Diagnostic ultrasonography of equine lens and posterior segment abnormalities

Purpose To define the indications for equine ocular ultrasonography and to provide representative ultrasonographic images of lens and posterior segment diseases. Methods Retrospective study. Equine medical records dating from January 1983 to March 2001 were reviewed. All cases that: (1) had a lens and/or posterior segment abnormality; and (2) received a complete ophthalmic examination and ocular ultrasonography were included. Results Forty‐three cases (n = 64 eyes) out of 112 total cases of equine lens and/or posterior segment abnormalities qualified. The following conditions were identified ultrasonographically in order of decreasing frequency: cataracts, vitreal opacities, retinal detachment, lens luxation, endophthalmitis, microphthalmos, choroiditis, lens rupture, lenticonus, buphthalmos and phthisis bulbi. Ultrasonography often enabled diagnoses to be made in the presence of anterior opacities in both surgical (pre and/or postoperatively) and nonsurgical cases. Additional ocular conditions were identified in adults with cataracts more frequently than in foals with cataracts. Conclusions Cataracts were the most common lens abnormality identified in horses that received ocular ultrasound examination. Cataracts were commonly found in association with other ocular abnormalities. Ultrasonography was a practical and effective method of evaluating the lens and posterior segment, particularly in cases with anterior opacities. Ultrasonography also provided critical information with regard to the potential for surgical removal of cataracts and was a valuable component of postsurgical follow‐up.     

Posterior lenticonus with congenital cataract in a Shih Tzu dog

A seven-month-old, male Shih Tzu dog weighing 3.7 kg had an immature cataract in its left eye. A biomicroscopic examination revealed numerous vacuolations in the posterior cortices with nucleus cataracts, covered by an intact anterior lens capsule. The changes observed by ocular sonographic examination (OSG) of the left eye were hyperechoic, and a funnel-cone shape was observed posteriorly with cortex hyperechogenicity in the lens. The left eye was diagnosed as having a posterior lenticonus with congenital cataract. Phacoemulsification was performed on the left eye as diagnostic treatment of the posterior lenticonus and cataract. Postoperative OSG on the left eye revealed a V-shaped linear echo that was indicative of a posterior capsule of the lens. Moreover, it was confirmed that hyperechoic cataract material inside the lens had disappeared.     

The incidence of posterior capsule disruption during phacoemulsification and associated postoperative complication rates in dogs: 244 eyes (1995-2002)

OBJECTIVE: The objective of this retrospective study was to report the incidence of posterior capsule disruption during routine phacoemulsification and to document the postoperative outcomes and complications in eyes with posterior capsule disruption compared with eyes with intact posterior capsules. PROCEDURES: Records of 143 dogs (244 eyes) were reviewed. Data collected included whether the posterior capsule was disrupted, whether the disruption was planned or accidental, whether an intraocular lens was implanted, and visual outcome. Records were reviewed for postoperative complications. Intraocular lens implantation rates, complication rates, and visual outcomes were compared between intact and disrupted posterior capsule groups using Chi-square analyses. RESULTS: The posterior capsule was disrupted in 33/244 eyes (14%). Planned capsulotomies accounted for 36% of the disruptions. Intraocular lenses were implanted in 76% of eyes without a disruption of the posterior capsule and in 31% of eyes with a posterior capsule disruption. Intraocular lenses were more likely to be implanted in eyes with a planned disruption of the posterior capsule (7/12; 58%) than in eyes with an accidental disruption (3/20; 15%). There were no significant differences in postoperative complications or visual outcome between eyes with posterior capsule disruption and those without. CONCLUSIONS: The most significant complication of posterior capsule disruption during phacoemulsification is the inability to implant an intraocular lens. Intraocular lenses are more likely to be placed in eyes with intentional disruptions of the posterior capsule than those with accidental ruptures.     

