Retinal and optic nerve diseases.

Basic knowledge of the normal appearance and variations of the equine fundus coupled with frequent practice in ophthalmology will allow equine practitioners to be confident when assessing the equine fundus during ophthalmic examinations. Once the normal variations are mastered, appreciation of retinal, choroidal, optic nerve, and vitreal abnormalities is possible. Congenital and acquired lesions of the equine retina, optic nerve, and vitreous are discussed and illustrated.     

Evaluation of patients with decreased vision or blindness

A good ocular examination and careful evaluation of the pupillary light reflexes will localize most lesion(s) producing a complaint of blindness. Lesions of the clear media severe enough to produce blindness will prohibit fundus examination. Retinal, optic nerve, and complete chiasmal lesions will produce dilated, slowly reactive pupils. Retinal blindness is usually associated with dramatic ophthalmoscopic lesions of diffuse altered reflectivity and vascular attenuation, the major exceptions being the sudden acquired retinal degeneration syndrome and some patients with glaucoma. Optic nerve lesions may involve the optic disc where they may be recognized by either pallor or hyperemia and cupping or elevation. Confirmation of optic nerve blindness in practice usually is by ruling out retinal blindness, but a more definitive methodology is to have a normal electroretinogram, slow or absent direct pupillary light reflexes (PLR), and abnormal visual evoked potentials. Central blindness is diagnosed by normal eyes, normal PLR, and often central nervous system (CNS) signs indicative of a diffuse or multifocal CNS disease.     

Systemic hypertensive disease and the feline fundus

The fundoscopic appearance and some of the histopathological findings of arterial hypertension in the cat are reviewed in relation to the anatomical and physiological features that place retinal function at particular risk when the eye is subjected to sustained increased arterial blood pressure. The fundus changes fall into three categories: hypertensive retinopathy, hypertensive choroidopathy and hypertensive optic neuropathy, and information from cases with confirmed arterial hypertensive disease is used to provide a basis for discussion and future investigation.     

Ocular manifestations of equine motor neuron disease

The characteristics of the ocular manifestations of equine motor neuron disease (EMND) are described. Forty-two horses with histories, clinical signs and necropsies compatible with EMND were the subjects of this study. Ophthalmoscopic lesions that varied in severity were found in 40 of 42 horses and appeared as a distinct pigmented reticulated pattern at the tapetal-nontapetal junction or throughout the fundus, depending upon severity. The pattern colours ranged from yellow brown to black. Areas of hyperreflectivity formed mosaic patterns in the tapetal fundus. ERG B-wave amplitudes were usually at least 50% reduced and many animals showed extinguished amplitudes. None of the horses had apparent visual impairment. Histopathologically, all 42 horses had retinal pigment epithelial (RPE) congestion with ceroid-lipofuscin. Retinal degeneration was variable even within the eyes. Thin layer chromatography (TLC) analysis of the RPE and neural retina identified both green and orange emitting fluorescent compounds not found in normal horses. All unsupplemented horses had plasma vitamin E levels <1.0 microg/ml. The potential significance of this report is the pathognomonic role the ocular manifestations exhibit in helping to diagnose equine motor neuron disease.     

CASE REPORT: Bilateral vision loss in a captive cheetah (Acinonyx jubatus)

The following case report describes a 1‐year‐old female cheetah (Acinonyx jubatus) with bilateral blindness and unresponsive pupils. For comparison, a second healthy 2.5‐year‐old male cheetah without visual deficits was also examined. Clinical examination of both animals included biomicroscopy, indirect ophthalmoscopy, tonometry, and electroretinography. The young female cheetah showed no menace response, no direct or indirect pupillary light reflex, and no dazzle reflex in either eye. Fundus lesions, as detected by indirect ophthalmoscopy, are described for the female animal. In both eyes, the fundus color was green/turquoise/yellow with multiple hyperpigmented linear lesions in the tapetal area around the optic nerve. The optic nerve head was dark gray and about half the normal size suggesting bilateral optic nerve hypoplasia and retinal dysplasia or differentially optic nerve atrophy and chorioretinal scarring. The ERG had low amplitudes in the right eye but appeared normal in the left eye compared with the male cheetah. Blood levels did not suggest current taurine deficiency. This is addressed to some degree in the discussion. Bilateral optic nerve hypoplasia or optic nerve atrophy is a rare anomaly in cats and has not yet been described in a cheetah.     

