Nonhealing corneal ulcers in cats: 29 cases (1991-1999)

OBJECTIVE: To compare mean healing times after debridement, debridement with grid keratotomy, and superficial keratectomy in cats with nonhealing corneal ulcers. DESIGN: Retrospective study. ANIMALS: 29 cats with 36 nonhealing corneal ulcers. PROCEDURE: Medical records of cats with nonhealing corneal ulcers were reviewed. Signalment, duration of clinical signs, ophthalmic abnormalities, and response to various treatment protocols were recorded. RESULTS: Mean age of affected cats was 7 years, 8 months. Affected breeds included domestic shorthair (17 cats), Persian (9), Himalayan (2), and Siamese (1). Clinical signs were evident for approximately 2 weeks prior to referral. Both eyes were affected in 4 cats. Mean healing time of ulcers treated with superficial debridement was 30 days. Mean healing time of ulcers treated with superficial debridement and grid keratotomy was 42 days. Superficial keratectomy was performed on 2 eyes and resulted in a healing time of 2 weeks. Formation of a corneal sequestrum was evident in 2 of 21 eyes treated with superficial debridement. Formation of a corneal sequestrum was evident in 4 of 13 eyes treated with superficial debridement and grid keratotomy. CONCLUSIONS AND CLINICAL RELEVANCE: Brachycephalic cats appear to be predisposed to developing nonhealing corneal ulcers. The combination of superficial debridement and grid keratotomy did not decrease mean healing time of nonhealing ulcers, compared with superficial debridement alone. Grid keratotomy may predispose cats with corneal ulcers to develop a corneal sequestrum.     

Superficial, nonhealing corneal ulcers in horses: 23 cases (1989-2003)

Objective To characterize superficial, nonhealing corneal ulcers in the horse and to assess the affect of age, breed, sex, inciting cause of the ulcer, and treatment on healing time of these ulcers. Design Retrospective study. Animals Twenty‐three horses with superficial, nonhealing corneal ulcerations. Procedure Medical records from 1989 to 2003 of horses diagnosed with superficial, nonhealing corneal ulcers were reviewed. Signalment, duration of clinical signs, ophthalmic abnormalities, treatment and response to treatment were recorded. Horses were treated, in addition to medical therapy, using debridement, debridement and grid keratotomy, superficial keratectomy, and superficial keratectomy with conjunctival graft placement. Results Mean age ± SD of horses was 13.7 ± 5.8 years. The mean time of presence of the corneal ulceration was 38.9 ± 21.3 days. Mean time to complete re‐epithelialization of the corneal ulcers after treatment was 20 ± 14.7 days. Horses treated with debridement alone, grid keratotomy and superficial keratectomy healed in a mean time of 15.3 ± 14.6 days, 16 ± 12.6 days, and 22.8 ± 6.7 days, respectively. Conclusions and clinical relevance Horses treated with a single debridement at initial evaluation healed in a significantly shorter time period than horses treated with grid keratotomy or superficial keratectomy. The latter two procedures may be beneficial in the treatment of nonhealing ulceration in horses, but the results of this study suggest that these procedures should only be performed following failure of the ulcer to heal after epithelial debridement.     

Results of grid keratotomy, superficial keratectomy and debridement for the management of persistent corneal erosions in 92 dogs

Ninety-two cases of persistent corneal erosions in dogs were analyzed for breed, gender, age and which eye was affected. The results of the treatment of 92 persistent corneal erosions in dogs by superficial keratectomy (SK), grid keratotomy (GK), or debridement with a sterile dry cotton swab are presented. These techniques gave better rates of healing than have been previously reported. All cases of persistent corneal erosions healed in this study. However, it must be noted that three cases treated with debridement only failed to heal after several treatments and were eventually treated with SK. After one procedure 80 out of 92 (87%) had healed. After one procedure, 63% of cases treated with debridement healed, 100% of cases treated with SK healed, and 85% of cases treated with GK healed. At the first postoperative visit, 88% (21/24 cases) of ulcers treated by SK had healed, and 75% (39/52 cases) of ulcers treated by GK had healed. Only 25% of the persistent corneal erosions had healed at the first visit after debridement. All 24 cases of persistent corneal erosions treated with SK healed after one treatment in a mean +/- SD of 9.3 +/- 3.9 days (median of 7 days). Fifty-two cases were managed with GK; 44 (83%) of these healed with one procedure and eight cases required a second GK procedure to resolve. A mean +/- SD of 13.4 +/- 5.1 days (median of 11.5 days) following GK was required for the persistent corneal erosions to heal. Nineteen cases were initially managed by debridement with a dry cotton swab under local anesthesia. Sixteen out of these 19 debridement cases healed (giving an overall healing rate of 84%) in a mean +/- SD time of 23.4 +/- 11.1 days (median 21.5). There were three cases that did not heal with debridement. These cases were debrided at 10-20 day intervals for 30-60 days, and were then treated with SK. Two of these cases healed within 7 days, the other case required 18 days to heal. Sixty-three per cent of persistent corneal erosions treated with debridement healed after one procedure; however, only four out of 19 cases (21%) were healed at the first revisit. Complications were rare: corneal edema occurred in two cases following multiple GK, and excessive granulation tissue in one case was managed with a SK. There was the occurrence of an ulcer adjacent to the surgery site in four cases, two cases following GK and two cases following SK.     

