Inflammatory stromal keratopathies: medical management of stromal keratomalacia, stromal abscesses, eosinophilic keratitis, and band keratopathy in the horse.

This article discusses the diagnosis and medical treatment of stromal keratomalacia or "melting ulcers," stromal abscesses, eosinophilic keratitis (EK), and calcific band keratopathy. These are common and important inflammatory keratopathies of the equine corneal stroma. Keratomalacia and stromal abscesses are associated with infection, leukocytic invasion of the stroma, and loss of tissue and tear film proteinase homeostasis. Eosinophils infiltrate the stroma in response to unknown stimuli in EK. Calcium is deposited in the stroma and epithelium secondary to chronic equine recurrent uveitis in calcific band keratopathy. They are all associated with varying degrees of iridocyclitis.     

Microsporidial keratopathy in two dogs

A microsporidial keratopathy is described in two dogs. Both dogs presented with a unilateral stromal keratopathy characterized by multifocal coalescing opacities, and the diagnosis was made on histopathologic examination of keratectomy specimens. Transmission electron microscopy (TEM) on formalin‐fixed, paraffin‐embedded corneal tissue was performed in one dog, and the morphologic features were consistent with Nosema species infection. Both dogs were initially diagnosed and treated by superficial keratectomy. One dog received additional antifungal medication and underwent a penetrating keratoplasty following local recurrence two years later. No other systemic lesions attributable to the microsporidial infection were identified clinically. The clinical and diagnostic pathology findings, treatment, and follow‐up are discussed.     

Nonulcerative bullous keratitis associated with Pseudomonas alcaligenes infection in a Thoroughbred mare

A 5‐year‐old Thoroughbred mare presented with an intermittently mildly painful right eye with a nonulcerative corneal opacity of several weeks' duration that had improved with topical steroids but recurred when steroids were withdrawn. Ophthalmic examination demonstrated a focal region of moderate corneal oedema and midstromal corneal infiltrate centrally but no other significant ocular abnormalities, and suggested a diagnosis of immune‐mediated keratitis. Empirical courses of both topical and systemic anti‐inflammatory drugs, both nonsteroidal and steroidal, led to initial improvement but bullous keratopathy developed when corneal oedema became profound. Due to the rapidly progressive nature of the bullous keratopathy combined with poor response to medical therapy, a keratectomy and conjunctival graft were performed under general anaesthesia. Intraoperative corneal culture of the keratectomy site grew Pseudomonas alcaligenes, a common soil and water contaminant. Histopathology of the keratectomy specimen revealed neutrophilic inflammation. Keratectomy and conjunctival graft led to resolution of ocular pain and inflammation, with an acceptable cosmetic and visual outcome. This report describes an unusual case of a nonulcerative Pseudomonas keratitis that responded well to surgical therapy, and underscores the complicated nature of nonulcerative keratitis in horses.     

Efficacy of two chondroitin sulfate ophthalmic solutions in the therapy of spontaneous chronic corneal epithelial defects and ulcerative keratitis associated with bullous keratopathy in dogs

OBJECTIVE: To determine the efficacy of two antimicrobial-chondroitin sulfate ophthalmic solutions in the therapy of spontaneous chronic corneal epithelial defects (SCCED) and ulcerative keratitis associated with bullous keratopathy in dogs. ANIMALS STUDIED: Eighty dogs with SCCED and 14 dogs with ulcerative keratitis associated with bullous keratopathy. PROCEDURE: Following manual debridement of nonadherent epithelium, dogs were treated topically with a chondroitin sulfate ophthalmic solution containing either tobramycin or ciprofloxacin. Patients were re-evaluated at 2-week intervals for 4 weeks. RESULTS: After 2 weeks of treatment, 53.6% of eyes with SCCED and 17.6% of eyes with ulcerative keratitis associated with bullous keratopathy had healed. After 4 weeks of treatment, 81.0% of eyes with SCCED and 23.5% of eyes with ulcerative keratitis associated with bullous keratopathy had healed. There were no statistically significant differences in healing percentages between the tobramycin-chondroitin sulfate solution treatment groups and the ciprofloxacin-chondroitin sulfate solution treatment groups. Two dogs with SCCED, one treated with the tobramycin-chondroitin sulfate solution and the other treated with the ciprofloxacin-chondroitin sulfate solution, developed sterile corneal stromal abscesses during the study. CONCLUSIONS: Topical therapy with an antimicrobial-chondroitin sulfate ophthalmic solution combined with manual debridement of nonadherent epithelium compares favorably with other published medical and surgical therapies for SCCED; however, these compounds are only equivocally more effective than therapy with manual debridement alone. These solutions appear to be ineffective in the treatment of ulcerative keratitis associated with bullous keratopathy. The significance of the two cases of corneal stromal abscessation is unknown at this time and warrants further investigation.     