Traumatic brain injury manifested as optic neuropathy in the horse: A commentary and clinical case

Blindness from head trauma is a serious debilitating disease in the horse. It appears that blunt trauma to the skull results in intracranial injury to the optic nerve at the optic chiasm from mechanical and vascular mechanisms. Systemically administered iron and calcium chelation therapy may enable some horses to recover vision.     

Canine orbital meningiomas: a review of 22 cases

Clinical and pathologic features of primary orbital meningiomas in the dog were reviewed. Twenty-two meningiomas, confined to the orbit, were identified from the Comparative Ophthalmic Pathology Laboratory of Wisconsin from 1981 to 1997. The dogs ranged in age from 3 to 17 years (mean = 9.2 years). The clinical presentation, reported in 20 cases, was indicative of a retrobulbar mass and included exophthalmos and orbital swelling (18/20), and papilledema or abnormalities of the posterior segment (7/20). Visual acuity was reported in 15 cases; of those, 12 dogs were blind in the affected eye. Follow-up information was obtained on 17 cases; six dogs developed local recurrence of the neoplasm. Two dogs with recurrent neoplasms simultaneously developed blindness in the opposite eye. Extension along the optic nerve to the optic chiasm was suspected. No metastasis was found at the time of the study. Enucleation with excisional biopsy was effective therapy to date in 11 cases (0.2–4.5 years follow-up time). All neoplasms were located within the vicinity of the optic nerve and, when sectioned through the optic nerve head, appeared to completely envelope the nerve. The neoplastic cells were arranged in tight whorls and bundles characteristic of meningiomas. Most tumors had islands of chondroid and osseous metaplasia (17/22). Ocular invasion was limited to small foci in the posterior choroid or optic nerve head of six dogs. Immunoperoxidase stains on 10 cases were positive for vimentin and S-100, but negative for cytokeratin. Electron microscopy revealed complex interdigitations between cell membranes and few desmosomal intercellular attachments. Primary orbital meningiomas have a characteristic histologic appearance and may recur locally after surgical excision.     

Unilateral optic nerve hypoplasia and hydrocephalus in a Pekingese

A 3-year-old, castrated male Pekingese was examined 2 days after automobile-induced trauma. Multiple pelvic injuries and visual deficits in the right eye were identified. During a subsequent postmortem examination, multiple pelvic fractures were confirmed; however, there was no evidence of head injury. Both globes were bilaterally symmetrical and grossly normal. The intraorbital and intracranial portions of the right optic nerve were threadlike and rudimentary in appearance, while the left optic nerve was grossly normal. Moderate dilatation of the left lateral ventricle was noted. Microscopically the right optic nerve and left nerve tract contained few identifiable nerve fibers. The right optic disc was depressed, and there was thinning of the optic nerve fiber and ganglion cell layers of the retina. No microscopic abnormalities were evident in the left optic nerve, optic disc, retina and right optic tract. The histologic changes in the right eye are consistent with optic nerve hypoplasia. The relationship between the optic nerve/optic tract lesions and the hydrocephalus is unknown.     

Studies on the experimental induction of ptosis in horses

The precise appearance of ptosis due to lesions at different sites was investigated in experimental ponies. The angles of the eyelashes to the head was used as an objective measurement of ptosis after local anaesthesia of the sympathetic trunk or the palpebral nerve and the administration of an ocular alpha agonist or antagonist. It was shown that ptosis is not an inevitable consequence of palpebral nerve pathology, that ocular alpha antagonists can induce ptosis, and that alpha agonist eyedrops have an inconsistent effect on the equine pupil, but are consistent at reversing ptosis induced by sympathetic denervation in unsedated horses.     

