Anterior lens capsule disruption and suspected malignant glaucoma in a dog

A Boston Terrier puppy presented with a full-thickness peripheral corneal defect, iris prolapse and anterior lens capsule tear in the left eye (OS). Phacofragmentation and primary repair of the corneal laceration was performed. At surgery, subluxation of the lens was also apparent. One day postoperative, there was severe corneal edema, diffuse hyphema, an intraocular pressure (IOP) of 65 mmHg and a small amount of vitreous that protruded from the corneal incision OS. Malignant glaucoma or pupillary block glaucoma were suspected. Intravenous mannitol was administered preoperatively and had no effect. An anterior vitrectomy was performed on the vitreous within the anterior chamber and pupil. One day postoperative the IOP was 16 mmHg in the right eye (OD) and 20 mmHg OS. Postoperative iridocyclitis was managed medically, and additional elevations in IOP were not recorded. Resolution of the elevated IOP following anterior vitrectomy was supportive of pupillary block or malignant glaucoma. Vision returned 3 weeks after the initial surgery. Two years after the initial injury, the eye is visual and comfortable with infrequent topical anti-inflammatory therapy.     

Multiple ciliary body cysts and secondary glaucoma in the Great Dane: a report of nine cases

Between 1989 and 1995 nine Great Danes were presented to the small animal clinic of the University of Zurich Teaching Hospital with glaucoma and multiple cysts in the anterior and posterior chamber. In four of the nine dogs cysts were present in both eyes; however, bilateral glaucoma was seen in one case only. Mean intraocular pressure (IOP) at initial presentation was 42 mmHg measured by applanation tonometry. With the exception of one dog, all animals were treated medically for a minimum of 13 days. Two animals were subsequently lost to follow up. Two dogs underwent evisceration with implantation of a silicone prosthesis. The glaucomatous globe was enucleated in three dogs. One owner declined surgery and the dog remained buphthalmic with a poorly controlled IOP. One animal remained visual after trans-scleral diode laser cyclophotocoagulation. Histopathology of the three enucleated globes showed multiple cysts originating from the ciliary body epithelium. The mechanism of IOP elevation is probably by anterior displacement of the iris with narrowing of the angle and collapse of the ciliary cleft. A delicate pre-iridal fibrovascular membrane was also seen in each case, which could have also contributed to the elevation of IOP. The high odds ratio of 2.23 (CI 95% 1.14, 3.99) for glaucoma and 37.01 (CI 95% 16.42, 77.81) for ciliary body cysts suggests they are both inherited in this breed. Pedigree analysis of the affected dogs failed to definitely reveal the mode of inheritance.     

Semiconductor diode laser transscleral cyclophotocoagulation for the treatment of glaucoma in horses: a retrospective study of 42 eyes

Objective To evaluate the outcome of diode laser transscleral cyclophotocoagulation (TSCP) for the treatment of glaucoma in horses. Procedure Medical records at The Ohio State University were reviewed. All horses that underwent diode laser TSCP between the years of 1995 and 2007 were included. Preoperative, procedural and clinical follow‐up data were collected, and telephone follow‐up was performed. Results Forty‐two eyes of 36 horses were included. Twenty‐four hours prior to surgery mean intraocular pressure (IOP) was 37.17 ± 13.48 mmHg (42 eyes). Forty‐one of 42 eyes (98%) were sighted and 39 of 39 (100%) of eyes were receiving topical glaucoma medication. At 3–5 weeks postoperatively the average IOP was 19.36 ± 12.04 mmHg (22 eyes). IOP remained significantly lower than pretreatment values at all periods of clinical follow‐up (P < 0.05). There was no significant difference in vision outcome, or the requirement for topical glaucoma medication relative to pretreatment values at any follow‐up period. Hyphema in 5 of 42 eyes was the only complication noted. Of the 27 eyes seen for clinical follow‐up, 2 were enucleated because of refractory elevation of IOP. Mean telephone follow‐up was 49 months. Twenty‐one of 22 owners contacted (95%) reported that the treatment had been of value, 14 of 22 eyes (64%) were receiving topical glaucoma medication, and 13 of 22 eyes (59%) were considered sighted. Conclusions Diode laser TSCP aided in the control of IOP and maintenance of vision but did not eliminate the need for topical glaucoma medication during the period of clinical follow‐up.     

