Primary central corneal hemangiosarcoma in a dog

Purpose To report a case of primary central corneal hemangiosarcoma in the dog. Methods An 11‐year‐old, neutered, female, German shepherd mixed breed dog was referred to the Hospital Veterinario Sierra de Madrid (Spain) for evaluation of an enlarging corneal mass of the left eye (OS). The dog was predominantly housed outdoors and was diagnosed with a history of chronic superficial keratitis of both eyes (OU) by the referring veterinarian. The corneal mass was resected by routine superficial keratectomy and submitted for histopathology and Factor VIII immunohistochemical staining. Results The mass was diagnosed as a corneal hemangiosarcoma with complete excision. Postoperatively, the keratectomy site healed without complication and there was no evidence of recurrence three and a half months postoperatively. Complete systemic evaluation, including abdominal ultrasound and CT scan of the head and thorax, indicated no other detectable neoplasia in the dog. Discussion Outdoor housing and ultraviolet exposure, breed, and chronic superficial keratitis were all suspected as contributing factors to the development of a primary corneal hemangiosarcoma. Surgical removal and postoperative treatment for chronic superficial keratitis provided effective therapy.     

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.     

Mineralized corneal sequestrum in a cat.

An 8-month-old 3-kg (6.6-lb) sexually intact male cat was evaluated for chronic refractory keratitis and a corneal plaque that developed after treatment with a corticosteroid-containing ophthalmic preparation. Pertinent ophthalmic findings included blepharospasm, conjunctivitis, corneal vascularization, and a tan raised corneal plaque with a dense and gritty composition. Lamellar keratectomy was performed to excise the plaque. The cornea healed with mild scarring. Histologic examination revealed extensive coagulation necrosis and mineralization of the corneal stroma with increased inflammatory cells, blood vessels, and fibrosis, which is compatible with a diagnosis of mineralized corneal sequestrum. The history suggested chronic feline herpesvirus-1 (FHV-1)-induced keratoconjunctivitis as the underlying cause. Topical corticosteroid administration may have potentiated the preexisting corneal necrosis and initiated mineralization. To our knowledge, mineralization of a corneal sequestrum in a cat has not been reported in a clinical case but has been reported in cats experimentally infected with FHV-1.     

The effect of topical pimecrolimus on keratoconjunctivitis sicca and chronic superficial keratitis in dogs: results from an exploratory study

OBJECTIVE: Pimecrolimus is an ascomycin derivative that interferes selectively with the activation of T cells and mast cells and inhibits the production of inflammatory cytokines. This study evaluated the efficacy of an experimental ophthalmic formulation of pimecrolimus in treating keratoconjunctivitis sicca (KCS) and chronic superficial keratitis (CSK) in dogs. ANIMALS AND PROCEDURES: Eight dogs with KCS and six with CSK were included. The dogs were of various breeds, suffered from chronic conditions, and had been pretreated unsuccessfully. The affected eyes were treated with 1 drop of an experimental, corn oil-based pimecrolimus 1% formulation three times a day. Parameters evaluated included Schirmer tear test (STT), ocular discharge, conjunctival inflammation, corneal inflammatory cell infiltrate and scarring, and comfort level. RESULTS: The effect of pimecrolimus 1% was pronounced (increase in STT values to higher than 4 mm/min, no signs of inflammation) or moderate (increase in STT values of 3-4 mm/min, mild signs of corneal/conjunctival inflammation) in a total of 6/8 animals with KCS. In 4/6 animals with CSK, the effect was either pronounced (total regression of fibrovascular infiltration into the cornea, no corneal scarring) or moderate (distinct regression of pannus, mild corneal scarring). The response to treatment was unsatisfactory in four of 14 animals. CONCLUSION: Results of this exploratory study suggest that topical 1% pimecrolimus may be a new effective treatment for keratoconjunctivitis sicca and chronic superficial keratitis in dogs.     

Corneal squamous cell carcinoma in two dogs

Purpose To report two cases of corneal squamous cell carcinoma (SCC) in dogs. Methods Corneal tumors were resected by superficial keratectomy in two cases. Immunohistochemistry of the corneal tissues was performed using anti‐p53 antibody. Results The prominent features of the cases were a clinical history of pigmentary keratitis and chronic keratitis. In each case, a corneal mass was surgically removed with a superficial keratectomy and histologically diagnosed as corneal SCC. Both masses were negative for p53. To reduce chronic corneal irritation, 0.1% hyaluronate sodium ophthalmic solution was applied. After more than 15 months of postsurgical follow‐up there has been no recurrence of either neoplasm. Conclusion and discussion Chronic corneal irritation was suspected as the primary etiology for the corneal SCC. Appropriate surgical removal of the mass and subsequent conservative treatment for keratitis provided effective therapy in these two cases.     