Profiles of matrix metalloproteinase activity in equine tear fluid during corneal healing in 10 horses with ulcerative keratitis

OBJECTIVE: Levels of tear film matrix metalloproteinases (MMPs) activity are significantly elevated in horses with ulcerative keratitis and contribute to the excessive breakdown of stromal collagen. Changes in the amount of proteolytic activity in horse tear film during corneal healing and stromal remodeling have not yet been reported, but we hypothesize they should decrease. In the present study we analyzed serial tear fluid from horses with ulcerative keratitis to identify any changes in MMP activity during corneal healing and stromal remodeling. PROCEDURES: Samples of tear fluid were obtained from both eyes of 10 horses with ulcerative keratitis on the day of admission (day 1) at the hospital and then at various time points until complete healing of the cornea. Tear film MMP2 and MMP9 activity was determined by quantitative gelatin zymography. In all cases medical treatment included topical applications of equine serum, antibiotics, atropine and systemic administration of anti-inflammatory drugs. Surgical procedures were performed in several cases on day 2 in addition to the medical treatment. RESULTS: The mean total MMP activity (+/- SD) measured in relative standard units (RSU) in the tear fluid of the ulcerated eye (2.44 +/- 1.44) of the 10 horses was significantly higher than the mean in the contralateral eye (0.81 +/- 0.68) (P = 0.006), on the day of admission at the VMTH. The mean MMP activity in these ulcerated eyes significantly decreased (-82.4%) between the first day of admission and the day when the ulcer had completely healed (P = 0.0002). The activity level in the healed eye (0.43 +/- 0.17) was not significantly different to the one in the contralateral eye (0.36 +/- 0.18) on the day of complete corneal healing (P = 0.374). The level of MMP activity in the contralateral eye also decreased from 0.81 +/- 0.68-0.36 +/- 0.18 but this decrease (56%) was not significant (P = 0.069). CONCLUSIONS: Ulcerative keratitis in horses is associated with initially high levels of tear film proteolytic activity that decrease as the ulcers heal. The success of medical and surgical treatment of the corneal ulcers is reflected by the enzyme activity in tears. In horses successful treatment does lead to a rapid reduction in tear film proteolytic activity that corresponded with the improvement in the clinical signs of corneal ulceration. Measurement of MMP activity in the tear film might represent a way to monitor the progression of corneal healing in horses with ulcerative keratitis.     

Amniotic membrane transplantation for corneal surface reconstruction after excision of corneolimbal squamous cell carcinomas in nine horses

OBJECTIVE: The purpose of this study was to evaluate the usefulness and effectiveness of permanent amniotic membrane transplantation as an adjunctive treatment to superficial keratectomy alone or combined with strontium-90 irradiation for treatment of equine corneolimbal squamous cell carcinoma (SCC) to decrease corneal scarring and recurrence rate. STUDY: The retrospective case study included 11 horses (n = 12 eyes) diagnosed and treated for ocular SCC that involved the limbus and cornea. Nine of those horses (n = 9 eyes) were treated between 2002 and 2006, with superficial lamellar keratectomy alone or combined with strontium-90 irradiation and followed by placement of a permanent amniotic membrane graft in the surgical defect. The level of scarring (i.e. the clarity of the cornea) resulting with the use of amniotic membrane was subjectively compared to cases where a permanent bulbar conjunctival graft was performed following keratectomy combined with strontium-90 irradiation or cryotherapy (n = 3 eyes). Recurrence was defined as the postoperative and postirradiation regrowth of SCC in the same site and globe. RESULTS: The nine horses that received an amniotic membrane graft after keratectomy alone or combined with irradiation showed a minimal level of scarring in a cornea that regained a greater transparency in comparison to the horses that were treated with a bulbar conjunctival graft. All of the horses that received an amniotic membrane graft had 226 +/- 218 days of follow-up without tumor recurrence (mean +/- SD), ranging from 21 days to 778 days. CONCLUSIONS: The combination of superficial keratectomy alone or associated with beta-irradiation and permanent amniotic membrane transplantation is an effective treatment of corneal or corneolimbal SCC in horses. The placement of an amniotic membrane material represents an alternative surgical procedure to bulbar conjunctival grafts, especially if there is a lack of bulbar conjunctiva tissue available after tumor resection or if a particularly large corneal resection is necessary. The amniotic membrane is incorporated into the corneal defect and seems to create noticeably much less scarring than a corneal defect covered by bulbar conjunctiva.     

