Penetrating keratoscleroplasty and bimodal grafting for treatment of limbal melanocytoma in a dog

A 6-year-old, male neutered, German Shepherd dog presented for evaluation of a dark limbal mass OS. Based on the signalment and clinical findings, a presumptive diagnosis of limbal melanocytoma was made. Additionally, OU demonstrated corneal changes consistent with chronic superficial keratitis. Full thickness en bloc resection of the limbal mass was followed with reconstruction and grafting using both frozen cornea and bulbar conjunctiva. Nitrous oxide cryotherapy was utilized as an adjunctive modality for residual neoplastic cell destruction. Histopathologic evaluation confirmed the presumptive diagnosis. At 18 months postoperatively, there was no evidence of recurrence of the limbal melanocytoma. The dog was treated long-term with both topical steroid and tacrolimus 0.03% for control of the chronic superficial keratitis.     

Treatment of corneal squamous cell carcinoma using topical 1% 5‐fluorouracil as monotherapy

The purpose of this report is to discuss the use of topical 1% 5‐fluorouracil as a sole therapy for canine corneal squamous cell carcinoma (SCC). A 12‐year‐old castrated male pug was evaluated for a well‐demarcated, central, 3 mm in diameter, pale pink, raised, right corneal mass. An incisional biopsy was obtained using a #64 beaver blade after topical anesthesia and without sedation. A definitive diagnosis of corneal SCC was obtained after histopathologic evaluation of the biopsy. Topical 1% 5‐fluorouracil ointment was applied to the right eye four times daily for 2 weeks followed by no treatment for 2 weeks, then treatment again twice daily for 2 weeks. The cornea remained free of recurrence 10 months after cessation of treatment. In dogs affected with corneal SCC, topical 1% 5‐fluorouracil monotherapy may be a viable and cost‐effective treatment option with minimal side effects. This chemotherapy agent may also have an effect on corneal pigmentation. Chronic cyclosporine therapy did not contribute to the pathogenesis of corneal SCC in the case described.     

Corneal plaque containing levofloxacin in a dog

A 13‐year‐old castrated male Yorkshire terrier developed a corneal ulcer 2 weeks after intracapsular lens extraction (ICLE) in the right eye. The corneal ulcer was treated with levofloxacin eye drops. A plaque with a white luster developed in the central cornea 2 weeks after treatment with levofloxacin eye drops. The corneal plaque was surgically removed under inhalant anesthesia. The corneal plaque displayed antimicrobial activity against Escherichia coli. Furthermore, levofloxacin content in the plaque was confirmed by matrix‐assisted laser desorption/ionization time‐of‐flight/time‐of‐flight (MALDI‐TOF/TOF) mass spectrometry (MS). The corneal ulcer completely resolved 2 weeks after the surgical removal of the corneal lesion and replacement of levofloxacin eye drops with tobramycin eye drops. Although the topical use of levofloxacin is unlikely to lead to corneal chemical deposits due to the high water solubility of the drug compared to other topical fluoroquinolones, this patient developed corneal plaque of the antibiotic drop.     

A cross‐linked hyaluronan gel accelerates healing of corneal epithelial abrasion and alkali burn injuries in rabbits

Objective To evaluate the efficacy of a chemically modified and cross‐linked derivative of hyaluronan (CMHA‐SX) for treatment of corneal epithelial abrasion and standardized alkali burn injuries. Animals Twelve female New Zealand white rabbits in two groups were used. Procedures Bilateral 6‐mm diameter corneal epithelial abrasions were made in each of six rabbits in one group and 6‐mm standardized alkali burn injuries were made in the second group. A 1% CMHA‐SX formulation was applied topically four times per day in right eye of each rabbit for 1 week, and phosphate buffered saline (PBS) was placed in left (control) eye of each rabbit. The wound size was determined by staining with 1% fluorescein and photographed at the slit lamp with a digital camera at 0, 1, 2, 3 days postoperatively in the first group and 0, 1, 2, 3, 7, 12 days in the second group. Rabbit corneas were collected for histological examination on day 7 in the first group and day 12 in the second group. Results Closure of corneal wound in the abrasion model was complete in the CMHA‐SX treated eye by 48 h. The wound closure rate and thickness of the central corneal epithelium in the CMHA‐SX treated group was greater than in control eyes for both the abrasion and alkali burn injuries. Moreover, the CMHA‐SX treated cornea exhibited better epithelial and stromal organization than the untreated control cornea. Conclusions Chemically modified and cross‐linked derivative of hyaluronan improved corneal wound healing and could be useful for treating noninfectious corneal injuries.     