Corneal fungal disease in small animals

Corneal fungal diseases, including fungal keratitis and stromal abscess, are uncommon in small animals. Ocular infection secondary to systemic mycosis is reported far more frequently. Suspicion of a fungal corneal ulcer should be raised based on a history of underlying trauma, especially with plant material, geographic location, chronic use of topical antibiotics or corticosteroids, or an extremely prolonged course of disease despite appropriate treatment. Clinical signs observed with fungal keratitis may include blepharospasm, epiphora, miosis, corneal opacity, and vascularization. Unfortunately, none of these signs is specific to fungal infection. If fungal keratitis is suspected or confirmed, then aggressive medical therapy should be instituted. Medications used include topical antifungals, parasympatholytics, anticollagenases, and antibacterials as well as systemic anti-inflammatory drugs. Because there are very few fungicidal medications, the course of medical treatment for fungal corneal disease requires a prolonged duration with frequent re-examination and assessment. Surgical treatment is sometimes required to save the eye and vision. Surgeries to be considered include debridement, conjunctival graft placement, and corneal transplantation.     

Corneal epithelial disease.

This article reviews conditions that primarily affect the corneal epithelium as distinct from corneal stromal diseases. Corneal ulceration is discussed elsewhere in this issue. The other corneal conditions include a variety of more subtle epithelial disease,which might colloquially be termed epitheliopathies, as well as uninfected indolent superficial ulcerations, corneal neoplasia, and eosinophilic keratitis. The fungal plaque is an unusual and somewhat chronic form of epithelial infection. Although less common than corneal ulcers, this collection of lesions may present uniquely challenging obstacles to diagnosis and identification of a cure. Newer therapies and surgical strategies are discussed.     

Treatment of proliferative feline eosinophilic keratitis with topical 1.5% cyclosporine: 35 cases

Objective  Proliferative feline eosinophilic keratitis is a chronic keratopathy caused by a suspected immune mediated response to an unknown antigenic stimulus. The purpose of this study is to demonstrate the efficacy of topical 1.5% cyclosporine solution in proliferative feline eosinophilic keratitis.
Methods  Thirty-five cats were treated topically with 1.5% cyclosporine A between 1997 and 2007. Eosinophilic keratitis was diagnosed by clinical appearance and evidence of eosinophils and/or mast cells in corneal cytology. The patients were treated with topical cyclosporine (1.5%) twice (26 of 35, 74.3%) and three times (9 of 35, 25.7%) daily. The minimum period for follow-up was 5 months.
Results  The age of the patients ranged from 2 to 13 years with a mean age of 6.0 years. Twenty-two were neutered males, and 13 were females. The represented breeds were 30 DSH, 3 DLH, one Siamese and one Maine Coon. Cytologic examination of a corneal scrape revealed the presence of eosinophils in 34 of 35 specimens, and mast cells in 25 of 35 specimens. Improvement in the treated eyes was seen in 31 cats (88.6%). Four animals (11.4%) did not respond to the treatment with topical cyclosporine. Recurrences were seen in seven (22.6%) cases. Blepharitis was noted as an infrequent side effect.
Conclusion  Based on our findings, topical cyclosporine (1.5%) is an effective treatment of proliferative feline eosinophilic keratitis in the vast majority of cases. Recurrences were mainly associated with poor owner compliance. Chronic, often lifelong therapy with medications is thus recommended.     

Equine phacoclastic uveitis: the clinical manifestations, light microscopic findings, and therapy of 7 cases

This retrospective clinical study describes the clinical manifestations, light microscopic findings, and diagnosis and treatment of acute and chronic lens rupture in the horse. Rupture of the lens capsule in the horse usually results in a chronic, blinding inflammation (phacoclastic uveitis) unless prompt surgical and medical therapies are implemented. The clinical manifestations of acute lens capsule rupture included: cataract; intralenticular displacement of iridal pigment; lens cortical fragments attached to the perforated lens capsule, iris, and corneal endothelium; miosis; aqueous flare; and usually a corneal or scleral perforation with ulceration or focal full thickness corneal edema and scarring. The clinical signs of chronic phacoclastic uveitis include blindness, phthisis bulbi, and generalized corneal opacification related to scarring, vascularization, pigmentation, and edema. In one horse, acute phacoclastic uveitis was successfully treated with phacoemulsification to remove the ruptured lens and medical therapy to control the accompanying inflammation. The affected eyes of the horses with chronic phacoclastic uveitis were enucleated because of persistent clinical signs of nonulcerative keratitis and uveitis, despite long-term medical management. The clinical manifestations and lack of improvement with medical therapy are similar in the horse, dog, cat, and rabbit. However, the histologic findings in equine phacoclastic uveitis differ significantly from those in the dog, and rabbit.     