Multilobular tumour of bone at an unusual location in the axilla of a dog

Multilobular tumour of bone is a rare neoplasm of cartilage, bone and connective tissue that is seen almost exclusively in association with the skull of veterinary patients. A four-year-old, spayed Jack Russell terrier was presented to the University of Georgia Veterinary Teaching Hospital because of a progressive swelling in the right axilla. Radiographs of the region showed the mass to be caudal to the scapula, unattached to bone and to have numerous punctate calcific opacities throughout its substance. Excisional biopsy of the mass was carried out under general anaesthesia and histopathological examination showed it to be multilobular tumour of bone. This case report documents the occurrence of multilobular tumour of bone at a site other than the head. This tumour should be considered in the differential diagnosis of soft tissue masses with calcific opacities.     

Once in a blue moon: Lipid keratopathy and intrastromal hemorrhage in a Mission golden‐eyed tree frog (Trachycephalus resinifictrix)

Mimicking natural anuran biology is a major challenge faced in the husbandry management of frogs, and the quandary of lipid keratopathy in frogs under human care has plagued keepers and practitioners for decades. Unlike corneal lipid dystrophy or lipidosis secondary to degeneration, where there is limited or no vascular in‐growth or inflammatory response, lipid keratopathies are associated with vascularization, most often following the appearance of lipid. Hemorrhage from stromal neovascularization has not been described in a frog; however, the presence of vessels in lipid keratopathy certainly heralds the possibility. We report a rather unique case of lipid keratopathy in a 6‐year‐old female Mission golden‐eyed tree frog (Trachycephalus resinifictrix) that not only had concurrent intrastromal hemorrhage, but blue plasmoid staining of the corneal stroma. Current views on both the function of blue plasma in several species and lipid keratopathy are briefly discussed. Overall, evidence suggests that the cause of lipid keratopathy is probably multifactorial and will not successfully be rectified until anuran biology and husbandry are better understood.     

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.     

Antemortem diagnosis of congenital glaucoma in a white‐bellied caique (Pionites leucogaster)

A 34‐day‐old, male, white‐bellied caique (Pionites leucogaster) was presented for a complaint of bilateral buphthalmos. Clinical examination was unremarkable apart from the ophthalmic findings. The ophthalmologic examination was negative for direct, consensual, and dazzle reflexes in both eyes. The intraocular pressure exceeded 40 mm Hg OU. Fluorescein stain demonstrated corneal surface lesions suggestive of exposure keratopathy subsequent to bilateral buphthalmos. Diagnostic imaging tests were conducted to perform ocular biometric measurements and investigate the intraocular structures, including the iridocorneal angle and lens, by means of high‐resolution ultrasonography (HRUS). The presence of congenital glaucoma in this young parrot was strongly suspected after clinical and ophthalmological examination and the results of diagnostic imaging. Pharmacological treatment to reduce intraocular pressure was initiated using dorzolamide hydrochloride 2% and timolol maleate 0.5%. A month later, the parrot's eyes did not show any visual improvement, but the intraocular pressure had returned to normal. The parrot was unable to feed itself and died during a feeding procedure. Postmortem examination revealed ab ingestis pneumonia. Both eyes were submitted for histopathology, with severe anterior segment dysplasia and goniodysgenesis found OU. Histological findings added to the clinical presentation, the ophthalmologic examination and the imaging findings, confirmed the presence of congenital glaucoma.     

Mortierella wolfii keratomycosis in a horse

Purpose To describe a case of superficial keratomycosis caused by Mortierella wolfii (M. wolfii) in a horse. Methods A thoroughbred filly was presented with painful right eye of 2 days’ duration. A superficial corneal ulcer was observed ventrally together with multifocal punctuate opacities axially. Samples were collected by swabbing and scraping the ulcerated lesion and submitted for microbiologic and cytologic examination. Results Microscopic evaluation of debrided corneal tissue revealed the presence of nonseptate fungal hyphae, and culture of a corneal swab yielded fungal growth. Medical treatment with topical antifungal, antibiotic and autogenous serum and systemic anti‐inflammatory resolved the problem within 2 weeks. Conclusions Cytologic evaluation of a corneal scraping was useful to make a clinical diagnosis of keratomycosis. Based on the mycological characteristics, the fungus isolated from the corneal lesion was identified as M. wolfii. To the authors’ knowledge, this is the first case report of equine keratomycosis associated with this fungus, although the organism is known to infect various organs of cattle.     