Cullen frontal sinus valved glaucoma shunt: preliminary findings in dogs with primary glaucoma

PURPOSE: To evaluate the efficacy of a novel, professionally manufactured, frontal sinus valved glaucoma shunt in maintaining normal intraocular pressure (IOP) and vision in dogs with primary glaucoma. METHODS: Three eyes of three dogs diagnosed with primary glaucoma were included in this prospective clinical study. A Cullen frontal sinus valved glaucoma shunt was implanted into each glaucomatous globe. Dogs were treated postoperatively with topical neomycin/polymyxin B/0.1% dexamethasone and 0.03% flurbiprofen every 6 h tapered over 8-12 weeks, and meloxicam at 0.1 mg/kg orally every 24 h for 7-10 days. IOP, intracameral shunt position and apparent patency, and vision were assessed twice daily for up to 4 (n= 3 eyes) and 10 (n= 2 eyes) days postoperatively, and then at re-examination periods of up to 36 weeks (n= 1 eye). Postoperative complications were recorded and documented photographically. RESULTS: Normal IOP was maintained in all shunted globes (range 10-29 mmHg; mean = 16.7 mmHg at 24 h; IOP = 23 mmHg at 36 weeks) postoperatively for 2 days (3/3 eyes), 8 weeks (2/2 eyes), and 36 weeks (1/1 eye) without additional antiglaucoma therapies. Photopic vision and shunt position and patency were maintained in all shunted globes for all follow-up periods. Postoperative complications included mild aqueous flare and fibrin (n= 3 eyes for 3-10 days postoperatively); intracameral shunt occlusion with fibrin (n= 1 eye at days 2 and 4); partial anterior chamber tube extrusion (n= 1 eye at day 4), and focal corneal edema (n= 1 eye at 18 weeks). Tissue plasminogen activator injected intracamerally through the silicone tube near the frontal sinus effectively resolved the fibrinous shunt occlusion. CONCLUSIONS: The Cullen frontal sinus valved glaucoma shunt shows promise for the management of canine primary glaucoma.     

Uveitic glaucoma in the horse

Glaucoma is a serious complication of anterior uveitis that can result in significant ocular discomfort and loss of vision. As glaucoma is insidious and mostly asymptomatic until late in the course of disease, it is often undiagnosed. Equine recurrent uveitis is the most common underlying disorder: it is a disease of high prevalence, characterised by recurrent‐remitting episodes of ocular inflammation. Here, the inflammatory cells and mediators they release alter the normal anatomic structure of the anterior chamber and aqueous drainage pathways of the eye. These changes alter the homeostatic mechanisms of intraocular pressure control. Management of glaucoma secondary to uveitis can be challenging due to the difficulties of managing the underlying disorder and its effects on the eye. This article reviews the pathogenesis of uveitic glaucoma in the horse and medical and surgical management options.     