Histologic evaluation of the immediate effects of diamond burr debridement in experimental superficial corneal wounds in dogs

Purpose To evaluate the corneal changes immediately after diamond burr debridement of superficial corneal wounds in dogs. Spontaneous chronic corneal epithelial defects (SCCEDs) are the most common form of canine recurrent corneal ulcers. The diamond burr has been used in the management of corneal lesions in humans since 1983. Recently, it has been successfully used in the treatment of SCCEDs in dogs; however, little has been documented as to its mechanism of action. Methods Five adult female research dogs euthanized for reasons unrelated to the study were included, providing 10 normal eyes. An excimer laser spatula was used for epithelial removal after delineation with an 8 mm punch biopsy trephine. Diamond burr debridement was performed for 30 and 45 s in five eyes each (groups 1 and 2 respectively). The procedure was performed on the ventral half of the experimental defect as well as ventral normal cornea, immediately after euthanasia, and prior to enucleation. Samples were processed routinely for histologic evaluation and stained with periodic acid–Schiff. Results No stromal defects could be identified under light microscopy. In experimental corneal wounds, multi‐focal areas remained covered by the epithelial basement membrane (BM) after diamond burr treatment in both groups (group 1 = 48%±16SD, group 2 = 26%±12SD). Removal of BM on group 2 was significantly higher than group 1 (P < 0.05). Conclusions The diamond burr allows a safe method of debridement and does not create defects beyond the epithelial BM in corneal wounds in normal dogs. Evaluation of the diamond burr debridement in cases of SCCEDs is warranted.     

A new perspective on canine keratoconjunctivitis sicca. Treatment with ophthalmic cyclosporine

Keratoconjunctivitis sicca is the major cause of chronic or recurrent conjunctivitis in dogs. The diagnosis of KCS is often delayed or mistaken for allergic or bacterial conjunctivitis and inappropriate or insufficient treatment leads to progressive corneal scarring and blindness in many dogs. The cause of KCS in dogs has not been proven, but evidence supports an immune-mediated etiology for the majority of cases. In an attempt to specifically treat the cause of KCS, a new immunosuppressant drug, cyclosporine, has been used in a topical preparation. Treatment results using ophthalmic cyclosporine are dramatic compared with historical treatments. Resolution of corneal scarring and increased lacrimation are seen in most dogs. Investigations of the mechanism of action of ophthalmic cyclosporine suggest the efficacy may have been serendipitous. A local neuroendocrine effect of cyclosporine on the lacrimal gland may actually be responsible for the increased lacrimation. Early diagnosis of KCS and treatment with ophthalmic cyclosporine may avert a major cause of blindness in dogs.     

Grid keratotomy as a treatment for superficial nonhealing corneal ulcers in 10 horses

OBJECTIVE: To describe the clinical symptoms of 10 cases of superficial nonhealing corneal ulcers in horses and to evaluate the results of grid keratotomy in these patients. DESIGN: Retrospective study. ANIMALS: Ten horses with superficial nonhealing corneal ulceration in one eye. PROCEDURE: The signalment, history and clinical symptoms are reported of 10 patients with superficial nonhealing corneal ulcers during the period from August 2003 to February 2005. Grid keratotomy was performed in all cases. In addition, the surgical procedure of grid keratotomy and response to therapy are described. RESULTS: Horses generally responded well to grid keratotomy (eight cases healed after one grid keratotomy and one horse healed after a second grid keratotomy; one case was not available for follow-up). Only 2/10 had discomfort after treatment and only 2/9 had some degree of scarring after treatment. The healing time, which was known in seven cases, averaged 8.4 days (+/- SD 4). CONCLUSIONS AND CLINICAL RELEVANCE: Grid keratotomy is an appropriate option for treatment of superficial nonhealing corneal ulcers in horses. The procedure is simple to perform. It generally induces a rapid and uncomplicated healing of the cornea. Only in a limited number of cases does a small amount of scarring occur.     

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.     

Corneal pannus (chronic superficial keratitis) in the German Shepherd Dog

The clinical features, histopathology and treatment of corneal pannus (chronic superficial keratitis) in a series of eighty-four German Shepherd Dogs are reported. The aetiology of the condition and its therapeutic management are discussed in the light of these findings.     