Effect of topical administration of epidermal growth factor on healing of corneal epithelial defects in horses

OBJECTIVE-To characterize healing of corneal epithelial defects in horses and to evaluate the ability of epidermal growth factor (EGF) to modulate rate of corneal epithelial healing in horses. SAMPLE POPULATION: 20 eyes in 12 adult horses. PROCEDURE: Corneal epithelial wounds were created by mechanically debriding the limbus. Corneal healing was recorded for 3 treatment groups: 50 microg of EGF/ml (n = 5 eyes), 5 microg of EGF/ml (7), and PBS solution (8). Corneal healing was recorded once daily after instillation of fluorescein stain by use of photography and calculating the area of the wound, using imaging software. RESULTS: After corneal debridement, re-epithelialization was rapid and progressed in a linear fashion for the first 5 to 7 days after surgery in all groups. After that period, rates of healing decreased. A profound increase in the degree of inflammation, neovascularization, melanosis, and scarring was observed in eyes treated with the high dose of EGF (50 microg/ml), but there was not a statistical difference in mean healing time or in mean decrease in radius during the linear phase between the control and either EGF treatment groups. However, for all 8 horses in which both eyes were debrided, the first eye healed significantly faster than the second eye, regardless of treatment. CONCLUSIONS AND CLINICAL RELEVANCE: Beneficial effects of topical administration of a high dose of EGF for acceleration of healing of corneal defects in eyes of horses are outweighed by the intensity of the associated inflammatory response.     

Spontaneous chronic corneal epithelial defects in dogs: a review

Spontaneous chronic corneal epithelial defects (SCCEDs) in dogs are typically found in middle-aged dogs of all breeds. These epithelial defects may be present for weeks to months, particularly if left untreated or if treated inappropriately. Typical histopathological findings include loss of the corneal epithelial basement membrane and formation of a superficial, acellular, hyalinized zone in the stroma. Together, these histological abnormalities lead to delayed wound healing and poor epithelial adhesion. Epithelial debridement, anterior stromal puncture, grid keratotomy, and superficial keratectomy are the most common treatment options applied to the defects. Procedures that address the stromal changes present generally have a higher success rate than epithelial debridement alone.     

Ulcerative keratitis in thoroughbred racehorses in Japan from 1997 to 2008

Objective To describe the number of cases, etiologies, healing times, and results of microbial culture and susceptibility testing of corneal ulcers in thoroughbred racehorses in Japan. Procedure Retrospective study of the medical records of racehorses belonging to the Japan Racing Association (JRA) from 1997 to 2008. Results A total of 2846 horses suffered ulcerative keratitis. These horses accounted for 90.5% of all the corneal problems and 54.9% of the entire number of horses with ocular diseases. Running in races was the cause in 64.3% of the cases. The mean healing time of the ulcers developed in races was 5.5 ± 9.6 days, which was shorter than that of the ulcers unrelated to racing (8.6 ± 11.7 days). In horses presented for examination by the next day after the race, healing was even more rapid (4.1 ± 7.5 days) than in horses presented later (12.4 ± 14.7 days). Microbial culture was performed on 74 samples of 58 horses. Forty‐four bacterial and four fungal organisms were isolated from 35 samples of 29 horses. Pseudomonas aeruginosa (10) and Streptococcus equi subspecies zooepidemicus (5) were the bacteria most frequently isolated. There was no tendency of increasing antibiotic resistance of these organisms. Conclusions Ulcerative keratitis is the most frequent corneal and ocular disease of the racehorse in Japan. Careful observation of the eyes after racing is necessary as early diagnosis and treatment of corneal ulcers speeds healing. Many antibiotic have efficacy against the bacterial isolates, however, potent antibiotics should be reserved for the most severe corneal ulcers.     