The future of canine glaucoma therapy

Canine glaucoma is a group of disorders that are generally associated with increased intraocular pressure (IOP) resulting in a characteristic optic neuropathy. Glaucoma is a leading cause of irreversible vision loss in dogs and may be either primary or secondary. Despite the growing spectrum of medical and surgical therapies, there is no cure, and many affected dogs go blind. Often eyes are enucleated because of painfully high, uncontrollable IOP. While progressive vision loss due to primary glaucoma is considered preventable in some humans, this is mostly not true for dogs. There is an urgent need for more effective, affordable treatment options. Because newly developed glaucoma medications are emerging at a very slow rate and may not be effective in dogs, work toward improving surgical options may be the most rewarding approach in the near term. This Viewpoint Article summarizes the discussions and recommended research strategies of both a Think Tank and a Consortium focused on the development of more effective therapies for canine glaucoma; both were organized and funded by the American College of Veterinary Ophthalmologists Vision for Animals Foundation (ACVO‐VAF). The recommendations consist of (a) better understanding of disease mechanisms, (b) early glaucoma diagnosis and disease staging, (c) optimization of IOP‐lowering medical treatment, (d) new surgical therapies to control IOP, and (e) novel treatment strategies, such as gene and stem cell therapies, neuroprotection, and neuroregeneration. In order to address these needs, increases in research funding specifically focused on canine glaucoma are necessary.     

Use of a Baerveldt gonioimplant for secondary glaucoma in a horse

This case report describes the surgical placement of a Baerveldt glaucoma shunt in the right eye of a 14‐year‐old Arabian gelding. The glaucomatous right eye was refractory to aggressive medical and repeated surgical therapies yet maintained functional vision. Despite the need for intensive post operative management and continued daily topical therapy, shunt placement surgery was successful at maintaining normotension and vision for a period of 402 days. This is the first report of long‐term successful glaucoma filtration surgery in this species. Further studies are warranted to evaluate long‐term success of glaucoma shunt placement in equine glaucoma cases.     

Ahmed valve implantation to control intractable glaucoma after phacoemulsification and intraocular lens implantation in a dog

An 11-year-old spayed female Miniature Poodle presented with bilateral senile cataracts. Treatment was cataract removal by phacoemulsification and intraocular lens implantation. Five hours after surgery the operated right eye was partially closed and painful. The right pupil was fully dilated, there was generalized corneal edema, and intraocular pressure (IOP) was increased. After 12 h of medication IOP was controlled. Ten weeks after surgery the owners reported cloudiness of right eye, and the dog was again evaluated. The IOP was again increased and an Ahmed valve was implanted. This case describes describe the progression of this case and benefits of controlling postcataract surgery glaucoma by the implantation of an Ahmed valve.     

Long-term management of a glaucomatous eye in a dog treated with medical therapy alone.

An acute open angle glaucoma of the right eye was diagnosed in an 8-year-old male Yorkshire terrier which was presented with anorexia, depression, and trembling. Abnormal findings of the right eye on admission included elevated intraocular pressure (IOP; 40 mmHg), the presence of fibrin and flare in the anterior chamber, and immature cataract. Morphological abnormalities of the iridocorneal angle were not detected, and an open angle was seen in the eye. Although an elevated IOP was observed at one year after admission, lowering IOP (< or = 24 mmHg) was maintained with medical therapy using dichlorphenamide (DCPA) and timolol maleate, DCPA alone, or no-treatment for 1973 days. This case suggests that lower IOP can be maintained with medical therapy alone for a long period in a patient with open angle glaucoma.     

A review of the pharmacology of carbonic anhydrase inhibitors for the treatment of glaucoma in dogs and cats

Glaucoma is a heterogeneous group of disorders usually associated with elevated intraocular pressure (IOP), leading to optic nerve damage, retinal ganglion cell death and irreversible vision loss. Therefore, medications that lower IOP are the mainstay of glaucoma therapy. Carbonic anhydrase inhibitors (CAIs) are some of the principal drugs used in the management of canine and feline glaucoma. This paper summarises current knowledge of the mechanism of action of these agents and their effect on IOP in dogs and cats. It also discusses potential harmful side effects of CAIs and presents current opinions about their role and place in the medical management of glaucoma in small animals.     