Keratitis due to microfilariae in dogs: a newly recognized disease

Parasitic agents have been associated with keratitis, but a diagnosis of parasitic keratitis has not been commonly made in domestic animals. The purpose of this study was to describe the clinical and histopathological findings in seven dogs with chronic keratitis caused by microfilariae diagnosed in Brazil. All dogs presented with superficial corneal opacities of varying degrees affecting the perilimbal and central regions of the cornea, with other opaque areas appearing as crystalline deposits and corneal vascularization. The lesions were bilateral and were associated with mild‐to‐moderate conjunctival hyperemia. There was no history of blepharospasm or pruritus, and no subjects presented with epithelial erosions. Corneal biopsy revealed free microfilariae in the corneal stroma, with varying degrees of inflammation and collagen fiber destruction. The microfilariae were also found in skin lesions by skin snip technique. No adult worms were found in these dogs, and no dogs were on heartworm preventative before diagnosis. Monthly doses of oral ivermectin improved ocular and dermal lesions. One dog showed complete remission with the treatment. The species of the microfilariae was not identified.     

Laparoscopic Cystotomy for Removal of a Large Bladder Polyp in a Juvenile Alpaca with Polypoid Cystitis

Objective: To describe a method for laparoscopic cystotomy in an alpaca. Study Design: Case report. Animals: Female alpaca. Methods: An 8‐month‐old female alpaca was admitted with a 6‐week history of straining to urinate and vulvar swelling. Transrectal ultrasound examination revealed a 1.5 × 1.5 × 2 cm polyp within the bladder. Results: The mass was excised using laparoscopic cystotomy. Leakage from the cystotomy site resolved over 12 days using a Foley catheter. The alpaca was healthy and urinating normally at 9 months after surgery. Conclusion: Minimally invasive surgery by laparoscopic cystotomy can be used to remove large urinary polyps in alpacas. Clinical Relevance: Urinary bladder polyps should be considered as differential diagnosis in alpacas with stranguria.     

A retrospective study of 30 cases of frozen lamellar corneal graft in dogs and cats

Frozen lamellar corneal grafts and nictitating membrane flaps were used in 18 dogs and 12 cats to repair deep corneal defects. In all dogs either melting corneal ulcers or descemetoceles were present. In the 12 cats, nine had either a melting corneal ulcer or descemetocele, two animals had acute bullous keratopathy, and one cat had corneal sequestrum. Initial vascularization with gradual clearing of the graft occurred during the first 45 days postoperatively. At 60 days postoperatively, all eyes were visual. Frequent postoperative complications included: focal dehiscence of the wound ( n  = 9); melting of part of the graft ( n  = 7); and pigmentation of the graft ( n  = 4). The frozen lamellar corneal graft was a very safe technique, and restored the tectonic and the optical function of the cornea. It provided the best results in corneas with nonperforating corneal defects. This technique provides poorer results when the cornea was perforated prior to surgery or during the surgical procedure.     

Keratitis in red deer

Twenty-five of 40 red deer (Cervus elaphus) exhibited corneal opacities and ulceration resembling mild bovine infectious keratitis. Attempts to incriminate either a bacterial or viral causal agent were unsuccessful.

Subconjunctival injections of a penicillin/streptomycin mixture were administered in both eyes of affected and in-contact animals. Resolution over an 8 week period was uneventful.     

Successful management of severe hypoventilation and hypercapnia in an alpaca (Vicugna pacos) with short‐term mechanical ventilation

Objective – To describe the successful management of an alpaca with severe hypoventilation and hypercapnia, suspected to be secondary to an anesthesia‐related event. Case Summary – A 3‐year‐old, female alpaca underwent a routine eye enucleation under general anesthesia after traumatic globe perforation. Severe hypoventilation and associated hypercapnia developed postoperatively resulting in a severe primary respiratory acidosis. The awake alpaca was supported with positive‐pressure ventilation for approximately 20 hours before successful weaning. Recovery to hospital discharge occurred over the subsequent 5 days with the alpaca regaining apparently normal respiratory function. New or Unique Information Provided – To the knowledge of the authors, this is the first report describing positive‐pressure ventilation of an alpaca in the veterinary literature. In this case of severe hypoventilation, ventilatory support was essential to the positive outcome. As South American camelids continue to increase in popularity there may be an increased demand for high‐quality and sophisticated veterinary care for these animals. Mechanical ventilation can be used to help restore and maintain normal PO₂, PCO₂, and respiratory acid‐base status in alpacas with ventilatory dysfunction.     