Corneal squamous cell carcinoma in a dog: a case report

Purpose:  To report a case of primary corneal squamous cell carcinoma (SCC) in an English Bulldog. In addition, immunohistochemistry of the corneal tissue mass was performed using a panel of antibodies. A prominent feature of the present case was the clinical history of chronic keratitis due to eyelid abnormalities.
Results:  No papillomavirus antigen was detected in section of normal or neoplastic corneal tissue. The corneal epithelial cells were positive for pancytokeratins AE1/AE3 and MNF116, and E-cadherin. The neoplastic cells in close proximity to the normal epithelial lining were positive for both pancytokeratins and E-cadherin with gradual loss of staining toward the center of the neoplastic mass. Rare neoplastic cells demonstrated positive staining for caspase 3 and a large number was strongly positive for GADD45 and p53.
Conclusion and discussion:  The observed loss of the various cytokeratins, the strong p53 expression, and low numbers of caspase 3 positive cells were suggestive that a p53 mutation may have caused this primary corneal SCC. Over-expression of the tumor-suppressor gene p53 is likely to be a consequence of ultraviolet radiation exposure. Two factors, however, may have played a role in the formation of this primary corneal SCC: chronic irritation of the corneal surface (microtrauma) and exposure to UV radiation.     

Feline corneal disease

The cornea is naturally transparent. Anything that interferes with the cornea's stromal architecture, contributes to blood vessel migration, increases corneal pigmentation, or predisposes to corneal edema, disrupts the corneas transparency and indicates corneal disease. The color, location, and shape and pattern of a corneal lesion can help in determining the underlying cause for the disease. Corneal disease is typically divided into congenital or acquired disorders. Congenital disorders, such as corneal dermoids are rare in cats, whereas acquired corneal disease associated with nonulcerative or ulcerative keratitis is common. Primary ocular disease, such as tear film instability, adenexal disease (medial canthal entropion, lagophthalmus, eyelid agenesis), and herpes keratitis are associated with the majority of acquired corneal disease in cats. Proliferative/eosinophilic keratitis, acute bullous keratopathy, and Florida keratopathy are common feline nonulcerative disorders. Nonprogressive ulcerative disease in cats, such as chronic corneal epithelial defects and corneal sequestration are more common than progressive corneal ulcerations.     

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.     

Posterior lamellar keratoplasty for treatment of deep stromal absesses in nine horses

OBJECTIVE: To describe and evaluate the use of posterior lamellar keratoplasty as a surgical treatment for deep corneal stromal abscesses in horses. Animals studied Nine horses of various breeds and ages that presented with corneal stromal abscesses located in the posterior one-third of the cornea. Procedure Retrospective medical record study. RESULTS: Nine horses had deep corneal stromal abscesses that were treated with posterior lamellar keratoplasty. Median patient age was 3 years. Six patients were females and three were geldings. Medical therapy alone had been attempted prior to surgery in all nine animals. Corneal abscess culture and histopathology were performed in 8/9 horses. Cultures were positive for an infectious etiology in 4/8 (50%). Histopathology was positive for an infectious etiology in 5/8 (62.5%). Mean surgical time was 71.0 +/- 18.8 min and the average healing time was 23.7 +/- 5.2 days. Visual outcome was positive in 8/9 cases. Conclusion Posterior lamellar keratoplasty is a promising procedure for treatment of deep corneal stromal abscesses in horses. The procedure resulted in considerable shorter surgery time and healing time than had been observed with full-thickness penetrating keratoplasty. Scar formation with this procedure was not significantly different than with penetrating keratoplasty.     

The Treatment of Acute Glaucoma in Dogs and Cats

Objective: Glaucoma is an optic nerve disease that may result in rapid loss of vision. Early detection of acute glaucoma and aggressive treatment is important to preserve vision. Continued treatment is indicated in chronic glaucoma to alleviate discomfort associated with chronic elevated intraocular pressure.
Etiology: In primary glaucoma, an abnormal iridocorneal angle results in obstruction to outflow of aqueous humor. In secondary glaucoma, an otherwise normal iridocorneal angle is obstructed by abnormalities such as a luxated lens, neovascular membranes or inflammatory material.
Diagnosis: The diagnosis is made by a combination of clinical signs such as corneal edema, mydriasis, decreased vision, episcleral hyperemia, and confirmed by measuring an elevation in intraocular pressure. Complete ophthalmic examination, knowledge of breed predisposition to various ocular diseases and gonioscopy will aid in distinguishing between primary and secondary glaucoma
Therapy: Aggressive medical management is important in acute glaucoma. Surgical procedures are often indicated after initial emergency medical treatment of acute glaucoma. Chronic, painful blind eyes are best treated with one of various surgical procedures.
Prognosis: The prognosis for maintaining vision or regaining temporarily lost vision in acute glaucoma is related to numerous factors including time between onset of clinical signs and appropriate treatment, etiology of the glaucoma, initial response to therapy and client compliance.     

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.