The use of porcine small intestinal submucosa for the repair of full-thickness corneal defects in dogs, cats and horses

OBJECTIVE: To evaluate the efficacy of using a porcine small intestinal submucosa (SIS) graft covered by a conjunctival flap for the surgical repair of full-thickness corneal wounds in dogs, cats and horses. PROCEDURE: All records dating from August 1999 to February 2003 from Purdue University Veterinary Teaching Hospital of patients that had undergone ophthalmic surgical procedures and received a SIS corneal graft for a full-thickness lesion were reviewed. Fifteen cases were identified including six dogs, two cats and seven horses. Requirements for inclusion in this study were that SIS was used as a corneal graft in a full-thickness corneal defect and that the graft was completely covered with a conjunctival flap. RESULTS: Of the 15 cases, one canine patient had received SIS following removal of an epibulbar melanocytoma. The remaining five canine patients had undergone this surgical procedure for the repair of corneal perforation. The two feline patients had been presented for corneal perforation following chronic ulceration. One equine patient had been presented for a deep melting ulcer, three for stromal corneal abscesses, and three for corneal perforations. Complications encountered postoperatively included aqueous leakage, conjunctival flap dehiscence, synechia, cataract and fibrin in the anterior chamber. Fourteen out of 15 patients were visual at the final re-evaluation. CONCLUSION: SIS is an inexpensive, easy-to-handle biomaterial that appears to be suitable for the repair of full-thickness corneal wounds in dogs, cats and horses. Results of our study support the conclusion that this relatively new product is an effective alternative to traditional implantation materials utilized in veterinary ophthalmology.     

The clinical presentation of a mid‐tail melanocytoma with sudden malignant transformation in a bay Irish Draught gelding

Equine melanocytic tumours may be either a benign or malignant skin disease. They commonly involve the skin of grey horses. There are no reports of mid‐tail melanocytoma with sudden malignant transformation. Partial tail amputation was used to resect a melanocytic tumour mass from the mid‐tail of a 16‐year‐old bay Irish Draught (ID) horse. There was no evidence of significant re‐growth or complications at a 6‐month post operative examination.     

Tolerance of the rabbit cornea to an n-butyl-ester cyanoacrylate adhesive (Vetbond)

Objective An n‐butyl‐ester cyanoacrylate adhesive available for veterinary surgery (Vetbond^®, 3M) was tested in rabbits for corneal irritation. Procedures Two experimental procedures were used on 24 rabbits: injection of the adhesive into an intralamellar corneal pocket (n = 10) and application of the glue to a mid‐stromal corneal defect (n = 14). In both experiments the eyes were examined for 20 days for evidence of corneal irritation and tolerance. At the end of each experiment, histopathologic studies were performed on all corneas. Results The corneal reaction to the intrastromally injected cyanoacrylate was characterized clinically by slight edema and vascularization localized to the vicinity of the adhesive. A moderate foreign body‐type reaction was found histologically. Following application of the adhesive to a central stromal defect, the treated corneas remained totally clear and histopathologic examination showed that the healing process was not altered compared to the controls. The mean retention time of the glue patch was 14 days. Conclusions Intrastromal injection and surface application to a corneal defect of n‐butyl‐ester cyanoacrylate to a corneal defect induced only a mild inflammatory response and did not interfere with the reparative process. These findings suggest that this surgical adhesive would be acceptable for treating corneal ulcerations in animals.     