Use of thermokeratoplasty for treatment of ulcerative keratitis and bullous keratopathy secondary to corneal endothelial disease in dogs: 13 cases (1994-2001)

OBJECTIVE: To evaluate the outcome of thermokeratoplasty for treatment of ulcerative keratitis and bullous keratopathy secondary to corneal endothelial disease in dogs. DESIGN: Retrospective study. ANIMALS: 13 dogs. PROCEDURES: Medical records from 1994 to 2001 for dogs evaluated because of ulcerative keratitis and bullous keratopathy and treated with thermokeratoplasty were reviewed. RESULTS: There were 7 spayed females, 5 castrated males, and 1 sexually intact male, ranging from 6 to 16 years of age. Ten dogs had endothelial degeneration, and 3 dogs had breed-related endothelial dystrophy. All dogs had bullous keratopathy, characterized by microbullae formation that was detected via biomicroscopy. Recurrent or nonhealing corneal ulcers were detected unilaterally in 5 dogs and bilaterally in 8 dogs. Mean +/- SD duration from thermokeratoplasty until ulcerations were healed for all dogs was 2.2 +/- 1.1 weeks. All dogs that underwent thermokeratoplasty for nonhealing corneal ulceration secondary to endothelial disease and corneal edema had epithelial wound healing and resolution of corneal ulceration. Mean duration of treatment (ie, topical treatment required until resolution of ulceration) was significantly less after thermokeratoplasty than duration of treatment (with multiple treatments) prior to referral. CONCLUSIONS AND CLINICAL RELEVANCE: It may be necessary to perform thermokeratoplasty of the entire cornea to prevent recurrence of ulcerations in areas that have not been treated with thermokeratoplasty.     

Indolent-like corneal ulcers in 3 horses

Three horses were admitted with indolent-like corneal ulcers. All horses were treated topically with antibiotics. Two horses had ulcers with redundant epithelial borders, which were debrided with cotton-tipped applicators after topical anesthesia was induced. One ulcer healed after 2 debridements. Of 2 horses treated surgically, one had complications.     

Marjolin’s Ulcer in Two Horses with Hereditary Equine Regional Dermal Asthenia

Two Quarter Horse mares with hereditary equine regional dermal asthenia (HERDA) were diagnosed with metastatic squamous cell carcinoma (SCC) associated with chronic nonhealing wounds. The lesions were similar to the development of SCC from chronic nonhealing ulcers, known as Marjolin’s ulcers in humans. The horses showed recurrent skin wounds in the saddle and paralumbar regions and were confirmed by molecular techniques as having HERDA. Both horses were maintained as research animals for prolonged periods and received regular veterinary care and wound treatment. Both horses were ultimately euthanized because of their chronic progressive wounds, coupled with declining health. At necropsy, the nonhealing wounds were found to be complicated by infiltrative SCC; both horses had metastasis to lungs. Chronically inflamed, recurrent skin wounds that heal slowly and incompletely as a consequence of HERDA are proposed as a major pathogenetic factor in tumorigenesis. Consistent findings with respect to proliferation index (Ki-67) and mutations of p53 tumor suppressor gene were confirmed by immunohistochemistry in one horse. SCC consistent with Marjolin’s ulcer has been previously suggested in association with chronic ulcers or burn scars in horses, but this is the first report of an association with chronic poor healing wounds in HERDA horses.     

Multiple striate keratotomy: a treatment for corneal erosions caused by epithelial basement membrane disease

Objective To study the efficacy of multiple striate keratotomy for the treatment of persistent corneal erosions suspected to be caused by primary corneal epithelial basement membrane disease.
Design A retrospective study.
Animals 16 dogs, three cats and one Australian dingo.
Procedure A technique called multiple striate keratotomy was used to treat twenty animals suffering from persistent corneal erosions.
Results All persistent corneal erosions healed with only one treatment. Most cases healed within 2 weeks. One case developed a second erosion in the same eye but in a different position to the original erosion.
Conclusions Multiple striate keratotomy is a safe, effective and well tolerated technique for the treatment of persistent corneal erosions thought to be caused by corneal epithelial basement membrane disease.     

