Ocular inserts for application of drugs to bovine eyes—effects of hydrophilic contact lenses

SUMMARY Hydrophilic contact lenses were developed for use in the eyes of cattle. With prolonged wear, corneal edema developed. Bacterial numbers increased in the conjunctival sac after lens insertion but this increase was not associated with the corneal edema. Based on studies in other species corneal edema was attributed to anoxia.     

The effect of topical pimecrolimus on keratoconjunctivitis sicca and chronic superficial keratitis in dogs: results from an exploratory study

OBJECTIVE: Pimecrolimus is an ascomycin derivative that interferes selectively with the activation of T cells and mast cells and inhibits the production of inflammatory cytokines. This study evaluated the efficacy of an experimental ophthalmic formulation of pimecrolimus in treating keratoconjunctivitis sicca (KCS) and chronic superficial keratitis (CSK) in dogs. ANIMALS AND PROCEDURES: Eight dogs with KCS and six with CSK were included. The dogs were of various breeds, suffered from chronic conditions, and had been pretreated unsuccessfully. The affected eyes were treated with 1 drop of an experimental, corn oil-based pimecrolimus 1% formulation three times a day. Parameters evaluated included Schirmer tear test (STT), ocular discharge, conjunctival inflammation, corneal inflammatory cell infiltrate and scarring, and comfort level. RESULTS: The effect of pimecrolimus 1% was pronounced (increase in STT values to higher than 4 mm/min, no signs of inflammation) or moderate (increase in STT values of 3-4 mm/min, mild signs of corneal/conjunctival inflammation) in a total of 6/8 animals with KCS. In 4/6 animals with CSK, the effect was either pronounced (total regression of fibrovascular infiltration into the cornea, no corneal scarring) or moderate (distinct regression of pannus, mild corneal scarring). The response to treatment was unsatisfactory in four of 14 animals. CONCLUSION: Results of this exploratory study suggest that topical 1% pimecrolimus may be a new effective treatment for keratoconjunctivitis sicca and chronic superficial keratitis in dogs.     

Phacoemulsification and +14 diopter intraocular lens placement in a Saddlebred foal

A 2‐month‐old, 110‐kg Saddlebred filly presented for evaluation of bilateral cataracts. A hypermature cataract in the left eye (OS) and an incipient nuclear cataract in the right eye (OD) were diagnosed. Electroretinography and ocular ultrasound revealed no contraindications for surgical removal of the cataractous lens OS. Phacoemulsification and implantation of a +14 diopter (D) intraocular lens (IOL) OS were performed at 4 months of age without complication, with the exception of a partial iridectomy performed on a small iris section that prolapsed through the corneal incision. Complete ophthalmic examinations, including ocular ultrasound and streak retinoscopy, were performed 1, 2, 6 weeks, 4 months, 1, and 2 years postoperatively. Diffuse corneal edema and a superficial corneal ulcer developed OS during the early postoperative period and resolved without complication. Dyscoria was identified owing to anterior synechia of the dorsomedial iris at the incision site. Two years after surgery, menace response, palpebral reflex, dazzle reflex, and pupillary light reflexes were present in both eyes (OU). The IOL remained centrally positioned within the capsule, with mild anterior tilting of the superior portion of the IOL and mild fibrosis of the lens capsule. The postoperative net refractive error was +0.31 D OS. Based on this report, a +14 D IOL may be the appropriate choice following lens extraction in a foal to achieve refraction near emmetropia at maturity. To our knowledge, this is the first report of phacoemulsification and IOL implantation in a foal with long‐term follow‐up.     

MHC class II risk haplotype associated with canine chronic superficial keratitis in German Shepherd dogs

Canine chronic superficial keratitis (CSK) is an inflammatory ocular disease of an autoimmune origin leading to blindness if untreated. The main symptoms of CSK are progressive, bilateral vascularisation, fibrous tissue formation and pigmentation of the anterior corneal stroma. Although CSK is found in many breeds it is most prevalent in German Shepherd dogs (GSDs). Since Major Histocompatibility Complex (MHC) class II is associated with several autoimmune diseases in dogs we investigated the possible role of DLA-DRB1, -DQA1 and -DQB1 in GSDs affected with CSK. Our study population included 25 healthy controls and 30 CSK dogs. Most of the affected dogs were females suggesting a female predisposition. We identified 11 unevenly distributed haplotypes of which DLA-DRB1*01501/DQA1*00601/DQB1*00301 was significantly associated with the CSK dogs (OR=2.67, CI=1.17-6.44, p=0.02). We also found that overall homozygosity of MHC class II increases risk for CSK (OR=4.37, CI=1.27-18.46, p=0.02) and homozygosity of the risk haplotype by over eight-fold (OR=8.5, 95% CI=1.4-224, p=0.017). This study identifies a MHC class II risk haplotype for CSK in GSD and further supports the autoimmune origin of the disease.     