A matched observational study of canine survival with primary intraocular melanocytic neoplasia

A retrospective histopathologic study was performed to evaluate the effect of primary intraocular melanocytic neoplasia on canine survival. Tumor size, location within the globe, extent of infiltration, and mitotic index were analyzed for their potential to predict survival. A total of 244 cases of dogs with melanocytic tumors submitted to the Comparative Ocular Pathology Laboratory of Wisconsin from 1988 to 1998 were evaluated. Histopathologic criteria (mitotic index, cytologic features of anaplasia) were used to differentiate 188 benign melanocytomas from 56 malignant melanomas. Signalment evaluation of age, sex, and breed revealed similarities in both tumor populations, with the majority of tumors discovered in 9-year-old, female/spayed, mixed-breed dogs. A greater percentage of left eyes (66%) vs. right eyes (47%) was found in the melanoma population, but an equal distribution was found in the melanocytoma population (48% and 52%, respectively). The majority of tumors arose from the anterior uveal tract (79% in the melanocytoma and 95% in the malignant melanoma populations). The German Shepherd breed was predisposed in the limbal distribution. At the time of enucleation, most tumors had invaded the sclera, but did not show extrascleral extension (51% in the melanocytoma and 61% in the malignant melanoma populations). Survival analysis showed a significant difference in survival between control and malignant melanoma populations ( P  = 0.0081) and was suggestive of a difference between the melanocytoma and melanoma populations ( P  = 0.031). Tumor extension, tumor size, and mitotic index were not found to be reliable predictors of survival.     

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.     

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.     

Expression of matrix metalloproteinases, type IV collagen, and interleukin-10 in rabbits treated with morphine after lamellar keratectomy

Purpose To study the effects of topical administration of 1% morphine on corneal analgesia in rabbits submitted to lamellar keratectomy and to assess the expression of matrix metalloproteinase‐1, metalloproteinase‐2, metalloproteinase‐9 (MMPs), type IV collagen, and interleukin‐10 (IL‐10) during the treatment. Methods Morphine group (MG) received 50 μL of topical 1% morphine four times daily, while the control group received saline instead. Corneal touch threshold (CTT) and the wound area were assessed until corneal healing. Corneal samples were processed for routine histology, immunohistochemistry, zymography, and ELISA. Results Following keratectomy, CTT increased significantly from 6 to 96 h time points. Mean corneal re‐epithelization rate and scores of leukocyte infiltration did not differ significantly between treatment groups. Immunolabeling pattern for MMP‐1, MMP‐9, and type IV collagen was similar in both treatment groups. In the MG, zymography indicated significantly higher levels of active MMP‐2 on days 6 and 12; and in the latent MMP‐9, on days 3 and 6, and in the active MMP‐9, on day 6. Latent MMP‐2 and MMP‐9, and active MMP‐9 decreased to values close to those of healthy corneas on day 12, but levels of active MMP‐2 remained significantly elevated in the MG. IL‐10 levels measured on days 1–6 were reduced as compared to those of healthy corneal tissue and returned to levels close to those of healthy corneas on day 12. Conclusion Topical morphine promoted corneal analgesia for up to 4 days and did not delay corneal re‐epithelization. The re‐establishment of MMPs and IL‐10 to levels close to baseline values at the end of the study and the expression of type IV collagen in both groups reinforce that, with caution, 1% morphine can be used after lamellar keratectomy in rabbits.     

Postnatal development of central corneal thickness in chicks of Gallus gallus domesticus

Objective To investigate the changes in corneal thickness that occur during maturation of the Gallus gallus domesticus chick eye over the first 450 days of life. Animals studied Twenty‐nine chicks, of which 12 were males and 17 were females. Procedures The central corneal thickness (CCT) was measured by ultrasonic pachymetry from hatch until 450 days of age. Segmented regression was applied to capture the two phases observed in the CCT plotted against age. Eye and gender were also included in the model. Results Mean CCT values initially decreased, with the lowest point being reached at around 12 days of age. CCT then gradually increased as the chick matured. At 70 days of age the animals have completed corneal development and reached the plateau value of 0.242 ± 0.0002 mm. CCT differences between gender or between left and right eyes were not statistically significant. Prediction equations for mean CCT according to the bird's age are presented. Conclusions There is an initial decrease in corneal thickness until approximately 12 days of age, which presumably mirrors maturation of corneal endothelial cell function. The pattern of changes in corneal thickness during the first phase of development of the chick CCT was similar to the one reported for dogs and humans. However, a unique feature of the development of CCT in chicks is that after reaching a plateau at 70 days corneal thickness did not significantly change over the remainder of the study period. Additionally, unlike in humans and dogs, there is no gender difference for corneal thickness in chicks.     

