Effects of radiofrequency hyperthermia on the healthy canine cornea

Radiofrequency hyperthermia was used to induce axial corneal lesions in the eyes of 10 dogs. Clinical observations were continued for up to 6 months, using biomicroscopy and indirect ophthalmoscopy. Eyes were harvested at intervals for light and electron microscopic evaluation. Clinical alterations included immediate corneal opacification and epithelial disruption at the site of electrode contact. Ulcerative keratitis persisted for 4 to 6 days, accompanied by anterior uveitis. Additional corneal changes included stromal thinning, edema, and vascularization. Final evaluation revealed negligible alterations in corneal contour or clarity 6 months after treatment. Microscopically, epithelial and superficial stromal necrosis preceded epithelial loss. Stromal alterations included edema (associated with focal endothelial detachments), vascularization, and inflammatory cell infiltration. Recovery was characterized by keratocytic hyperplasia and hypertrophy, epithelial proliferation, and stromal condensation.     

Advances in the molecular understanding of canine retinal diseases

Retinal dystrophies are a common cause of blindness in purebred dogs. Progressive retinal atrophy, the canine equivalent of retinitis pigmentosa in humans, is the most common dystrophy. Molecular studies have led to the identification of the genetic defect underlying some forms of progressive retinal atrophy and the mapping of the chromosomal location of others. Additionally, the gene mutation that causes a severe retinal dystrophy in the briard, which is the equivalent of Leber congenital amaurosis in humans, has been identified. These advances have led to the development of DNA-based diagnostic tests for some retinal dystrophies, thus facilitating their eradication. The study of these dystrophies in dogs has also provided useful information about the equivalent diseases in humans. Recently, gene therapy has been used to restore vision to dogs with a retinal dystrophy due to a mutation in the RPE65 gene. Such studies are important in the quest to develop therapies for similar conditions in humans.     

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.     

Keratoprosthesis with retrocorneal fixation: preliminary results in dogs with corneal blindness

Objective To evaluate the use and complications of a penetrating keratoprosthesis implantation in the management of corneal opacification in dogs. Methods A retrospective clinical study describes the indications for the surgical technique utilized and the outcomes of this procedure in 20 eyes of 19 dogs with blindness of corneal origin. A successful surgical outcome was defined as a clear keratoprosthesis optic and improvement or restoration of functional vision over a follow‐up period ranging from at least 8 months to a maximum of 7 years. Results Eyes with total corneal opacification resulting from chronic superficial keratitis (n = 11), keratoconjunctivitis sicca (n = 5), endothelial dystrophy (n = 3) and chemical burn (n = 1) were treated by unilateral (n = 18) or bilateral (n = 1) full‐thickness implantation of a keratoprosthesis. Keratoprostheses were retained in 15 eyes (75%) which regained vision to the date of reporting. Among these eyes, six had uncomplicated postoperative course, five developed retroprosthetic membranes and four developed granulation tissue over the optic of the keratoprostheses. These complications were successfully removed surgically in the nine eyes. The five remaining eyes (25%) developed serious early postoperative complications, for which enucleation had to be performed. Conclusion In keratopathies in which the corneal opacification could not be treated by standard medical or surgical procedures, this keratoprosthesis appears to be promising to restore vision in chronic superficial keratitis and deep corneal dystrophy. It appears to have a poor prognosis in keratoconjunctivitis sicca in brachycephalic dogs. The post operative complications retro‐prosthetic membranes and granulomatous overgrowth could be treated well.     

Recent advances in understanding the spectrum of canine generalised progressive retinal atrophy

Canine generalised progressive retinal atrophy (gPRA) is a large and ever-increasing collection of naturally occurring, heterogeneous, progressive disorders. Most are inherited in an autosomal recessive manner and new, breed-specific forms continue to be described. The gPRAs cause photoreceptor cell death and subsequent retinal degeneration, culminating in blindness. In humans, similar inherited retinal dystrophies are recognised as retinitis pigmentosa and macular dystrophy. Molecular biological studies have revealed disease-causing mutations in several genes in humans and also in mice with retinal dystrophies. Recently, molecular genetic techniques have identified the cause of one form of gPRA in Irish setters while important candidate genes have been investigated in other breeds. Identification of mutations responsible for different forms of gPRA allows carrier and pre-degenerate animals to be detected using DNA-based tests. Such genetic tests will greatly facilitate the eradication of these diseases in different breeds.     