Cyanoacrylate tissue adhesive for treatment of refractory corneal ulceration

Isobutyl cyanoacrylate tissue adhesive (BCTA) was used in the treatment of refractory superficial corneal ulcers in 17 dogs, one cat, and one rabbit, present 2 weeks to 7 months (mean 6.8 weeks +/- 6.1) prior to referral. Little to no sedation was required in the majority of cases, with only topical anesthetic applied prior to debridement and BCTA application. The presence of the tissue adhesive caused mild discomfort for several days after application, as reported by the owners. The ulcers healed, and the tissue adhesive sloughed in approximately 3 weeks (+/- 1 week). Mild neovascularization of the cornea resolved with topical corticosteroids. The use of BCTA offers a simple, safe and noninvasive treatment for refractory corneal ulcers.     

Thermal cautery of the cornea for treatment of spontaneous chronic corneal epithelial defects in dogs and horses

A thermal cautery technique was used to treat spontaneous chronic corneal epithelial defects (SCCEDs) in 9 eyes of 8 dogs and 2 eyes of 2 horses. Animals were sedated, and a topical anesthetic was applied. A handheld thermal cautery unit was then used to make multiple, small (< or = 1 mm in diameter), superficial burns throughout the affected area. The cautery unit was applied just until the slightest degree of contraction of the collagen fibrils was observed. After the stromal bed of the defect was treated, a rim of epithelium that extended approximately 1 mm around the denuded stroma was also subjected to thermal cautery. Following surgery, a contact lens was placed in dogs but not in horses, and the eye was treated with broad-spectrum antimicrobial ophthalmic solutions. Defects in all 11 eyes healed with minimal scarring; mean time to healing in dogs was 2.1 weeks (range, 2 to 3 weeks). The defect healed in 1 week in 1 horse and in 2 weeks in the other. Many therapeutic options are available for the treatment of SCCEDs. Procedures such as epithelial debridement and anterior stromal puncture have been shown to have a high rate of success. In cases for which these less invasive procedures fail, our results suggest that thermal cautery may be a reasonable alternative to previously described treatments for SCCEDs in dogs and horses prior to more invasive procedures such as superficial keratectomy.     

Deep lamellar endothelial keratoplasty in 10 horses

Objective  To describe and evaluate a surgical technique utilized for the therapy of deep corneal stromal abscesses (DSA) in horses. The DSA is excised and replaced with a partial thickness corneal lamellar allograft.
Methods  A retrospective clinical study describing the indications for the surgical technique utilized and the outcomes of this procedure in 10 eyes of 10 horses.
Results  Each affected eye had a discrete DSA within the posterior stroma. An initial partial thickness semicircular corneal incision was made at the limbus, followed by anterior stromal lamellar dissection over the lesion. After excision of the DSA and replacement with a larger diameter split-thickness donor button, the anterior stroma was replaced into its original position and the initial corneal incision was repaired. All of the animals that underwent deep lamellar endothelial keratoplasty (DLEK) procedure healed appropriately and with subjectively less postoperative scarring and complications than previously described surgical approaches to DSA.
Conclusions  This procedure is an effective technique for surgical removal of DSA in horses and, in most cases, results in a visual and cosmetically acceptable globe. The advantages of this technique compared to other surgical approaches to DSA are the peripheral location of the incision, shortened anesthesia times, the resultant minimal scarring and shorter healing times associated with DLEK.     

Rose bengal positive epithelial microerosions as a manifestation of equine keratomycosis

Purpose To describe the clinical appearance of corneal epithelial cell microerosions associated with keratomycosis in the horse. METHODS: Retrospective clinical study. RESULTS: Multifocal, punctate, superficial corneal opacities with positive rose bengal retention were noted in six horses with presumed 'viral keratitis'. Faint fluorescein staining was also present in three cases. Equine herpesvirus tissue culture inoculation was negative for a cytopathic effect in three cases. Aspergillus (n = 3), Curvularia (n = 1), and an unidentified fungus (n = 1) were cultured in five horses, and hyphae found on corneal cytology from the sixth. Mixed bacterial infections were present in three eyes. The eyes of two horses with Aspergillus progressed to deep melting corneal ulcers that required surgical therapy. The microerosions remained superficial, but persistent in the other four eyes. Natamycin was utilized topically in all six horses. Transmission electron microscopy from case 6 revealed mucin layer disruption, an intact corneal epithelial cell layer, and fungal attachment to degenerating epithelial cells. The visual outcome was positive in all six horses, although healing was prolonged (48.5 +/- 14.5 days on average in the horses with no surgery; 62 days on average in the two horses that required surgery). CONCLUSIONS: Complete removal or full-thickness penetration of the corneal epithelial cell barrier may not be necessary to allow fungal adherence and initiation of keratomycosis in the horse. Prior to colonization and invasion of the horse cornea, fungi may induce changes in the mucin layer of the tear film that result in or are associated with rose bengal positive microerosions of the superficial corneal epithelium. Horses with painful eyes, and eyes with superficial, multifocal corneal opacities should have their corneas stained with both fluorescein and rose bengal as fungal microerosions may stain weakly, or not at all, with fluorescein, and may thus be mistaken for presumed 'viral keratitis' of the horse.     