Phacoemulsification and acryl foldable intraocular lens implantation in dogs: 32 cases

This study evaluated the surgical outcome and complications of phacoemulsification and the implantation of an acryl foldable intraocular lens (IOL) with a squared edge in dogs with cataracts. Thirty-two eyes from 26 dogs were examined. The mean follow up period was 75.9 days ranging from 23 to 226 days. The complications after phacoemulsification were posterior capsular opacity (PCO) around the IOL (n = 11), ocular hypertension (n = 4), focal posterior synechia (n = 4), hyphema (n = 3) and corneal ulcer (n = 2). The complications associated with the IOL were decenteration of the optic (n = 2) and ventral haptic displacement (n = 1). Most cases of PCO were found only around the margin of the IOL, and all eyes had vision during the observation period. In conclusion, the implantation of an acryl-foldable lens with a squared edge at the time of phacoemulsification is an effective method for preserving the central visual field of dogs with cataract.     

Lens luxation in the dog and cat

Dislocation, or luxation, of the lens arises as a result of rupture of the zonular fibers, which suspend the lens from the ciliary body. In the dog, lens luxation is most frequently encountered as a primary, heritable condition in which there appears to be an inherent weakness of the zonule. The condition is limited mainly to the Terrier breeds but has also been described in the Tibetan Terrier and Border Collie. The disease is essentially bilateral but seldom becomes apparent clinically before 3 or after 7 years of age. In most primary luxations, the lens passes into the anterior chamber and such cases must be regarded as emergencies on account of the likely development of secondary glaucoma; posterior luxations are usually less troublesome. Other causes of lens luxation include cataract formation, glaucoma, and uveitis. Congenital dislocations and those attributable to trauma alone are rare. In the cat, lens luxations are usually secondary and arise in later life.     

A modified ab externo approach for suture fixation of an intraocular lens implant in the dog

The goals of canine cataract and lens instability surgery should be to ensure a small incision, minimal tissue trauma, shortened surgical time, maintenance of the anterior chamber, and restoration of emmetropia through the use of a stable intraocular lens specifically designed for the canine eye. While this is usually the case with routine phacoemulsification and in-the-bag intraocular lens implantation, it is often not the case with lens instability, lens luxation or large posterior capsular ruptures. In such cases the incisions are often larger, surgical time and tissue trauma are excessive, and the patient is often left aphakic. The goal of this paper is to present a modified ab externo technique designed to allow removal of the lens and placement of a ciliary sulcus sutured IOL through a small incision, with minimal trauma and shortened surgical time. Use of this technique may allow more canine patients to be emmetropic postoperatively. In addition, the ease of this procedure may encourage earlier removal of an unstable lens and decrease the risk of secondary glaucoma and retinal detachment that occur in association with lens luxation.     

Histologic and immunohistochemical characterization of lens capsular plaques in dogs with cataracts

OBJECTIVE: To determine histologic and immunohistochemical characteristics of the multifocal adherent plaques that commonly develop on the internal surfaces of the anterior and posterior lens capsules in dogs with cataracts. SAMPLE POPULATION: 31 anterior and 4 posterior capsular specimens collected during lens extraction surgery in dogs with cataracts. PROCEDURE: Specimens were evaluated, using light and transmission electron microscopy. Immunohistochemical techniques were used to localize cytokeratin, vimentin, alpha-smooth muscle-specific actin, fibronectin, tenascin, and transforming growth factor-beta (TGF-beta) within plaques. RESULTS: Histologically, plaques comprised elongated spindle-shaped cells that formed a placoid mass. Cells were embedded in an extracellular matrix containing collagen fibrils, often with duplicated or split basement membranes. Immunohistochemically, normal lens epithelial cells and cells within plaques stained for vimentin. Most cells and some areas of the extracellular matrix within plaques stained for TGF-beta and alpha-smooth muscle-specific actin. Fibronectin and tenascin were also detected in the extracellular matrix. CONCLUSIONS AND CLINICAL RELEVANCE: Canine lens capsular plaques are histologically and immunohistochemically similar to posterior capsule opacification and subcapsular cataracts in humans, which suggests that the canine condition, like the human conditions, is associated with fibrous metaplasia of lens epithelial cells. Transforming growth factor-beta may play a role in the genesis of capsular plaques. Because severity of plaques was correlated with stage of cataract development, earlier surgical removal of cataracts may be useful to avoid complications associated with plaque formation.     