Persistent corneal ulcers. What to do when ulcers won't heal

Persistent corneal erosions may be primary or secondary to a variety of ocular diseases such as KCS, infection, or adnexal disease. Primary corneal diseases that may result in nonhealing erosions include corneal EBMD and endothelial dystrophy or degeneration. The challenge that the practitioner faces is to differentiate between them and to apply the appropriate treatment. A variety of medical and surgical therapies are at the disposal of the practitioner. These include debridement, contact lens placement, superficial keratectomy, punctate keratotomy, hyperosmotic solutions, and several new drug modalities such as epidermal growth factor, fibronectin, and aprotinin.     

Chronic corneal edema in aged ranch mink

Chronic corneal edema occurred in 53% of 116 ranch mink (Mustela vison) 8 to 11 years old. Most were royal pastel females, the main group at risk. Bilateral in 46 of 66 affected mink studied, the edema evolved over a month or so until the cornea became opaque, diffusely pale blue-gray or white, and greatly thickened. The swollen cornea did not become ulcerated, pigmented, or vascularized, even after it had been severely edematous for a year or two. The edema supervened as a consequence of spontaneous deterioration of the corneal endothelium. Attenuation and loss of the endothelial monolayer were the most common light microscopic changes. Other changes included discrete excrescences (guttata) along the posterior surface of the thickened Descemet's membrane and a subendothelial fibrillar or fibrocellular layer (posterior collagenous layer) often apposed to the excrescences. Likened to the primary endothelial dystrophies of man and the dog, this endothelial disorder of mink is regarded as an abiotrophic degeneration with its own distinguishing features in this species.     

Light at the end of the tunnel? Advances in the understanding and treatment of glaucoma and inherited retinal degeneration

Glaucoma and inherited retinal degeneration/dystrophy are leading causes of blindness in veterinary patients. Currently, there is no treatment for the loss of vision that characterizes both groups of diseases. However, this reality may soon change as recent advances in understanding of the disease processes allow researchers to develop new therapies aimed at preventing blindness and restoring vision to blind patients. Elucidating the molecular mechanisms of retinal ganglion cell death in glaucoma patients has led to the development of neuroprotective drugs which protect retinal cells and their function from the disastrous effects of elevated pressure. Identification of the genetic mutation responsible for inherited degenerations and dystrophies of the outer retina has enabled researchers using gene therapy to restore vision to blind dogs. Other patients may benefit from retinal transplantation, stem cell therapy, neuroprotective drugs, nutritional supplementation and even retinal prostheses. It is possible that soon it will be possible to restore sight to some blind patients.     

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.     

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.     

Tear production in dogs with epiphora and corneal epitheliopathy

Measurement of tear volume by phenol red thread tear test (PRT), Schirmer's tear test (STT-1) and Schirmer's tear test with topical anesthesia (STT-2), and vital staining with a combination of fluorescein and rose Bengal of the cornea were performed in dogs with normal eyes and those with epiphora. The breeds included the Shih-Tzu ( n  = 26), and five other breeds ( n  = 50). The PRT, STT-1 and STT-2 results from the five breeds of normal dogs were 26.9 ± 3.0 mm, 17.4 ± 4.3 mm, and 8.8 ± 3.2 mm, respectively. The PRT, STT-1, and STT-2 results for the Shih-Tzu eyes were (mean ± standard deviation): 28.2 ± 4.3 mm, 19.5 ± 4.1 mm, and 9.2 ± 4.5 mm, respectively. In the five breeds, corneal epitheliopathy, as evidenced by the retention of topical fluorescein and rose Bengal, occurred in 97% of dogs with epiphora and in 55% of the dogs without epiphora. Also in the dogs with corneal epitheliopathy the STT-2-value was low (4.0 ± 2.8 mm) compared with those eyes without corneal epitheliopathy (8.8 ± 3.1 mm). In the Shih-Tzu breed the STT-2 results were not significantly different between those dogs with corneal epitheliopathy and those with normal corneas. In the non-Shih-Tzu breeds the decrease in basic tear secretion, as measured by the STT-2, is associated with the corneal epitheliopathy.     