Management of a persistent corneal erosion in a boxer dog

A dog was presented to the New York State College of Veterinary Medicine with a one-month history of corneal ulceration. The corneal lesion was diagnosed as a persistent corneal erosion (PCE) and treated initially with debridement and supported with a contact lens. One week later, the corneal erosion remained unepithelialized. Following debridement, multiple anterior stromal punctures were performed. Within 10 days, the erosion was healed as evidenced by coverage of the cornea with adherent, uninterrupted epithelium. The proposed etiology and management of PCE in dogs is discussed.     

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.     

Practical usefulness of a therapeutic soft contact lens for a corneal ulcer in a racehorse

Therapeutic soft contact lenses (TSCL) were applied to a thoroughbred racehorse with corneal ulcer refractory to topical medication. The insertion of the TSCL was conducted on day 36 using a nose twitch under sedation, auriculopalpebral nerve block, and topical anesthesia. The lens was retained, with the duration of wear lasting 114 days. Ocular pain improved immediately and fluorescein tests were negative 17 days after insertion. The horse was able to undergo training and ran in two races while wearing the TSCL. Thus a TSCL was found to be clinically useful for treating corneal ulcers in racehorses.     

Implantation of a foldable intraocular lens in dogs

A 1-piece, tripod-shaped, acrylic intraocular lens was implanted in the posterior chamber after phacoemulsification to remove cataracts in 20 eyes of 16 dogs. Biomicroscopy and intraocular pressure measurements were performed at 1, 8, 30, and 90 days after surgery; retinoscopy was performed at day 30. Complications were not encountered during implantation of the lens. All dogs had mild ocular inflammation characterized predominantly by aqueous flare and mild corneal edema at day 1, which resolved completely by day 8; 3 eyes had mild hyphema at day 1, which resolved by day 8. Three eyes developed fibrin in the anterior chamber, which resolved by day 30. Two eyes developed distorted pupils caused by adherence of vitreous humor or fibrin to the incision site. Postoperative intraocular pressure ranged from 7 to 21 mm Hg. Implantation resulted in 9 emmotropic eyes, 5 myopic eyes, and 6 hyperopic eyes. Maintenance of central lens position was excellent in 19 eyes; in 1 eyes, a disclocated superior haptic at day 2 was easily repositioned.     

Lens morphometry determined by B-mode ultrasonography of the normal and cataractous canine lens

Purpose To determine axial lens thickness, anterior chamber depth and axial globe length in canine eyes with normal lenses and in eyes with immature, mature, congenital, posterior polar and diabetic cataract. Methods B‐mode ultrasonography was performed in 50 normal dogs and, as a prephacoemulsification screening procedure, in 100 dogs with cataract. Axial B‐mode ultrasonograms were used to determine lens thickness, anterior chamber depth and globe diameter. Statistical comparisons between groups were made by analysis of variance and multivariate analysis, with a significance level of P < 0.05. Results Axial globe lengths were not statistically significantly different between groups apart from the smaller globes in younger dogs with congenital cataract. Axial lens thickness in diabetics (8.4 ± 0.9 mm) was statistically significantly different from the lens thickness in normal eyes (6.7 ± 1.0 mm), eyes with immature cataract (6.4 ± 0.8 mm) and eyes with mature cataract (7.4 ± 0.9 mm) although these groups, while varying in thickness, were not statistically significantly different from each other. Anterior chamber depth was statistically significantly reduced in eyes with diabetic cataract (2.9 ± 0.1 mm) from that in normal eyes (3.8 ± 0.1 mm), eyes with immature cataract (3.5 ± 0.1 mm) and eyes with mature cataract (3.2 ± 0.6 mm) although these groups, while varying in chamber depth, were not statistically significantly different from each other. Conclusions Lenses with diabetic cataracts were significantly increased in axial thickness compared to lenses in other eyes, although lenses with mature cataracts showed a trend towards increased axial thickness and immature cataracts demonstrated a trend towards reduced thickness. While previous studies on cataract pathobiology have suggested a reduction in lens thickness in immature cataract through lens protein loss and an increase in thickness in mature cataracts through intumescence, this study is the first to document these changes in the canine lens.     