Keratometry, biometry and prediction of intraocular lens power in the equine eye

OBJECTIVE: To determine ocular dimensions (A- and B-scan ultrasound) and corneal curvature (radius of corneal diameter determined in B-scan ultrasound) in the equine eye and to calculate the appropriate dioptric power for a posterior chamber intraocular lens (IOL) necessary to achieve emmetropia in the eyes of horses undergoing lens extraction. ANIMALS: Fourteen clinically normal adult horses of various breeds. Additionally, for comparison, one American Miniature colt foal, and one 2.5-year-old Shire gelding were examined. PROCEDURE: B-scan ultrasound was performed on one eye from each horse. One eye from both the Shire and the American Miniature were examined for comparison. Data from ultrasound (globe measurements and corneal curvature), and the estimated postoperative IOL positions were entered into theoretical IOL formulas (Binkhorst and Retzlaff theoretical formulas) in order to calculate the predicted IOL strength required to achieve emmetropia after lens extraction in horses. Results: Mean axial length of globes was 39.23 mm +/- 1.26 mm, mean preoperative anterior chamber depth (ACD) was 5.63 +/- 0.86 mm, and mean lens thickness was 11.75 +/- 0.80 mm. Predicted postoperative ACD (PACD) was calculated as the ACD plus 50% of the lens thickness. Additionally, PACD 2 mm anterior and 2 mm posterior to the center of the lens were calculated in order to evaluate the effect of IOL position on its required refractive power. Required IOL strength calculated, using the three values for the predicted postoperative ACD, was 29.91 D +/- 2.50, 29 D +/- 2.52 (center of lens); 27.13 D +/- 2.27, 26.33 D +/- 2.20 (2 mm anterior to center of lens); and 33.18 D +/- 2.78, 32.24 D +/- 2.68 (2 mm posterior to center of lens) with the Binkhorst and Retzlaff theoretical formulas, respectively. CONCLUSIONS: An IOL of substantially lower diopter strength than that needed in either dogs or cats is required to achieve emmetropia after lens extraction in adult horses. IOL strength of approximately 30 D, depending on where the IOL ultimately comes to rest, will probably be required.     

Familial cataracts and concurrent ocular anomalies in chow chows.

A closely inbred line of Chow Chows affected with congenital cataracts was studied. Sixteen dogs were examined including 1 adult male, 2 adult females, and 13 pups. Twelve of the pups were from 6 different litters, out of 6 different bitches, all sired by 1 adult male. The exact relationship of the thirteenth pup was undetermined. Clinical evaluation included slit-lamp biomicroscopy, biomicroscopic photography, and indirect ophthalmoscopy. Clinical appearance of the cataracts was variable, ranging from incipient nuclear or capsular lesions to advanced cortical opacity. The lens nucleus was most consistently affected, with variable involvement of the lens cortex. Concurrent ocular anomalies of some eyes included wandering nystagmus, entropion, microphthalmia, persistent pupillary membrane remnants, and multifocal retinal folds. A correlation was not apparent between the character or severity of the cataracts and the finding of the other anomalies. Histologic examination of 12 lenses revealed posterior displacement of the lens nucleus, retained lens epithelial cell nuclei in the nuclear and cortical lens, anterior capsular irregularity and duplication, anterior lens epithelial duplication, and posterior subcapsular migration of epithelium. The high incidence of cataract in this family of Chow Chows suggested an inherited defect, although the inheritance pattern was undetermined.     

Anterior and posterior segment photography. An alternative approach using a dSLR camera adaptor

Purpose To describe a novel digital single lens reflex (dSLR) camera adaptor for anterior and posterior segment photography. Methods The adaptor was used to evaluate canine, feline, and equine patients presenting to Tufts Ophthalmology service. Anterior segment imaging was conducted with the adaptor mounted between a dSLR camera body (Canon 7D) and a macro lens (Canon EF‐S 60mm/f2.8). Posterior segment imaging was performed with the aid of an indirect ophthalmic lens mounted in front of the macro lens. Coaxial illumination during viewing was provided by a single white light‐emitting diode (LED) within the adaptor, while illumination during exposure was provided by the pop‐up flash or an accessory flash. Corneal and/or lens reflections were eliminated using a pair of linear polarizers, having their azimuths at right angles to one another. Results This dSLR camera adaptor provides quality high‐resolution, reflection‐free, images of both the anterior and posterior segments. It was easy to transport, assemble, and handle. The necessary adjustments, positioning, and focusing required for quality images were easily performed. Conclusion The described dSLR camera adaptor provides an alternative to existing imaging systems. High‐resolution image acquisition occurred at a fraction of the cost of established imaging system, particularly those devoted to the posterior segment.     