Combined transscleral diode laser cyclophotocoagulation and Ahmed gonioimplantation in dogs with primary glaucoma: 51 cases (1996-2004)

OBJECTIVE: To evaluate the combined diode laser cycloablation procedure and adjunctive Ahmed gonioimplant use in dogs with primary glaucoma. DESIGN: Retrospective study. ANIMALS: 48 dogs, 51 eyes with primary glaucoma. PROCEDURE: Medical records from two large private clinical ophthalmology services were reviewed. Signalment, duration of glaucoma, gonioscopic evaluation, laser power and duration settings, immediate postoperative and final intraocular pressure and visual results, short and long-term visual outcome, and surgical complications were recorded. RESULTS: The age range of affected dogs was 3.0-14.0 years, with a mean age of 7.5 +/- 2.6 years. Eleven pure breeds were represented, with the most common being the American Cocker Spaniel. The sex distribution was 22 neutered males, 1 intact male, 23 spayed females, and 2 intact female dogs. The right eye was affected in 33 cases, and the left eye in 18 cases. The average total joules, which was administered with the diode laser, was 109.6 +/- 23.6 J. Immediate surgical complications included fibrin formation in the anterior chamber (15), corneal ulcers (4), hyphema (7), and focal retinal detachment (1). Long-term complications included cataract formation (8 total, 2 of which were significant, vision-threatening), elevated intraocular pressure (IOP) (6), unstable gonioimplant (1), and glaucoma recurrence (14). Additional surgeries performed on the eyes over the course of study included: intrascleral prosthesis (4), enucleation (1), resection of fibrotic scar tissue (5), and repeat laser cycloablation (8). The dogs were examined for a mean follow-up time of 17.6 months (range: 2-83 months postoperatively). Twenty-nine cases were followed greater than one year. Vision was maintained in 42/51 eyes (82%) in the immediate short-term of this study. In all cases included in the study, good control of IOP was achieved in 39/51 (76%) of eyes, and IOP was poor or uncontrolled in 12/51 (24%) of eyes. Twenty out of 41 eyes (49%) maintained fair to excellent vision six months after surgery. Twelve months postoperative observations demonstrated that 12/29 (41%) of the eyes were still visual. CONCLUSIONS: In primary glaucoma, the combined procedure of laser diode cyclophotocoagulation and Ahmed valve implant was associated with return or maintenance of vision in 42/51 eyes (82%) in the immediate short-term of this study, and a long-term IOP control in 39/51 (76%) of the cases, with 12/29 eyes (41%) visual after 12 months.     

Treatment of equine glaucoma by transscleral neodymium:yttrium aluminum garnet laser cyclophotocoagulation: a retrospective study of 23 eyes of 16 horses

Contact neodymium:yttrium aluminum garnet (Nd:YAG) laser transscleral cyclophotocoagulation (TSCP) was performed on 23 eyes of 16 horses for treatment of glaucoma. The mean highest preoperative IOP was 51 ± 17 mmHg. Follow-up evaluation was available for 19 eyes 1 day after surgery, 14 eyes from 1 to 2 weeks, 16 eyes from 4 to 6 weeks, 9 eyes from 12 to 16 weeks, and 10 eyes greater than 20 weeks after laser treatment. The mean intraocular pressure (IOP) the day following surgery was 34 ± 13 mmHg. The mean IOP for each follow-up period was: one to two weeks postoperative, 23 ± 9 mmHg; four to six weeks, 24 ± 7 mmHg; 12–16 weeks, 28 ± 10 mmHg; and  20 weeks, 22 ± 9 mmHg. IOP measurements were significantly different from pretreatment values for all follow-up intervals except for weeks 12–16 ( P < 0.05). Treatment success was defined as maintenance of IOP < 30 mmHg. Treatment success was achieved in 93%, 88%, 78%, and 70% of the treated eyes at the 1–2 weeks, 4–6 weeks, 12–16 weeks, and the  20 weeks re-evaluation, respectively. No significant difference was found between the number of eyes visual at presentation (52.2%) and visual at 20 weeks (60%). The most common laser complications were conjunctival hyperemia (21.7%) and corneal ulcers (13.0%). Results of this study indicate that Nd:YAG TSCP is an effective method of controlling IOP and preserving vision in horses with glaucoma. An effective Nd:YAG laser protocol for TSCP in the equine glaucomatous eye is a power setting of 11 W, duration of 0.4 s, applied 5 mm posterior to the limbus at 60 sites, resulting in a total energy dose of 264 J.     