Clinical application of multidetector computed tomography and magnetic resonance imaging for evaluation of cranial nerves in horses in comparison with high resolution imaging standards

Although horses are affected by cranial nerve disease, our understanding of these structures' imaging anatomy is limited, and the optimal modality for imaging of each of these nerves is unclear. The aim of this study was to describe the imaging appearance of the equine cranial nerves on high‐resolution 1.5T magnetic resonance imaging (MRI) and computed tomography (CT) scans of a cadaver head, and with these as standards, examine the utility of MRI and CT performed in clinical cases. High‐resolution MRI and CT images were prospectively acquired of the head of a normal Thoroughbred gelding following euthanasia. Ten clinical cases undergoing high‐field MRI under general anaesthesia and 10 clinical cases undergoing CT in the standing horse under sedation were retrospectively evaluated by three reviewers to assess cranial nerve visibility. On high‐resolution, thin‐slice, MRI scans of the normal cadaver head, each of the 12 cranial nerves and their topographic location could be appreciated. On high‐resolution cadaver CT, cranial nerves II, V and VII were clearly visible, but others were less easily identified; osseous structures were clearly visualised. Clinical MRI and CT allowed for variable visualisation of the cranial nerves, dependent on the sequence and the orientation of scan planes. High‐field MRI allowed excellent visualisation of equine cranial nerves, whereas CT allowed for more detailed visualisation of the osseous canals and foramina. In live horses, the ability to identify all 12 nerves is challenging with either MRI or CT; however, high‐field MRI enables better visualisation of the nerve bundles than CT.     

Ischemic optic neuropathy and blindness after arterial occlusion for treatment of guttural pouch mycosis in two horses

Ischemic optic neuropathy accompanied by blindness was induced in 2 horses after surgical occlusion of the external and internal carotid and greater palatine arteries, performed as part of the management of guttural pouch mycosis. The blindness was acute and unilateral and may have been caused by ischemic retinal damage. Vascular occlusion is a recommended procedure for treatment of guttural pouch mycosis. Retinal damage and blindness are a possible complication if all possible sources of hemorrhage are occluded.     

Local anaesthetic techniques for the equine head,towards guided techniques and new applications

Perineural nerve blocks are often used in equine practice, especially since the use of diagnostic and surgical procedures in the standing sedated horse have expanded over recent decades. The purpose of this review is to discuss the different perineural nerve blocks for the equine head. The review starts with the currently most used blind approaches as described in textbooks and scientific studies. In human medicine, the role of guided techniques, such as ultrasound guidance, advanced imaging guidance and nerve stimulator guided techniques, is very extensively described. These techniques are promising to use in equine medicine as well. The first studies that describe these techniques in equine cases are also discussed in this review, as well as the possibilities for neuromodulation in equine pain syndromes like equine trigeminus-mediated headshaking and the role of perineural nerve blocks in diagnosing this syndrome.     

Comparative optic nerve physiology: implications for glaucoma, neuroprotection, and neuroregeneration

The axoplasm of optic nerve axons moves bidirectionally at various speeds along an intra-axonal pressure gradient from the retinal ganglion cell (RGC) somata toward its synapse, and from the synapse towards the RGC somata. The axoplasmic flow of optic nerve axons is precarious even at normal intraocular pressures (IOP) as it moves from the intraocular optic nerve through the scleral lamina cribrosa to the intraorbital optic nerve. The scleral lamina cribrosa is not simply a porous region of the sclera but a specialized extracellular matrix of the central nervous system whose movement during fluctuations in IOP can affect optic nerve axoplasmic flow. The abundant optic nerve blood supply maintains adequate optic nerve head perfusion through a process of vascular autoregulation. Glaucoma is associated with reduced optic nerve axoplasmic flow and compromised optic nerve circulation such that RGC death due to glutamate excitotoxicity and neurotrophin deprivation result.     