Morphologic alterations in the anterior lens capsule of canine eyes with cataracts

OBJECTIVE: To examine the morphologic changes in the anterior lens capsule and lens epithelium of canine eyes with cataracts. SAMPLE POPULATION: Anterior lens capsules from the eyes of 25 dogs with cataracts and from an additional 10 canine globes with lenses subjectively assessed to be normal. PROCEDURE: Thickness of each anterior lens capsule was measured by use of a digital microscopic camera and imaging software. All 25 capsules from eyes with cataracts were submitted for light microscopy; 4 were also submitted for electron microscopy. RESULTS: Thickness of the anterior lens capsule increased with age for the normal lenses and the lenses with cataracts; the change with age was similar for both groups. Light microscopy revealed fibrous metaplasia of lens epithelial cells in 7 of 25 anterior lens capsules with focal thickenings of the posterior aspect of the capsule. Electron microscopy revealed deposition of collagen and basement membrane-like material by fibroblast-like cells. CONCLUSIONS: Results indicate that thickness of the anterior lens capsule in dogs increases with age and that this increase in thickness is not significantly different between normal lenses and lenses with cataracts. In addition, epithelial cells from lenses with cataracts may undergo metaplasia to form plaques composed of fibrous tissue and ectopic basement membrane produced by epithelial cells.     

Autogenous lamellar corneal grafting in dogs

Lamellar, autogenous, corneal grafts were performed on 9 clinically normal dogs (1 eye in each of 2 dogs and both eyes in each of 7 dogs) and 7 dogs with corneal disease (1 eye in each dog). Nylon, polyglycolic acid, polyglactin 910, and polydioxanone suture materials were used in 8-0 to 10-0 sizes. The eyes of the normal dogs were examined weekly for up to 16 weeks; corneal endothelium was reestablished in all eyes by 6 weeks after surgery. The eyes of the dogs with corneal disease were reexamined periodically for up to 9 months. Twenty-two of 23 (95.7%) grafts were considered successful in that they were translucent, and the dogs were able to see after surgery. The suture materials that caused the least tissue reaction were nylon and polyglactin 910. This procedure is indicated for chronic descemetoceles and other perforating corneal disease. It has the advantage of rapidly resolving severe corneal disease, with a high degree of success.     

Traumatic corneal laceration with associated lens capsule disruption: a retrospective study of 77 clinical cases from 1999 to 2009

Objective Examine prognostic factors that may indicate when surgical lens removal is indicated to prevent vision‐threatening complications in patients presented following traumatic perforating corneal laceration with associated lens capsule disruption. Procedures Seventy‐seven patients (10 cats and 67 dogs) were evaluated with this injury; of these, 47 were presented acutely and treated surgically and/or medically. Successful outcome was defined as functional vision in the treated eye. Results The 47 patients with acute injuries were divided into 3 treatment groups A‐C for comparison; A ‐ corneal repair/lens removal (n = 15), B ‐ corneal repair/no lens removal (n = 9), C – medical management (n = 23). Groups A and B showed a significantly greater rate of vision loss compared to Group C that was most obvious greater than 18 months post‐injury (P = 0.029 and 0.0097, respectively). Cox proportional hazards regression analysis found a significantly higher increased rate of vision loss in Group A (HR = 4.5; P = 0.023) and a higher but nonsignificant increased rate of vision loss in Group B (HR = 3.0; P = 0.23) compared to Group C after controlling for age and cause of injury. The length of the corneal laceration and time interval from injury to referral were also relevant prognostic factors. Conclusions Medical management is an appropriate therapy for patients of all ages suffering perforating corneal injuries with associated lens capsule disruption. Patients with corneal injuries requiring surgical repair or managed by lens removal following corneal repair suffered vision‐threatening complications approximately 3 to 4.5 times the rate of patients treated by medical management, respectively. Favorable prognostic signs for treatment by medical management include good corneal wound apposition and a formed anterior chamber without uveal prolapse or continued aqueous leakage.     