Pharmacology of topical prostaglandin F2α analogs and their place in the treatment of glaucoma in small animals

A distinguishing feature of the most common types of glaucoma is an increased intra‐ocular pressure (IOP), which has a damaging effect on optic nerve axons, leading to the progressive loss of retinal ganglion cells. Therefore, IOP‐lowering medications are the mainstay of glaucoma therapy. Topical prostaglandin F₂α analogs (PGAs) are a relatively new class of ocular hypotensive drugs, which have made a huge impact on the treatment of glaucoma in dogs. This study summarizes the current state of knowledge on the mechanism of action of these agents and their effect on IOP in dogs and cats. It also discusses potential harmful side effects of PGAs and presents contemporary opinions about their role and place in the medical management of glaucoma in small animals.     

Effects of unilateral topical administration of 0.5% tropicamide on anterior segment morphology and intraocular pressure in normal cats and cats with primary congenital glaucoma

Objective To determine the effects of topical 0.5% tropicamide on anterior segment morphology (ASM) and intraocular pressure (IOP) in normal and glaucomatous cats. Animals used Normal cats and cats with inherited primary congenital glaucoma (PCG). Procedures Control IOP curves were performed in untreated normal and PCG cats. In the first experiment, tropicamide was applied OD in eight normal and nine PCG cats. IOP and pupillary diameter (PD) were measured at 0, 30, and 60 min, then hourly until 8 h post‐treatment. In a second experiment, six normal and seven PCG cats received tropicamide OD. High‐resolution ultrasound images were obtained at 0, 1, 5, and 10 h post‐treatment to measure ASM changes. IOP and PD were measured OD at 0, 1, 2, 3, 5, 7, and 9 h. Results In untreated normal cats IOP OU decreased throughout the day. In PCG cats IOP OU had wide fluctuations over time. In normal cats IOP response varied in the treated eye but did not change significantly in untreated eyes. IOP significantly increased from baseline in both eyes of all treated PCG cats. Increases in IOP were associated with some ASM changes. Cats with PCG had a significantly smaller angle recess areas, diminished ciliary clefts and decreased iris‐lens contact. ASM changes were not strongly correlated with IOP in all cats. Conclusions The ASM of PCG cats is markedly different from normal cats, and clinically significant increases in IOP OU occur in cats with PCG after tropicamide treatment. The mechanism for this increase remains unclear.     

Comparison of the effect of hypertonic hydroxyethyl starch and mannitol on the intraocular pressure in healthy normotensive dogs and the effect of hypertonic hydroxyethyl starch on the intraocular pressure in dogs with primary glaucoma