Canine ocular gliomas: a retrospective study

Objective The purpose of this paper is to classify glial tumors observed in the canine retina and optic nerve, describe the histopathological features and provide prognostic information on these neoplasms. Methods The database of the Comparative Ocular Pathology Laboratory of Wisconsin (COPLOW) was searched to collect canine glioma cases. Clinical and follow-up information was gathered from submission forms and an extensive follow-up survey. Slides were reviewed to describe the histopathological characteristics of the neoplasm and classify them. Immunohistochemistry for Glial Fibrillary Acidic Protein (GFAP) was performed in all cases. Results 18 canine glioma cases were found in the COPLOW database. There was no breed or gender predilection. The mean age was 9.33 ± 3.67 years. Follow-up information was available for 12 dogs, 8 of which were dead at the time of most recent contact, with a survival time ranging from 0 days (globes received after euthanasia) up to 20 months post-enucleation. In 6 of the 8 dogs that had died during this stud), tumor extended to the margin where the optic nerve had been sectioned. Light microscopic examination of the optic nerve of the affected eyes of four dogs that were still alive during this study revealed no tumor at this surgical margin. One neoplasm was classified as low-grade astrocytoma, 5 tumors as medium-grade astrocytoma, 11 tumors as high grade-astrocytoma and 1 tumor as oligodendroglioma. GFAP was positive in all but two tumors. Conclusion Retinal and optic nerve gliomas may be considered as differential diagnoses of intraocular and orbital masses. The metastatic potential appears to be low, but ascending invasion into the ventral aspect of the brain is possible.     

Immunohistochemistry of the extracellular matrix of the normal equine lamina cribrosa

Purpose To use immunohistochemical techniques to identify and localize the structural macromolecules of the extracellular matrix (ECM) of the normal adult equine lamina cribrosa in order to make comparisons to the extracellular matrix of the lamina cribrosa of horses with glaucoma. METHODS: Normal eyes of five adult horses between 5 and 10 years of age were fixed in 10% neutral buffered formalin and embedded in paraffin. Polyclonal rabbit-derived antibodies against human elastin, laminin, fibrillin-1, and collagen types I, III and IV, and polyclonal goat-derived antibodies against collagen type VI were used as primary antibodies. Transverse and longitudinal histologic sections of the optic nerve head and lamina cribrosa were stained using several dilutions of the primary antibodies, biotinylated link antibody, horseradish peroxidase-labeled streptavidin, and 3,3'-diaminobenzidine as a chromogen. The immunohistochemical staining patterns were qualitatively interpreted. RESULTS: The normal adult horse lamina cribrosa labeled positively for collagen types I, III and VI, laminin, elastin and fibrillin. Collagen type VI staining of the laminar ECM was most intense, followed by labeling for collagen types III and I, respectively. Laminar blood vessels were weakly positive for laminin and slightly positive for type IV collagen. The scleral ECM of the laminar insertion zone had more intense labeling for collagen types I and VI than did the laminar plates. CONCLUSIONS: The extracellular matrix of the laminar plates of the adult equine lamina cribrosa is similar to the dog as it consists of elastic and collagen fibers (with collagen types VI, III and I). Both the normal dog and horse lamina display more intense staining of collagen type VI than is found in the ECM of the normal human lamina cribrosa. The macromolecular structure of the equine lamina cribrosa suggests that it is a very resilient structure that may provide some protection to the optic nerve axons during episodes of elevated intraocular pressure.     

Morphologic changes in the lamina cribrosa of beagles with primary open-angle glaucoma

Optic nerve axoplasmic flow is known to be impaired at the scleral lamina cribrosa in Beagles with hereditary primary open-angle glaucoma and is similar to the condition in human beings. Trypsin and detergent digestion to remove all neural, vascular, and glial cellular tissue revealed a well-developed scleral lamina cribrosa in the normal dog in this study. Beagles with primary open-angle glaucoma had signs of mechanical distortion of the anterior lamina cribrosa prior to the detection of ophthalmoscopic changes in the optic nerve head. This change in the supporting architecture of the optic nerve began early and increased in severity as the disease process progressed.     