Clinical management of superficial complicated corneal ulcerations infected with newly identified fastidious bacteria with unknown antibiotic sensitivity in three horses

This case series addresses a clinical approach to a specific type of infected corneal ulceration in horses; the slow-healing superficial complicated corneal ulceration involving a fastidious or possibly newly identified bacteria for which no antibiotic sensitivity can be determined. These corneal ulcerations present as superficial, nonhealing lesions that appear infected based on cellular infiltration of the cornea. Because they are superficial, they do not appear to be as serious to the referral veterinarian as deep stromal corneal ulcerations. However, superficial corneal ulcerations are complicated and slow healing, ultimately frustrating both owners and primary care clinicians. Culture results are often negative, or implicate a newly identified bacteria with no known antimicrobial sensitivity in horses.     

Corneal stromal sequestration in a dog

A case of corneal sequestrum in a 9-year-old Shih Tzu is reported. On the ophthalmic examination a brown-pigmented ulcer with mild edema and corneal vascularization was present. The brownish plaque was facing an inferior palpebral tumor. A superficial keratectomy followed by a grid keratotomy and removal of the palpebral mass were performed. Histological findings revealed an inflammatory cell infiltration underneath the acellular stromal layers. No melanin granules were observed. No vascular infiltration was present within the necrotic stroma. The surgical area healed and no recurrence has been reported by the owners at the time of writing. To the authors' knowledge, this is the first report of a corneal sequestrum in a dog.     

Posterior lamellar keratoplasty for treatment of deep stromal absesses in nine horses

OBJECTIVE: To describe and evaluate the use of posterior lamellar keratoplasty as a surgical treatment for deep corneal stromal abscesses in horses. Animals studied Nine horses of various breeds and ages that presented with corneal stromal abscesses located in the posterior one-third of the cornea. Procedure Retrospective medical record study. RESULTS: Nine horses had deep corneal stromal abscesses that were treated with posterior lamellar keratoplasty. Median patient age was 3 years. Six patients were females and three were geldings. Medical therapy alone had been attempted prior to surgery in all nine animals. Corneal abscess culture and histopathology were performed in 8/9 horses. Cultures were positive for an infectious etiology in 4/8 (50%). Histopathology was positive for an infectious etiology in 5/8 (62.5%). Mean surgical time was 71.0 +/- 18.8 min and the average healing time was 23.7 +/- 5.2 days. Visual outcome was positive in 8/9 cases. Conclusion Posterior lamellar keratoplasty is a promising procedure for treatment of deep corneal stromal abscesses in horses. The procedure resulted in considerable shorter surgery time and healing time than had been observed with full-thickness penetrating keratoplasty. Scar formation with this procedure was not significantly different than with penetrating keratoplasty.     

Outcome of superficial keratectomy without conjunctival graft as a surgical technique for immune-mediated keratitis in horses: Four cases

This case report describes four horses with unilateral superficial or mid-stromal immune-mediated keratitis (IMMK) treated with a superficial keratectomy (SK) without a conjunctival graft. In two horses, the surgery was performed under general anaesthesia, and in two horses standing with sedation and local blocks. Results of this report show that SK is a viable treatment option in horses with chronic superficial and/or mid-stromal IMMK that can even be performed in the standing, sedated horse. When sufficient corneal tissue is removed, no recurrence is to be expected in the long-term follow-up (up to 31 months). In two horses, healing occurred without complications. Two horses developed a secondary bacterial infection post-operatively (Enterococcus faecalis and Staphylococcus aureus). In one case, this resulted in a pre-perforating melting corneal ulcer necessitating conjunctival pedicle graft surgery 13 days post keratectomy. In three horses, there was no recurrence of the IMMK with a long-term follow-up of 6–31 months. One case showed recurrence of IMMK in the cornea region surrounding the keratectomy 9 months after surgery.