PURPOSE: The purpose of this study was to determine if intravenous hypertonic hydroxyethyl starch (7.5%/6%) (HES) could decrease the intraocular pressure (IOP) in healthy normotensive dogs, and compare its effect with that of mannitol (20%) (experimental study). In addition, the potential IOP-lowering effect of hypertonic HES was evaluated in six dogs with primary glaucoma (clinical study). MATERIAL AND METHODS: Experimental study: eight male ophthalmoscopically and clinically healthy Beagles were included in this study. The IOP of each dog was measured by applanation tonometry in both eyes to obtain control values at 10:00, 10:15, 10:30, 10:45, 11:00 a.m., and then every hour until 6:00 p.m. prior to the first treatment (control period). Each dog received, with at least 2-week intervals and in a random order, an intravenous (IV) infusion of 4 mL/kg hypertonic HES (1.2 g/kg NaCl; 0.96 g/kg HES) and 4 mL/kg mannitol 20% (1 g/kg) over a period of 15 min starting at 10:00 a.m. IOP was measured oculus uterque (OU) at the same time intervals as in the control study. The differences in IOP between the treatment groups and the baseline IOP (before the start of infusion), between oculus sinister (OS) and oculus dexter (OD) and between the same time points of all groups were determined with a Student's t-test for paired samples (P = 0.05). Clinical study: six dogs with primary glaucoma (representing seven eyes) received an IV infusion of 4 mL/kg hypertonic HES over a period of 15 min. IOP was measured before and 15 and 30 min after starting the infusion. RESULTS: Experimental study: no significant difference between IOP of both eyes was found. A significant decrease in IOP from baseline value was recorded at 15, 30, 45, and 60 min after the start of mannitol infusion (mean amplitude in IOP decrease 3.21 mmHg; P < 0.05) and at 15 and 30 min in dogs treated with HES (mean amplitude in IOP decrease 2.43 mmHg; P < 0.05). At 120 and 180 min there was a significantly higher IOP (P < 0.05) in HES treatment group compared to the values of the control group. Clinical study: in 5/7 eyes diagnosed with primary glaucoma a maximum decrease in IOP of an average of 24% from the baseline value (IOP before start of the infusion) was observed (range of decrease 2-21 mmHg). In three of these five cases the maximum decrease was reached at 15 min and in two cases at 30 min. In one case an increase in IOP of 35% (+ 18 mmHg) was seen after 15 min and 26% (+ 13 mmHg) after 30 min. Case 4 showed an increase in IOP of 5% (+ 3 mmHg) after 15 min and a decrease of 6% (- 4 mmHg) after 30 min. CONCLUSIONS: Intravenous hypertonic HES is comparable to intravenous mannitol 20% in lowering the intraocular pressure in healthy normotensive dogs. But this effect lasted half an hour longer after mannitol. In 6/7 eyes with primary glaucoma, hypertonic HES decreased IOP.     

Progressive changes in ophthalmic blood velocities in Beagles with primary open angle glaucoma

Objective To measure changes in the ocular and orbital blood flow velocities by color Doppler imaging (CDI) in beagles with primary open angle glaucoma as the disease progressed from early to advanced stages. Methods CDI measurements were performed periodically on 13 glaucomatous Beagles during the nontreated mild, moderate and advanced stages of POAG over the course of 4 years. CDI was performed with the dogs lightly anesthetized (butorphanol 0.1 mg/kg IV, acepromazine maleate 0.02 mg/kg IV, and atropine sulfate 0.05 mg/kg) while the CD transducer was placed directly on the cornea anesthetized with 0.5% tetracaine hydrochloride. Intraocular pressure (IOP) by pneumatonography or TonoPen XL, heart rate and mean arterial blood pressure were measured at the beginning, middle and end of each study. The ophthalmic vessels examined included: external ophthalmic arteries and veins, long and short posterior ciliary arteries, anterior ciliary arteries and veins, primary retinal arteries, and vortex veins. Recordings of each vessel included peak systolic velocity (PSV), end diastolic velocity (EDV) and time averaged velocity (TAV), and when possible the resistive index (RI) and pulsatility index (PI) were computed. Results CDI abnormalities were present before intraocular pressure exceeded the normal range. As the animals aged, and the glaucoma progressed with higher levels of IOP, significant changes occurred in nearly all vessels, and generally included a major increase in RI (P < 0.001) and an increase in the PI (P < 0.001). Mean arterial blood pressure (105 ± 18 mmHg) and heart rate (118 ± 33/min) remained reasonably constant. The IOP gradually increased as the disease progressed (early and normotensive: 19.4 ± 3.9 mmHg; moderate: 29.7 ± 2 mmHg; and advanced: 44.5 ± 6 mmHg). The ocular veins seemed most influenced early on in the disease. Late in the disease, ocular venous blood flow could not be consistently demonstrated. An increase in the PI of ocular veins occurred in the moderately and severely affected glaucomatous Beagles. As the IOP increased, there were trends of increasing resistive index and pulsatility index in most arteries, and periods of marked decreased velocities of the vortex and external ophthalmic veins in severe cases. Conclusion CDI measurements in Beagles with primary open angle glaucoma during the course of 4 years indicate easily measurable and repeatable progressive blood flow abnormalities before the elevation of IOP and, thereafter, with gradually increased levels of IOP.     