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.     

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.     

Analysis of a deletion in the nephronophthisis 4 gene in different dog breeds

Cone‐rod dystrophy is a progressive inherited retinal degenerative disorder that occurs in humans and dogs. The deletion in the nephronophthisis 4 (NPHP4) gene was established as a causative mutation in standard wire‐haired Dachshunds. We analyzed all varieties of Dachshunds from the Czech Republic and five other dog breeds and found that the deletion in the NPHP4 (in heterozygous state) is present not only in standard‐, but also in miniature wire‐haired Dachshunds, but not in other varieties of Dachshunds or in other breeds.     

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.     

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.     

Adnexal surgery in dogs and cats

Abnormalities in eyelid position and function can lead to chronic irritation of cornea and conjunctiva. Corneal ulceration, vascularization and pigmentation are common consequences. Loss of vision, or loss of the globe may be the end result. The combination of ptosis and entropion of the upper eyelid is commonly seen in breeds with abundant forehead skin folds. Treatment options include surgical reduction of skin folds, suspending the brows, enforced secondary granulation of the upper eyelid, or a combination of procedures. Lid-shortening procedures reduce corneal exposure, improve functional blinking and reduce likelihood of traumatic proptosis. Although a lateral canthoplasty is technically easier to perform, a medial canthoplasty is the preferred method of eyelid shortening. An involuted lateral canthus with entropion is seen in certain dog breeds with a broad skull base and redundant facial skin. Surgical correction is by either applying traction to the lateral canthus, or by resection of the lateral canthal ligament. A combination of entropion, ectropion and macroblepharon may result in the presence of diamond shaped eyelids. Surgical correction involves the combination of several procedures. Upper eyelid agenesis is a congenital absence of part of the upper eyelid in cats. Treatment options include a skin-orbicularis flap from the lower eyelid with a conjunctival pedical graft, the transposition of the lower eyelid to the upper eyelid, cross lid flap and subdermal plexus flap, and subdermal collagen injection. Several techniques for reconstruction of upper and lower eyelid defects are described.     

A keratoprosthesis prototype for the dog

Objective  To describe the technique for implantation of a novel keratoprosthesis (KP) prototype and evaluate its application for the treatment of corneal blindness in dogs.
Animals studied  Seven dogs, all of them being clinically blind before surgery as a result of severe corneal endothelial disease (5/7) or chronic superficial keratitis (2/7) that were unresponsive to prior therapy.
Procedures  A silicone KP was implanted unilaterally, just anterior to Descemet's membrane, after creating a stromal pocket by deep stromal lamellar dissection.
Results  Implantation of the KP was accomplished without complication in six of seven operated dogs. In the remaining case, an intra-operative complication (perforation of Descemet's membrane) was associated with extrusion of the KP 8 weeks postoperatively. All operated eyes regained limited vision after surgery. Three to six months after implantation purulent keratitis occurred in all five eyes with endothelial disease, necessitating surgical removal of the KP 6 months postoperatively in 5/7 eyes.
Conclusions  This KP prototype shows promise as a treatment for certain blinding corneal diseases. However, changes in the design of this KP, allowing improved stromal integration, will be necessary before its clinical application can be approved.     

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.     

Glaucoma in the dog and cat

Conjunctivitis, mydriasis, corneal edema, lens luxation, buphthalmos, and blindness are caused by elevated IOP in the glaucomas. Primary glaucomas with a bilateral potential for development are noted in two cats and several dog breeds, with secondary glaucomas caused by uveitis and neoplasia common in the cat and dog. Tonometric evaluation is essential for the early diagnosis and management of glaucoma. Medical therapy of topical demecarium bromide and timolol maleate, with systemic dichlorphenamide, are recommended for general glaucoma maintenance therapy in dogs and cats. Transcleral cyclophotocoagulation will surgically reduce IOP in cases in which maximum medication has been reached.