Bacterial and fungal pathogens isolated from corneal ulcerations in domesticated elephants (Elephas maximus maximus) in Sri Lanka

Infective corneal diseases are common among the domesticated elephants in Sri Lanka, causing morbidity including blindness leading to loss of revenue to their owners. From 140 elephants of different ages and both sexes, 36 animals (25.7%) had evidence of keratitis, corneal ulcers, corneal opacities, and some had foreign bodies in their eyes. Nine elephants (6.4%) had lesions in both eyes (6.41%). Cultures for both bacteria and fungi were obtained from 26 corneal ulcers, including the nine elephants with bilateral lesions. The other 10 animals could not be restrained for sample collection. Swabs from the normal corneas of an additional 20 elephants without signs of any ophthalmic diseases were also collected. Twenty-three of the 35 (65.71%) samples from affected corneas yielded bacterial pathogens, and 14 (40%) also had fungal isolates. None of them yielded a fungal isolate alone. The predominant bacteria isolated were Staphylococcus aureus , beta hemolytic streptococci and coliforms. Fusarium , Cladosporium , Curvularia and Aspergillus species were the primary fungal isolates. No bacteria or filamentous fungi were isolated from the eyes with the normal corneas. Microbial identification including fungal isolations is suggested in the management of infective corneal diseases in elephants.     

Haemolytic anaemia and bilateral uveitis associated with leptospirosis in a 6‐year‐old Quarter Horse gelding

A 6‐year‐old Quarter Horse gelding was presented for bilateral uveitis resulting in vision loss as well as icterus. Anaemia with autoagglutination was consistent with a presumptive immune‐mediated haemolytic anaemia. Urinary PCR was positive for Leptospira spp. and microscopic agglutination test (MAT) titres were elevated to multiple serovars supportive of a diagnosis of leptospirosis. Treatments included broad spectrum antibiotics and aggressive anti‐inflammatory medications. While the horse was hospitalised, the development of bilateral corneal ulcers precluded the use of topical ophthalmic anti‐inflammatories for a number of days. The corneal ulceration resolved, vision returned in both eyes and the immune‐mediated haemolytic anaemia resolved. After 9 days of hospitalisation, oral minocycline was administered for 2 weeks at home as well as low dose oral flunixin meglumine and topical ophthalmic diclofenac and atropine. This case represents the first published case of haemolytic anaemia associated with leptospirosis in a horse.     

The effect of UV-blocking contact lenses as a therapy for canine chronic superficial keratitis

Objective To evaluate the effect of UV‐blocking soft contact lenses in treatment for chronic superficial keratitus (CSK). Methods Twenty six dogs with CSK were treated continuously with UV‐blocking contact lenses for 6 months. A contact lens was placed on one eye of each dog; the other eye remained without a lens as a control eye. After this primary study, five of the dogs were further treated and they wore then contact lenses in both eyes. Continuously, all patients were concurrently treated topically with cyclosporine. The contact lenses were changed every 4 weeks and an ophthalmic examination performed. Evaluation criteria included corneal alterations as pigmentation, edema, pannus and vascularization. To determine the transmittance characteristics of the contact lenses before and after use, 32 contact lenses were measured with a UV‐vis‐NIR spectrophotometer. Results Pigmentation increased in eyes wearing lenses and in control eyes over the evaluation period of 6 months. Corneal edema increased in the eyes wearing lenses, but remained unaffected in the control eyes. A significant difference in the incidence of pannus and the extent of corneal vascularisation could not be evaluated. Adverse effects were noted in six cases (corneal edema and vascularisation, conjunctivitis, blepharospasm). All new lenses studied reduced UV‐radiation to a safe level, whereas used lenses did not maintain their transmittance characteristics. Conclusions No positive effect of UV‐blocking contact lenses could be proven with the study design used.     