Efficacy and safety of mitomycin C as an agent to treat corneal scarring in horses using an in vitro model

Objective Mitomycin C (MMC) is used clinically to treat corneal scarring in human patients. We investigated the safety and efficacy of MMC to treat corneal scarring in horses by examining its effects at the early and late stages of disease using an in vitro model. Procedure An in vitro model of equine corneal fibroblast (ECF) developed was used. The ECF or myofibroblast cultures were produced by growing primary ECF in the presence or absence of transforming growth factor beta‐1 (TGFβ1) under serum‐free conditions. The MMC dose for the equine cornea was defined with dose‐dependent trypan blue exclusion and (3‐4,5‐dimethylthiazol‐2‐yl)‐2,5‐diphenyltetrazolium bromide (MTT) assays after applying MMC to the cultures once for 2 min. The efficacy of MMC to control corneal scarring in horses was determined by measuring mRNA and protein expression of corneal scarring markers (alpha‐smooth muscle actin and F‐actin) with western blotting, immunocytochemistry and/or quantitative real‐time polymerase chain reactions. Results A single 2‐min treatment of 0.02% or less MMC did not alter ECF phenotype, viability, or cellular proliferation whereas 0.05% or higher MMC doses showed mild‐to‐moderate cellular toxicity. The TGFβ1 at 1 ng/mL showed significant myofibroblast formation in ECF under serum‐free conditions. A single 2‐min, 0.02% MMC treatment 24 h (early) after TGFβ1 stimulation significantly reduced conversion of ECF to myofibroblasts, however, a single 0.02% MMC treatment 11 days after TGFβ1 stimulation showed moderate myofibroblast inhibition. Conclusions That MMC safely and effectively reduced scarring in ECF by reducing the degree of transdifferentiation of corneal fibroblasts to myofibroblasts in vitro. Further clinical in vivo investigations are warranted using MMC in horses.     

Skin diseases in the alpaca (Vicugna pacos): a literature review and retrospective analysis of 68 cases (Cornell University 1997–2006)

This retrospective study describes 68 alpacas with skin diseases investigated from 1997 through 2006 at Cornell University. During this time period, 40 of 715 (5.6%) alpacas presented to the university hospital had dermatological diseases. In addition, skin‐biopsy specimens accounted for 86 of 353 (24.4%) of alpaca biopsy specimens submitted to the diagnostic laboratory, and of these 86 specimens, follow‐up was available for 28 cases. The following diseases were most common: bacterial infections (22%); neoplasms, cysts and hamartomas (19%); presumed immunological disorders (12%); and ectoparasitisms (10%). Conditions described for the first time included intertrigo, collagen and hair follicle hamartomas, lymphoma, hybrid follicular cysts, melanocytoma, anagen defluxion, telogen defluxion, presumed insect‐bite hypersensitivity, ichthyosis, and possible hereditary bilateral aural haematomas and chondritis. The results of the retrospective study are compared and contrasted with the results of a literature review.     

Successful treatment of an unusually large corneal epithelial inclusion cyst using equine amniotic membrane in a dog

A 10‐year‐old intact male Yorkshire Terrier was referred for investigation of a large raised and nonpainful corneal lesion oculus dexter. Clinical examination revealed a pale, translucent corneal mass, which occupied half of the corneal surface and measured 11 mm × 11 mm × 13 mm. The mass was removed by superficial keratectomy and equine amniotic membrane (AM) was transplanted into the large corneal defect to cover the wound and provide tectonic support for the remaining cornea. The mass was histologically confirmed as a corneal epithelial inclusion cyst. There was no evidence of recurrence or complication at the surgical site 100 days postoperatively. Corneal epithelial inclusion cysts are uncommon in dogs. Although superficial keratectomy is the recommended treatment for corneal inclusion cyst, the combination of superficial keratectomy and AM transplantation had to be considered as an alternative for repair of large corneal defects. This is the first case report of the combined application of AM and superficial keratectomy to successfully treat a corneal inclusion cyst in a dog.     