COMPUTED TOMOGRAPHIC APPEARANCE OF MELANOMAS IN THE EQUINE HEAD: 13 CASES

Melanomas are one of the most common neoplasms in the horse and are frequently found in the head region. There is a genetic predisposition in horses with a gray hair coat. Computed tomography (CT) is frequently used in referral practice to evaluate the equine head but there are few reports describing the CT appearance of melanomas in this location. The aim of this retrospective, case series study was to describe characteristics in a group of horses with confirmed disease. Case records from two referral hospitals were reviewed, and 13 horses were identified that had undergone CT of the head, with a diagnosis of melanoma based on cytology, histopathology, or visual assessment of black (melanotic) tissue. A median of 11 melanomas was identified per horse (range 3–60), with a total of 216 masses. Melanomas were found most frequently in the parotid salivary gland, guttural pouches, surrounding the larynx and pharynx and adjacent to the hyoid apparatus. In noncontrast CT images, all melanomas were hyperattenuating (median; 113.5 Hounsfield units (HU), IQR; 26 HU) compared to masseter musculature (median; 69 HU, IQR; 5.5 HU). Fifty‐six (25.9%) masses were partially mineralized and 41 (19.4%) included hypoattenuating areas. Histopathological assessment of these melanomas suggested that the hyperattenuation identified was most likely a result of abundant intracytoplasmic melanin pigment. Melanomas of the equine head appeared to have consistent CT features that aided detection of mass lesions and their distribution, although histopathological analysis or visual confirmation should still be obtained for definitive diagnosis .     

Neuroanatomy of the equine dorsal cricoarytenoid muscle: surgical implications

Reason for performing study: Studies are required to define more accurately and completely the neuroanatomy of the equine dorsal cricoarytenoid muscle as a prerequisite for developing a neuroprosthesis for recurrent laryngeal neuropathy. Objective: To describe the anatomy, innervation, fibre types and function of the equine dorsal cricoarytenoid muscle. Methods: Thirty‐one larynges were collected at necropsy from horses with no history of upper airway disease and 25 subjected to gross dissection. Thereafter, the following preparations were made on a subset of larynges: histochemical staining (n = 5), Sihler's and acetylcholinesterase staining for motor endplates (n = 2). An additional 6 larynges were collected and used for a muscle stimulation study. Results: Two neuromuscular compartments (NMC), each innervated by a primary nerve branch of the recurrent laryngeal nerve, were identified in all larynges. Stimulation of the lateral NMC produced more lateral displacement of the arytenoid cartilage than the medial NMC (P<0.05). The medial NMC tended to rotate the arytenoid cartilage dorsally. Motor endplates were identified at the junction of the middle and caudal thirds of each NMC. If fibre type grouping was present it was always present in both NMCs. Conclusions: The equine dorsal cricoarytenoid muscle has 2 distinct muscle NMCs with discrete innervation and lines of action. The lateral NMC appears to have a larger role in increasing cross‐sectional area of the rima glottidis. Potential relevance: This information should assist in planning surgical reinnervation procedures and development of a neuroprosthesis for recurrent laryngeal neuropathy.     

Genetics of upper and lower airway diseases in the horse

Genetic predispositions for guttural pouch tympany, recurrent laryngeal neuropathy and recurrent airway obstruction (RAO) are well documented. There is also evidence that exercise‐induced pulmonary haemorrhage and infectious diseases of the respiratory tract in horses have a genetic component. The clinical expression of equine respiratory diseases with a genetic basis results from complex interactions between the environment and the genetic make‐up of each individual horse. The genetic effects are likely to be due to variations in several genes, i.e. they are polygenic. It is therefore unlikely that single gene tests will be diagnostically useful in these disorders. Genetic profiling panels, combining several genetic factors with an assessment of environmental risk factors, may have greater value, but much work is still needed to uncover diagnostically useful genetic markers or even causative variants for equine respiratory diseases. Nonetheless, chromosomal regions associated with guttural pouch tympany, recurrent laryngeal neuropathy and RAO have been identified. The association of RAO with other hypersensitivities and with resistance to intestinal parasites requires further study. This review aims to provide an overview of the available data and current thoughts on the genetics of equine airway diseases.