Computed tomographic dimensions of the normal adult equine eye

There are limited data on whether the dimensions of the equine eye and its internal structures change with bodyweight in horses. The aim of this study was to identify whether the size of the equine eye and its individual structures varied in a predictable manner with bodyweight, and to examine the reliability of computed tomography (CT) scans in the measurement of the equine eye. Ninety horses which had undergone CT examination of the head for non‐ocular disease were included. All measurements of the eye were performed twice on all eyes by the same operator to quantify intra‐operator agreement, and in 10 cases were also performed by a second operator to quantify inter‐operator agreement. Agreement was excellent for all but the rostrocaudal measurement of the anterior chamber, which was fair. The following variables correlated significantly with bodyweight: anterior‐posterior size of the globe (correlation coefficient: 0.586) and posterior segment (correlation coefficient: 0.554); the latero‐medial size of the globe (correlation coefficient: 0.452), anterior chamber (correlation coefficient: 0.504) and posterior segment (correlation coefficient: 0.455); and the orbital fossa diameter (correlation coefficient: 0.219). The lens size and anterior‐posterior distance of the anterior chamber did not correlate significantly with bodyweight. These results suggest that overall eye size and the size of the orbital fossa change with the bodyweight of the horse, but lens size remains consistent, and that CT measurements of the internal structures of the eye are repeatable and reproducible. This information aids in interventional procedures for ocular pathology and assessment of normal anatomy.     

An outbreak of cataract with lens rupture and nuclear extrusion in wolf-fish (Anarhicas spp.)

Eight spotted (Anarhicas minor Olafsen) and five common wolf-fish (Anarhicas Lupus L), developed cataracts shortly after an episode of increased water temperature and decreased salinity 5 years prior to examination. On clinical examination, the cataracts were mostly bilateral and complete, and a majority of the lenses were lobulated. Inflammatory reaction was, apart from one eye with severe inflammation, limited to iris atrophy. Of the 14 eyes collected for pathomorphological examination, eight had lens rupture with extrusion of the nucleus to the posterior chamber, two showed partly dislocated nuclei with posterior protrusion and two lenses were morgagnian. A multilayered squamous epithelium with abundant desmosomes had developed on the surface of seven of the extruded nuclei. The main cause of the cataracts was considered to be the rapid decrease in water salinity, causing osmotic changes within the eyes with secondary swelling of lens fibers and rupture of the lens capsules.     

Surgical management and histologic and immunohistochemical features of a cataract and retrolental plaque secondary to persistent hyperplastic tunica vasculosa lentis/persistent hyperplastic primary vitreous (PHTVL/PHPV) in a Bloodhound puppy

The objective of this study was to describe the clinical, histologic and immunohistochemical features, the surgical treatment, and outcome of a cataract secondary to persistent hyperplastic tunica vasculosa lentis/persistent hyperplastic primary vitreous (PHTVL/PHPV) in a dog. A 4-month-old male Bloodhound dog presented for evaluation of a cataract. A complete ophthalmic examination and ocular ultrasonography were performed. A resorbing cataract with intralenticular hemorrhage, lens induced uveitis, and PHTVL/PHPV were diagnosed. Extracapsular cataract extraction using phacoemulsification was performed. A primary posterior capsulectomy was performed to remove a retrolental plaque with the posterior capsule; the excised plaque was submitted for histopathology and immunohistochemical staining. A 41-Diopter intraocular lens (IOL) was implanted. Functional vision was maintained postoperatively during the 21-month follow-up period. Histologically, the posterior capsule was coiled and exhibited duplication. The retrolental plaque was comprised of dense fibrous connective tissue, blood vessels, free red blood cells, hemosiderin-laden macrophages, a pocket of neural tissue and numerous perivascular mast cells. With immunohistochemical staining, the neural elements were determined to be glial cells compatible with astrocytes. Cataract secondary to PHTVL/PHPV can be successfully treated using phacoemulsification and planned posterior capsulectomy. Posterior lens capsule duplication, mast cells and astrocytic glial cells may be normal components of the fibrovascular retrolental plaque associated with PHTVL/PHPV.     

