Treatment of equine keratomycosis, part 2: reporting common systemic and ocular complications to enhance decision-making for equine clinicians and owners.

Overview

• This study investigated the complications arising from the treatment of equine keratomycosis, focusing on both systemic and ocular issues.
• It aimed to provide data that can help veterinarians and horse owners understand risks linked to different treatment approaches, including surgery and anesthesia.

Study Objectives

• Primary objective: Describe systemic and ocular complications related to treating equine keratomycosis.
• Secondary objectives:
  • Determine if complication rates differ based on the type of treatment (medical vs. surgical).
  • Examine the relationship between complications and surgical factors such as graft size and anesthesia time.

Methods

• Retrospective analysis of 126 equine cases diagnosed with keratomycosis between 2004 and 2020.
• Data collected included:
  • Type and frequency of systemic and ocular complications during hospitalization.
  • Use of surgical treatments and details of procedures (e.g., donor graft size, anesthesia time).
  • Medications prescribed (topical and oral).
• Statistical tests used:
  • Fisher exact test and Chi-square (χ²) to compare complication frequencies across treatment groups.
  • Logistic regression to assess influence of graft size, anesthesia duration, and hospitalization length on complication rates.

Key Findings

• Systemic complications:
  • Hypercreatininemia (elevated creatinine levels) was most common in horses treated medically.
  • Colic was the most frequent systemic complication in all horses undergoing surgery.
  • The incidence of systemic complications did not significantly differ between medical and surgical treatment groups.
  • However, colic rates were significantly higher after general anesthesia compared to other treatments or no anesthesia.
  • All colic cases were successfully treated with supportive care, indicating effective management is possible.
• Ocular complications:
  • Conjunctival graft dehiscence (separation or failure of the surgical graft) was the most frequent ocular complication in surgical cases.
  • Neither donor graft size nor anesthesia time had a notable impact on the rate of ocular complications.
• Treatment components:
  • Medical therapy commonly involved:
    • Topical fluoroquinolones (antibiotics targeting bacterial infections).
    • Topical voriconazole (antifungal agent).
    • Topical atropine (to control eye inflammation/pain).
    • Oral NSAIDs (nonsteroidal anti-inflammatory drugs) for pain and inflammation.
    • Oral gastroprotectants to protect the gastrointestinal tract, likely due to risks associated with NSAIDs and anesthesia.

Conclusions and Clinical Implications

• Treatment of equine keratomycosis, whether medical or surgical, carries risks of systemic and ocular complications.
• Colic is a significant systemic complication, especially following general anesthesia, underscoring the need for careful perioperative management.
• The absence of a relationship between graft size, anesthesia time, or hospitalization duration and complication rates indicates other factors may be more influential.
• Comprehensive reporting of common complications enhances shared decision-making between veterinarians and horse owners by clarifying potential risks and expected outcomes.
• This study supports the importance of supportive care and monitoring to successfully manage complications like colic during keratomycosis treatment.