Modulation of matrix metalloproteinases by ultraviolet radiation in the canine cornea

Purpose To determine whether ultraviolet (UV) radiation can modulate expression and regulation of matrix metalloproteinases (MMP) in the canine cornea and to examine the expression of MMPs in canine chronic superficial keratitis (CSK). Methods Immunohistochemistry for MMP‐2 and MMP‐9 was performed on samples of CSK. In vitro, canine corneal epithelial cell (CEC) and stromal cell cultures were exposed to UV‐irradiation. Following 2, 8 or 24 h, cells were harvested. MMP expression was examined by zymography, and RT‐PCR was used to examine expression of Slug and Snail. CEC cultures treated with an EGFR inhibitor or a p38 inhibitor were UV‐exposed and harvested 24 h later to examine expression of MMPs, Slug and Snail. Results Canine CSK had increased immunopositivity for both MMP‐2 and MMP‐9 compared to normal canine corneas. In vitro, CEC and stromal cell cultures exposed to UV showed generally increased expression of MMP‐2, ‐9, Slug, and Snail; this response was dose and time dependent. Inhibition of the EGFR pathway did not prevent increased expression of MMP‐2, ‐9, Slug or Snail in UV‐exposed CEC; however, p38 inhibition did attenuate UV induction. Conclusions We have found increased expression of MMPs in clinical samples of CSK compared to normal corneas. In addition, we have shown that there is a temporal association and dose dependency between UV exposure and production of MMPs, Slug, and Snail. These findings suggest that overexpression of MMPs due to UV‐exposure may be linked to changes in the cornea that allow an influx of inflammatory cells and vascularization.     

An unusual case of feline acute corneal hydrops: atypical disease presentation and possible in vivo detection of Descemet's membrane detachment in the cat's unaffected eye

A 1‐year‐old, female spayed, domestic shorthair cat presented for blepharospasm of the right eye. Slit‐lamp biomicroscopic examination showed focal corneal ulceration and presumptive keratomalacia of the right eye. Examination of the left eye was normal apart from a focal endothelial opacity. Within the first 24 h of medical management, the right eye developed marked corneal edema and globular anterior protrusion of the corneal surface consistent with feline acute corneal hydrops (FACH). Surgical management consisted of a bridge conjunctival graft, nictitating membrane flap, and temporary tarsorrhaphy. Resolution of corneal edema and pain occurred in the right eye within 24 days. Spectral domain optical coherence tomography (SD‐OCT) of the anterior segment was performed in both eyes. Conjunctival tissue from the bridge graft precluded examination of deeper corneal structures in the right eye. The left eye displayed a focal separation of the corneal endothelium and Descemet's membrane from the overlying stroma. These SD‐OCT findings are similar to the analogous syndrome found in humans and represent a potential etiology for FACH of the right eye in the case presented here. Unfortunately, the cat was lost to follow‐up and the progression of this lesion to FACH in the left eye could not be determined.     

The use of hydrophilic contact lenses in corneal diseases of the dog and cat: A preliminary report

ABSTRACT
Two types of hydrophilic contact lenses were tested in dogs and cats as part of the therapeutic régime of recurrent corneal erosions, superficial corneal ulcers and keratoconjunctivitis sicca. It was found that the lenses are well tolerated by these species when properly fitted to the cornea. If the lenses were not properly fitted, they were lost before their therapeutic effectiveness could be evaluated. The use of hydrophilic contact lenses appeared to be beneficial in the treatment of superificial corneal ulcers and recurrent corneal erosions in the dog and cat, but ineffective in the treatment of keratoconjunctivitis sicca.     

Contrast-enhanced ultrasonography in the differentiation of retinal detachment and vitreous membrane in dogs and cats

Objectives : To evaluate contrast‐enhanced ultrasonography (CEU) and colour Doppler imaging (CDI) for detection of persistent vascularisation in retinal detachment. Methods : In 22 eyes, retinal detachment (n=13) and vitreous membranes (n=9) were confirmed by ophthalmological examination, during cataract surgery, by histopathology or after vitreoretinal surgery. Tentative diagnosis of retinal detachment or vitreous membrane was made using grey‐scale B‐mode ultrasonography. Assessment of retinal detachment was based on the presence or absence of vascularisation in the membranous structure using CDI and CEU. Results : Sensitivity, specificity, positive‐predictive value and negative‐predictive value of grey‐scale ultrasonography in differentiating retinal detachment from vitreous membrane were 92·3%, 66·6%, 80% and 85·7%. In 91% of eyes, colour Doppler assessment was unsuccessful due to the movement of the eye. Persistent vascularisation was demonstrated in all cases of retinal detachments with CEU. CEU was 100% accurate for detection and differentiation between retinal detachment and vitreous membrane. Clinical Significance : CEU is a useful clinical tool for the diagnosis of retinal detachment and vitreous membrane in dogs and cats.     