Immunohistochemical analysis of lens epithelial-derived membranes following cataract extraction in the dog

The objective of the study was to characterize the morphologic and immunohistochemical features of lens epithelial-derived proliferative membranes from the anterior segment of canine globes. These features were correlated with those previously identified for diseases resulting from lens epithelial cell (LEC) proliferation including posterior capsular opacification, traumatic subcapsular cataract, and subcapsular plaques associated with hypermature cataracts. Sixteen canine globes were removed as a result of glaucoma or other complications following cataract extraction. Light microscopic and immunohistochemical analysis was performed on sections from formalin-fixed, paraffin-embedded globes. The tissues were stained with a variety of antibodies for cellular markers for LECs, growth factors or other cellular constituents relevant to cellular metaplasia and proliferation. The membranes were composed of monolayers or multilayers of spindle-shaped cells on the external surfaces of the anterior and posterior lens capsule, ciliary processes, iris leaflets, and iridocorneal angle, and they could be seen extending from an obvious monolayer of LEC within the capsular sac. Variably, scattered pigment cells, presumably of uveal origin, were concurrently present. Cellular components of the membranes stained positive for vimentin, transforming growth factor-beta, basic fibroblast growth factor, and smooth muscle actin. An amorphous eosinophilic extracellular matrix consisting predominately of collagen was associated with the membranes. Proliferative anterior segment membranes following cataract surgery were morphologically and immunohistochemically similar to cellular and matrix components of posterior capsular opacification and capsular plaques seen with hypermature cataracts, both of which result from metaplasia and proliferation of LEC. The presence of these LEC-derived membranes in association with secondary glaucoma suggests that exuberant proliferation of LEC outside the confines of the lens capsular sac may cause pathologic alterations in the eye following cataract surgery in the dog.     

Posterior lens luxation with associated glaucoma in a pony

Secondary lens luxation is an infrequent consequence of equine recurrent uveitis (ERU). This Case Report describes a pony with posterior lens luxation with associated glaucoma, thought to be secondary to ERU.     

Quantitative analysis of animal model lens anatomy: accommodative range is related to fiber structure and organization

Purpose The results of a recent study on accommodation in humans and baboons has revealed that lens fiber structure and organization are key components of the mechanism of accommodation. Dynamic focusing involves the controlled displacement and replacement, or realignment, of cortical fiber-ends at sutures as the mechanism of accommodation at the fiber level. This emended explanation of the mechanism of accommodation raises the following question: as the structure of crystalline lenses are only similar, not identical between species, is accommodative amplitude related to differences in the structure and organization of fibers between species? To address this question, we have quantitatively examined the structure and organization of fibers in a number of the more commonly used animal models (mice, cattle, frogs, rabbits and chickens) for lens research. Materials and methods Lenses (a minimum of 12–18 lenses/species) from mice, cattle, frogs and rabbits were used for this study. Prior to fixation for structural analysis, measurements of the gross shape of the lenses (equatorial diameter, anterior and posterior minor radii [anterior + posterior minor radius = polar axis]) were taken directly through a stereo surgical dissecting microscope equipped with an ocular reticle. Lenses were then prepared for and examined by light (LM), transmission (TEM) and scanning electron microscopy (SEM). Scale computer-assisted drawings (CADs) of lenses and lens fibers were then constructed from quantitative data as described above and from quantitative data contained in micrographs. Results The differences in fiber structure and organization that effect accommodative range arise early in development and are continued throughout lifelong lens growth. In umbilical suture lenses (avian) secondary fibers develop with almost completely tapered anterior ends (85–90% reduction of their measures of width and thickness at the equator). By comparison, in lenses with line sutures (e.g. frogs and rabbits) secondary fibers develop with just a 50–60% reduction in anterior fiber taper. In lenses with Y sutures (mice and cattle), fiber width taper is only 25–40%. However, in all cases, while the taper of the posterior end width of fibers is just slightly less (approx. 15–20%) than that of anterior ends, posterior end thickness is only reduced by one half that of anterior thickness. Conclusions In humans, the mechanism of accommodation at the fiber level involves the controlled realignment of very flattened and flared, rather than tapered fiber-ends at sutures. In this manner, the simultaneous increase in lens thickness and surface curvature in the accommodated state is the result of fiber-ends being overlapped along multiple (9–12) suture branches covering the majority of the anterior and posterior surfaces. The results of this animal study strongly suggest that accommodative range is directly related to quantitative differences in fiber structure and organization in the different suture types. The very broad accommodative range in birds is made possible, at least in part, by the almost complete tapering of fiber-ends at umbilical sutures. In contrast, the essentially negligible accommodative range of animals that have line- and Y-suture lenses is at least partially the result of the fact that these lenses have fibers with very little end taper. Thus, the blunt ends of fibers in line- and Y-suture lenses precludes any significant overlap of end segments to effect accommodation.     