The use of transscleral cyclophotocoagulation with a diode laser for the treatment of glaucoma occurring post intracapsular extraction of displaced lenses: a retrospective study of 15 dogs (1995-2000)

The objective of this retrospective study was to evaluate transscleral cyclophotocoagulation (TSCP) using a diode laser for treating aphakic glaucoma that developed after intracapsular lens extraction (ICLE) had been performed for displaced lenses. Records of 15 dogs (21 eyes) were reviewed. The intraocular pressure (IOP) and the presence of vision were recorded at the time of ICLE and TSCP and at 1, 3, 6-9, 12 and 24 months post TSCP. The glaucoma was considered controlled if the IOP was less than 25 mmHg. The results indicated that the effectiveness of TSCP using a diode laser for treating aphakic glaucoma was of a short-term duration (1-3 months), with three patients needing repeat TSPC. In addition, adjunctive antiglaucoma medications were often required to maintain an adequately controlled IOP. Over the 24-month period the number of dogs requiring intrascleral prosthesis, intraocular gentamicin or enucleation, or that were lost to follow-up, increased.     

The long‐term effects of semiconductor diode laser transscleral cyclophotocoagulation on the normal equine eye and intraocular pressurea

Objective To describe the long‐term histologic and intraocular pressure (IOP) lowering effects of diode laser transscleral cyclophotocoagulation (TSCP) on the normal equine eye. Animals Eight normal adult horses. Procedures TSCP was performed in one randomly assigned eye. Sixty spots were treated at settings of 1500 ms and 1500 mW. Two horses were randomly selected for euthanasia at 2, 4, 12, or 24 weeks post‐TSCP. Both eyes were enucleated and histologically evaluated. Intraocular pressure was measured by applanation tonometry prior to TSCP, immediately post‐TSCP, twice daily for 7 days post‐TSCP and then monthly until study conclusion. A longitudinal model estimated the average IOP values for the treated and untreated eyes at 1 week, 1, 3, and 6 months post‐TSCP. Results All treated eyes at all time periods exhibited four characteristic histologic lesions: scleral collagen hyalinization, ciliary body pigment dispersion and clumping, focal disruption of the ciliary body epithelium, and focal ciliary process atrophy. After TSCP, there were no significant changes in IOP from baseline for the control eyes, while the IOP in treated eyes was significantly decreased from baseline (P < 0.05) at all time periods. The estimated decrease in IOP in the treated eyes compared to baseline IOP at 6 months was ‐3.76 mmHg for an average decrease in IOP of 20% from baseline. Conclusion  Diode laser TSCP produces histologic lesions in the equine ciliary body that result in a significant and sustained decrease in IOP. TSCP may be an effective management for equine glaucoma.     

Effect of single and multiple doses of 0.2% brimonidine tartrate in the glaucomatous Beagle