The Cryosurgical Treatment of Pigmentary Keratitis in Dogs An Experimental and Clinical Study

Forty normal dogs were exposed to double freezes of a 1 cm diameter area of their central corneas using a liquid nitrogen spray. Postoperative sequelae and final histopathologic results were evaluated. All eyes suffered epithelial damage and developed corneal edema, but dogs followed for 3 weeks returned to a normal or near normal condition. Nine clinical cases of pigmentary keratitis were subsequently treated by cryosurgery. The complications following this technique were similar to those seen in the experimental dogs. Reduction in corneal pigmentation and improvement of vision occurred in all cases.     

Radiotherapy for canine chronic superficial keratitis using soft X-rays (15 kV)

Objective  To evaluate the effect of soft X-ray therapy in the treatment of refractory chronic superficial keratitis (CSK).
Animals studied  Thirteen dogs with severe CSK, that had been refractory to prior medical and/or surgical therapy were treated with soft X-ray therapy.
Procedures  Both corneas of each dog were irradiated with soft X-rays (15 kV), to a total dose of 30 Gy, administered as two fractions over 48–96 h. Treatment was carried out under deep sedation in all dogs. Three dogs were treated by superficial lamellar keratectomy 48 h prior to radiotherapy. Changes in the extent of corneal pigmentation, pigment density and corneal vascularization were documented using a semi-quantitative grading scheme, schematic drawings and clinical photographs.
Results  Only minor, transient adverse effects of treatment, such as photophobia, epiphora and blepharitis were noted. Overall the effect of soft X-rays on the course of the keratitis was superior when compared to the effect of Sr-90 irradiation that had been determined in a previous study.
Conclusion  Soft X-ray irradiation combined with keratectomy is a safe and effective new treatment option for severe and advanced CSK with significant visual impairment due to corneal pathology.     

Success Rates of Unilateral vs. Bilateral Cataract Extraction in Dogs

Postoperative results of 113 unilateral and 77 bilateral extracapsular cataract extractions (EC-CEs) in dogs were evaluated retrospectively. Restoration or improvement of functional vision was achieved in 79.6% of the eyes in dogs with unilateral extraction and 85.7% of the eyes in dogs with bilateral extractions at weeks 4 to 6. Complications occurring 6 weeks to 9 months after lens extraction lessened the surgical success rate in both groups. Twenty-six percent of the dogs in which bilateral lens removal was performed suffered complications resulting in surgical failure in one eye. When using the criterion that one or both treated eyes had functional vision, a short-term success rate of 98.7% was found for bilateral extractions.     

Effects of intracameral injection of tissue plasminogen activator on corneal endothelium and intraocular pressure in dogs.

Contact wide-field specular microscopy was performed on eyes of 16 healthy dogs after tissue plasminogen activator at a concentration of 25 micrograms/100 microliters (group 1, n = 8) or 50 micrograms/100 microliters (group 2, n = 8) was injected into 1 anterior chamber of each dog. The contralateral eye served as a nontreated control. Applanation tonometry was used to measure intraocular pressure in both eyes for up to 168 hours. By use of computerized morphometric analysis and pachymetry, changes from baseline values in endothelial cell density, cell morphologic features, and corneal thickness were evaluated at postinjection hours 24, 48, and 168. Significant mean differences in intraocular pressure were not detected between treated eyes of group-1 dogs and those in group 2 at designated times, or between treated and nontreated eyes of dogs in either group. Mean corneal thickness of treated and nontreated eyes was similar in both groups through postinjection hour 168. Changes in mean percentage of endothelial cell sides were observed only in treated eyes of group-2 dogs, with the mean percentage of hexagons at postinjection hour 168 decreasing by 18%, a decrease that was significantly (P less than 0.05) greater than the decrease in nontreated eyes. The mean percentage of 6-sided cells in treated eyes of group-2 dogs was significantly (P less than 0.05) less than that in treated eyes of group-1 dogs at postinjection hour 168.