Postnatal development of corneal curvature and thickness in the cat

Objective To evaluate the postnatal development of central corneal curvature and thickness in the domestic cat. Animals studied Six Domestic Short‐haired (DSH) kittens starting at 9 weeks of age and 6 adult cats. Procedures Kittens were evaluated biweekly to monthly for a 12‐month period, starting at age 9 weeks. Corneal development was monitored by hand‐held keratometry and ultrasound biomicroscopy. Standard regression analysis using a nonlinear least squares method was used to generate a formula that would predict corneal curvature as a function of age. Results Mean keratometry (K) values for the 9‐week‐old cats were 54.51 (±1.02) diopters (D) and these values steeply declined over the next 3 months to 44.95 (±0.90) D. Thereafter, K‐values gradually decreased to reach a plateau by 12–15 months of age of 39.90 (±0.42) D. Because K‐values still appeared to be slightly diminishing at this point, six other > 2‐year‐old cats were evaluated by keratometry and were found to have K‐values of 38.99 (±0.81). Two to four diopters of astigmatism was common in young kittens whereas adult cats had a low mean degree of astigmatism (< 1 D). A formula that predicted keratometry values in diopters (K) as a function of age in weeks (w) was established as follows: K = 39.83 + 26.87 exp(?0.074 w). The central cornea increased in thickness primarily during the first 4 months of life with 9 week‐old kittens having values of 0.379 (±0.012) mm; 16‐week‐old kittens, 0.548 (±0.021) mm and 67 week‐old cats, 0.567 (±0.012) mm. Conclusions The maturation process of the feline cornea proceeds over the first 1–2 years of life to attain an adult status that is characterized by a roughly spherical state of approximately 39 D corneal curvature, substantially flatter than the human cornea, and a central thickness similar to the human cornea. Research studies of the refractive or optical properties of the cornea in which cats are used as experimental animals should be conducted on animals greater than 18 months of age.     

In vivo confocal microscopy of equine fungal keratitis

Objective To describe in vivo corneal confocal microscopy of horses with fungal keratitis and correlate findings with clinical, histopathological, and microbiological evaluations of clinical cases and an ex vivo experimental equine fungal keratitis model. Animals studied A total of 12 horses with naturally‐acquired fungal keratitis and ex vivo equine corneas experimentally infected with clinical fungal isolates. Procedures Horses with naturally‐acquired fungal keratitis were examined with a modified Heidelberg Retina Tomograph II and Rostock Cornea Module. Confocal microscopy images of clinical isolates of Aspergillus fumigatus, Fusarium solani, and Candida albicans were obtained by examination of in vitro cultures and experimentally infected ex vivo equine corneas. Results Non‐specific in vivo corneal confocal microscopic findings in horses with fungal keratitis included leukocyte infiltrates, activated keratocytes, anterior stromal dendritic cell infiltrates, and vascularization. Linear, branching, hyper‐reflective structures that were 2–6 μm in width and 200 to >400 μm in length were detected in all horses with filamentous fungal keratitis. Round to oval hyper‐reflective structures that were 2–8 μm in diameter were detected in a horse with yeast fungal keratitis. The in vivo confocal microscopic appearance of the organisms was consistent with fungal morphologies observed during examination of in vitro cultures and infected ex vivo equine corneas. Conclusions In vivo corneal confocal microscopy is a rapid and non‐invasive method of diagnosing fungal keratitis in the horse. This imaging technique is useful for both ulcerative and non‐ulcerative fungal keratitis, and is particularly advantageous for confirming the presence of fungi in deep corneal stromal lesions.     

CASE REPORT: Keratomycosis in a dog treated with topical 1% voriconazole solution

A 2‐year‐old Jack Russell Terrier was presented for treatment of a worsening corneal ulcer and keratomalacia following removal of a vegetative foreign body. The keratomalacia responded to topical gentamicin therapy; however, the eye became suddenly painful and at examination two areas of increased opacity had developed. Fungal keratitis was demonstrated by corneal scrape showing branching, septate fungal hyphae. Treatment with 1% voriconazole was effective in resolving the keratomycosis.