The objective of this study was to evaluate the changes in intraocular pressure (IOP) in glaucomatous dogs after instillations of 0.2% brimonidine once, twice and three times daily in single day studies, and after twice and three times daily for 4 days in multiple dose studies. We studied eight Beagles with inherited primary open angle glaucoma. Applanation tonometry (IOP), pupil size (PS) and heart rate (HR) measurements were obtained at 8 am, 10 am, 1 pm, 3 pm and 5 pm. The studies were divided into: eight glaucoma dogs and five of the eight dogs that demonstrated greater response to 0.2% brimonidine. Single-dose drug studies are divided into placebo (0.5% methylcellulose), 0.2% brimonidine administered once daily (8 am); twice daily (8 am and noon); and three times daily (8 am, noon and 5 pm). The 5-day multiple-dose studies included: day 1, no drug; and 4 days, 0.2% brimonidine instillations either twice daily (8 am and 2 pm) or three times daily (8 am, 2 pm and 9 pm). Statistical comparisons between drug groups included control (nondrug) and treated (placebo/0.2% brimonidine) eyes for both single- and multiple-dose studies. The mean +/- SEM diurnal decrease in IOP in the eight glaucomatous Beagles for the control and placebo eyes were 3.4 +/- 4.7 and 5.4 +/- 2.8 mmHg, respectively. The mean +/- SEM diurnal decrease in IOP after 0.2% brimonidine once, twice and three times daily was 6.4 +/- 3.5, 8.0 +/- 6.1 and 9.8 +/- 8.1 mmHg, respectively; this trend was not significant statistically. Significant miosis occurred starting 2 h postinstillations, and the resultant mean +/- SD pupil size was 2.7 +/- 0.3 mm. A significant decrease in heart rate also occurred (12%). In the five most responsive dogs the changes in PS and HR during these studies were similar to the larger group, but significant decreases in IOP occurred at most measurement times. In the multiple-dose study with 0.2% brimonidine twice daily the mean +/- SEM decrease in IOP for day 1 to day 4 was 5.0 +/- 1.3, 5.7 +/- 1.3, 1.4 +/- 3.3 and 4.9 +/- 1.3 mmHg, respectively. When 0.2% brimonidine was instilled three times daily the mean +/- SEM diurnal IOP decrease was from day 1 to day 4 and was 0.75 +/- 1.3, 2.4 +/- 1.5, 1.2 +/- 2.7 and 1.4 +/- 1.8 mmHg, respectively. The mean change in pupil diameter was 1.3 +/- 0.5 mm. Decrease in HR averaged 22%. In the same single-dose studies with the five most responsive dogs, PS and HR were similar, but the decreases in IOP were significant at more measurement intervals. We conclude that 0.2% brimonidine produces a decrease in IOP in dogs, a statistically significant miosis, and a reduced heart rate (12-22%). However, because of the limited drug-induced ocular hypotension, brimonidine should be combined with other drugs when used for the glaucomas in the dog.     

Circadian rhythm of intraocular pressure in cats

OBJECTIVE: To evaluate the rhythm of intraocular pressure (IOP) in healthy domestic cats with no evidence of ocular disease and to analyze the influence of photoperiod, age, gender and ocular diseases on diurnal-nocturnal variations of cat IOP. ANIMALS: All animals were Domestic Short-haired cats; 30 were without systemic or ocular diseases, classified as follows: 12 male intact adult cats, five intact adult female, five adult spayed female, and eight male cats; the latter were less than 1 year of age. In addition, five adult cats with uveitis and three adult cats with secondary glaucoma were included. PROCEDURE: IOP was assessed with a Tono-Pen XL at 3-h intervals over a 24-h period in 12 healthy adult male cats kept under a photoperiod of 12-h light/12-h darkness for 2 weeks. Eight animals from the same group were then kept under constant darkness for 48 h, and IOP was measured at 3-h intervals for the following 24 h. In addition, IOP was assessed at 3 p.m. and 9 p.m. in five intact females, five spayed females, and in eight young cats, as well as in five adult cats with uveitis and three glaucomatous cats. RESULTS: Consistent, daily variations in IOP were observed in animals exposed to a light-dark cycle, with maximal values during the night. In cats exposed to constant darkness, maximal values of IOP were observed at subjective night. Differences of IOP values between 3 p.m. and 9 p.m. (diurnal-nocturnal variations) persisted in intact females, spayed females, and young animals, as well as in uveitic and glaucomatous eyes. CONCLUSIONS: The present results indicate a daily rhythm of cat IOP, which appears to persist in constant darkness, suggesting some level of endogenous circadian control. In addition, daily variations of cat IOP seem to be independent of gender, age, or ocular diseases (particularly uveitis and glaucoma).