Prevalence of ophthalmic disease in blue‐eyed horses

A perception exists amongst referring veterinarians and the lay public that blue‐eyed horses have increased frequency of ocular disease. The aim of this retrospective study was to assess the prevalence of ocular disease in horses with blue or heterochromic eyes relative to those with brown eyes. The medical records of horses presenting to either the Comparative Ophthalmology services or Equine Medicine/Surgery services at 2 institutions were reviewed. Signalment, ocular and nonocular diagnoses were recorded. Ocular disease was divided into 4 categories: adnexa, cornea, intraocular/orbit and squamous cell carcinoma (SCC). Owners were contacted by telephone to confirm iris colour. Chi‐square analysis was used to compare group proportions. A total of 164 eyes of horses with ocular disease and 212 eyes of horses without ocular disease were included. Blue eyes were equally common in the ocular disease and nonocular disease groups (P = 0.265). There was no significant difference in the proportion of blue‐ and brown‐eyed horses when comparing the adnexal and corneal (P = 0.548), corneal and intraocular/orbit (P = 0.379) and adnexal and intraocular/orbit (P = 0.843) categories. A significant difference was detected in the proportion of blue‐eyed horses between the adnexal (P = 0.000), corneal (P = 0.033), intraocular/orbital (P = 0.000) and SCC categories, with a higher proportion of blue‐eyed horses in the SCC than in the other 3 groups. Horses with blue or heterochromic irides are more likely to develop ocular SCC than horses with brown irides, but are not more likely to have adnexal, corneal or intraocular/orbital disease or to be presented for evaluation of ophthalmic disease. Veterinarians should consider the results of this study when answering questions from the lay public regarding the predisposition of blue‐eyed horses to ocular disease.     

Distichiasis causing recurrent corneal ulceration in two Friesian horses

Two cases of distichiasis with subsequent recurrent superficial corneal ulceration are described in Friesian horses. Case 1 was a 9‐year‐old Friesian stallion with distichiae on the superior and inferior eyelids of both eyes corresponding to areas of recurrent superficial corneal ulceration. Case 2 was a 5‐year‐old Friesian gelding with a single distichia on the inferior lid associated with recurrent superficial corneal ulceration in the right eye. Case 1 underwent cryotherapy and epilation twice under standing sedation without resolution of distichiasis. A partial tarsal plate excision was then performed on the inferior left lid, which was the most severely affected. Cryotherapy was repeated one and 4 months post operatively due to recurrence. Cryotherapy was associated with skin depigmentation and repigmentation several months following the procedure. No recurrence has been reported up to 3 years following the fourth cryotherapy procedure. Case 2 was treated with epilation. Distichiasis should be included as a differential diagnosis when presented with a horse experiencing recurrent superficial corneal ulcerations. There has been no established breed association for Friesian horses and distichiasis but, due to the inherited nature of this condition in some human patients and dogs, this possibility should be investigated.     

Surgical treatment of epibulbar melanocytomas by complete excision and homologous corneoscleral grafting in dogs: 11 cases

Objective The aim of the study was to evaluate the efficacy, outcome, and complications following penetrating sclerokeratoplasty and frozen homologous corneoscleral grafting for the management of extensive canine epibulbar melanocytomas. Methods Medical records of canine patients treated at three different veterinary hospitals between 1999 and 2010 were reviewed. Signalment, location and extent of melanocytomas, recurrence rate, and early and late complications were reported. Patients were re‐examined postoperatively to provide follow‐up information. Results Patients included one intact male, three castrated males, six intact females, and one spayed female, with a median age of 5 years (range, 3–9). German Shepherds were overrepresented. Tumors extended from 2 to 4 clock hours at the limbus and up to 17 mm from clear cornea to globe equator. One case showed iridocorneal angle invasion; corneal involvement was present in all cases, and lipid keratopathy was present in four cases. In two cases, there was incomplete resection owing to tumor extent. Follow‐up time ranged from 3 to 72 months (median, 17 months), with one case of intraocular tumor progression. Early complications included anterior uveitis (11/11), intracameral fibrin (5/11), hyphema (4/11), corneal edema (4/11), exuberant corneal granulation tissue (2/11), focal retinal edema (1/11), dyscoria (1/11), and partial suture dehiscence (1/11). Late complications included corneal fibrosis and/or pigmentation (11/11), faint anterior cortical cataracts (3/11), and lipid keratopathy (1/11). Vision was retained in all cases. Conclusions This technique offers a surgically challenging but effective treatment for extensive epibulbar melanocytomas. In this case series, complications were mild and transient, with preservation of ocular anatomy and function.