Intraocular melanoma in a horse.

Sudden unilateral blindness occurred in a 7-year-old grey gelding Quarterhorse. Ophthalmoscopy revealed a pigmented mass arising from the nasal ciliary body of the right eye and extending around the posterior surface of the lens, and there were pigmented particles in the vitreous. Examination of the enucleated globe showed a circumscribed, black, dense and symmetrically ovoid mass with sessile attachment to the nasal ciliary region and extension to posterior lens capsule, vitreous and along the vitreal face of the detached retina to the optic papilla. The mass was composed of heavily pigmented, plump, polyhedral cells that invaded the vitreous and the inner limiting membrane of peripapillary retina and optic papilla. It was considered to be a primary, malignant, intraocular melanoma arising from a large uveal nevus.     

Immunohistochemical identification of Encephalitozoon cuniculi in phacoclastic uveitis in four rabbits

PURPOSE: Encephalitozoon cuniculi is a microsporidium with a wide range of mammalian hosts. In rabbits it can be responsible for cataract and lens-induced uveitis (LIU). The aim of this study was to provide specific immunohistochemical demonstration and localization of E. cuniculi within the eye, in rabbits with LIU. MATERIAL AND METHODS: Four rabbits were presented with a white mass in the eye and iris discoloration. Complete ophthalmic examinations were performed and a presumptive diagnosis of LIU was made in all cases. Initial therapy with a topical steroid, atropine and systemic enrofloxacin was instituted while serologic (IFA or ICA tests) and cytologic lab results were pending. The final outcome in all cases was enucleation. Routine histology and immunohistochemistry (ABC method) with an antiserum anti-Encephalitozoon cuniculi were performed. RESULTS: Indirect immunofluorescence performed on one rabbit serum expressed a titer of 1 : 32; carbon immunoassay on the serum of the other three rabbits expressed a titer of 1 : 5120 in one, and a titer of 1 : 2560 in the other two cases. Histologically, an intraocular, locally extensive pyogranulomatous infiltration that partially filled the posterior chamber, encasing a wide anterior lens capsule break, was detected in all cases. Immunohistochemically, spores reacting with anti-Encephalitozoon cuniculi antiserum were present in all specimens, occasionally within macrophages and lens epithelial cells. CONCLUSION: Detection of E. cuniculi in rabbits with phacoclastic uveitis has been investigated in the past with different methods. Based on our results, we suggest that immunohistochemistry should be regarded as a useful tool both for specific demonstration of E. cuniculi and for its localization within tissues.     

Rabbits' eye globe sonographic biometry

Objective To measure intraocular structures in New Zealand White breed rabbits (Oryctolagus cuniculus Linnaeus, 1758) using A‐mode and B‐mode ultrasound with a 20 MHz transducer. Procedures In this study, the eyes of 15 rabbits were evaluated for determination of intraocular measurements using an ophthalmic ultrasound unit able to operate in both A and B‐modes. The distances from the cornea to the anterior capsule of the lens (D1), from the anterior capsule of the lens to the posterior capsule of the lens (D2), from the posterior capsule of the lens to the retina (D3) and the complete length of the eye, which corresponds to the distance from the cornea to the retina (D4) were taken. Results The mean values obtained were 2.70 mm (±0.22 mm) for D1, 7.32 mm (±0.40 mm) for D2, 7.10 mm (±0.45 mm) for D3 and 17.12 mm (±0.41 mm) for D4. Statistical analyses using the Student’s t‐test showed that there were no differences between the eyes. Conclusions The study was feasible without the need of pharmacological restraint and yielded normal mean values for ocular sonographic biometry in rabbits.