes in the Anterior Uvea of Eyes With Chronic Equine Recurrent Uveitis. Veterinary Immunology and Immunopathology (1999) 71, no. 1, 17–28.
- Gilger BC, Wilkie DA, Clode AB, McMullen RJ, Utter ME, Komaromy AM, Brooks DE, Salmon JH. Long-Term Outcome After Implantation of a Suprachoroidal Cyclosporine Drug Delivery Device In Horses With Recurrent Uveitis. Veterinary Ophthalmology (2010) 13, no. 5, 294–300.
- Hermans H, Ensink JM. Complication After Implantation of a Suprachoroidal Cyclosporine Device in a Horse a Wandering Implant. Pferdeheilkunde Equine Medicine (2013) 29, no. 6, 712–715.
- Dong X, Shi W, Yuan G, Xie L, Wang S, Lin P. Intravitreal Implantation of the Biodegradable Cyclosporin A Drug Delivery System for Experimental Chronic Uveitis. Graefe′s Archive for Clinical and Experimental Ophthalmology (2006) 244, no. 4, 492–497.
- Pehlivan SB, Yavuz B, Çalamak S, Ulubayram K, Kaffashi A, Vural I, Çakmak HB, Durgun ME, Denkbaş EB, Ünlü N. Preparation and In Vitro/In Vivo Evaluation of Cyclosporin A-Loaded Nanodecorated Ocular Implants for Subconjunctival Application. Journal of Pharmaceutical Sciences (2015) 104, no. 5, 1709–1720.
- Gilger BC, Malok E, Stewart T, Ashton P, Smith T, Jaffe GJ, Allen JB. Long-Term Effect on the Equine Eye of an Intravitreal Device Used for Sustained Release of Cyclosporine A. Veterinary Ophthalmology (2000) 3, no. 2–3, 105–110.
- Stem MS, Todorich B, Yonekawa Y, Capone A, Williams GA, Ruby AJ. Incidence and Visual Outcomes of Culture-Proven Endophthalmitis Following Dexamethasone Intravitreal Implant. JAMA Ophthalmology (2017) 135, no. 4, 379–382.
- Ledbetter EC, Spertus CB, Kurtzman RZ. Incidence and Characteristics of Acute-Onset Postoperative Bacterial and Sterile Endophthalmitis in dogs Following Elective Phacoemulsification: 1,447 cases (1995–2015). Journal of the American Veterinary Medical Association (2018) 253, no. 2, 201–208.
- Jackson TL, Eykyn SJ, Graham EM, Stanford MR. Endogenous Bacterial Endophthalmitis: A 17-Year Prospective Series and Review of 267 Reported Cases. Survey of Ophthalmology (2003) 48, no. 4, 403–423.
- Lee JJ, Jo YJ, Lee JS. Clinical Characteristics and Risk Factors for Visual Prognosis According to the Types Of Infectious Endophthalmitis. PLoS One (2022) 17, no. 12, 0278625.
- Wejde G, Samolov B, Seregard S, Koranyi G, Montan PG. Risk Factors for Endophthalmitis Following Cataract Surgery: A Retrospective Case-Control Study. Journal of Hospital Infection (2005) 61, no. 3, 251–256.
- Chen A, Dun C, Schein OD, Srikumaran D, Zafar S, Makary M, Woreta F. Endophthalmitis Rates and Risk Factors Following Intraocular Surgeries in the Medicare Population From 2016 to 2019. British Journal of Ophthalmology (2023) 108, no. 2, 232–237.
- Santschi EM. Prevention of Postoperative Infections in Horses. Veterinary Clinics: Equine Practice (2006) 22, no. 2, 323–334.
- Patel SN, Gangaputra S, Sternberg P, Kim SJ. Prophylaxis Measures for Postinjection Endophthalmitis. Survey of Ophthalmology (2020) 65, no. 4, 408–420.
- Maalouf F, Abdulaal M, Hamam RN. Chronic Postoperative Endophthalmitis: A Review of Clinical Characteristics, Microbiology, Treatment Strategies, and Outcomes. International Journal of Inflammation (2012) 2012, no. 1, 313248.
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