Mortierella wolfii keratomycosis in a horse

Purpose To describe a case of superficial keratomycosis caused by Mortierella wolfii (M. wolfii) in a horse. Methods A thoroughbred filly was presented with painful right eye of 2 days’ duration. A superficial corneal ulcer was observed ventrally together with multifocal punctuate opacities axially. Samples were collected by swabbing and scraping the ulcerated lesion and submitted for microbiologic and cytologic examination. Results Microscopic evaluation of debrided corneal tissue revealed the presence of nonseptate fungal hyphae, and culture of a corneal swab yielded fungal growth. Medical treatment with topical antifungal, antibiotic and autogenous serum and systemic anti‐inflammatory resolved the problem within 2 weeks. Conclusions Cytologic evaluation of a corneal scraping was useful to make a clinical diagnosis of keratomycosis. Based on the mycological characteristics, the fungus isolated from the corneal lesion was identified as M. wolfii. To the authors’ knowledge, this is the first case report of equine keratomycosis associated with this fungus, although the organism is known to infect various organs of cattle.     

Clinical findings and progression of 10 cases of equine ulcerative keratomycosis (2004–2007)

Ulcerative keratomycosis is a serious sight‐threatening disease of horses and the veterinary literature is replete with cases of poor visual outcome following this condition. During a 3 year period, 10 horses were treated for confirmed keratomycosis at the Veterinary Teaching Hospital (VTH) of the University of Cordoba (Spain). Ulcerative keratomycosis accounted for an average of 8.62% of the total equine ophthalmic admissions during this time and an average of 33.3% of horses were diagnosed with infectious keratitis. Fungi were diagnosed using cytology (n = 4) and/or culture (n = 8) and histopathology (n = 1). Aspergillus sp. was the most commonly isolated fungus. Medical therapy alone or combined medical and surgical treatment was utilised for therapy depending on the clinical condition. Miconazole 1% was the most common topical antifungal therapy employed. Median duration of treatment was 73.12 days. Records were evaluated to determine visual outcome and globe survival.     

Prevalence of equine ulcerative keratomycosis in Colorado and association of environmental factors: A retrospective and descriptive study (2002–2017)

Equine ulcerative keratomycosis is relatively commonly presented to teaching hospitals in North America, with a prevalence from 24 to 86%. Horses in Colorado may have lower risk due to the dry mountain climate, but data are lacking. This study aimed to determine the prevalence of ulcerative keratomycosis amongst horses with ulcerative keratitis presented to Colorado State University Veterinary Teaching Hospital (CSU-VTH) ophthalmology service and to evaluate environmental factors (season, temperature, humidity, wind speed and elevation) associated with ulcerative keratomycosis in Colorado. A database search identified horses with ulcerative keratitis presented to the ophthalmology service at CSU-VTH from January 2002 to August 2017. Sixty-one horses met the inclusion criteria of a corneal cytology and/or culture or histopathology at the time of diagnosis; cases lacking that were excluded. Environmental factors at the boarding sites, including season, temperature, humidity, wind speed and elevation and clinical outcomes for fungal cases, were recorded. Prevalence of fungal infection amongst equine ulcerative keratitis was 16.4% (10/61), suggesting that CSU-VTH has considerably fewer ulcerative keratomycosis cases than other veterinary teaching hospitals in North America. Spring (50%, 5/10) and fall (40%, 4/10) had the highest prevalence of fungal ulcerative keratitis in Colorado. Only one case was reported in summer (10%, 1/10); no horses were positive (0%, 0/10) in winter. Only wind speed seemed to influence the development of ulcerative keratomycosis with higher wind speeds associated with greater rates of fungal involvement (P = 0.047). Other environmental factors did not show a detectable association (all P-values >0.05). Outcomes were variable. It was concluded that horses from the area of CSU-VTH appear to be at lower risk for ulcerative keratomycosis than from the areas around other North American veterinary teaching hospitals that have reported data. Most horses with keratomycosis in this area present in the spring and fall.     

Pseudallescheria boydii keratomycosis in a horse

The fungal organism Pseudallescheria boydii was isolated from the cornea of a Quarter Horse with ulcerative keratitis. Despite aggressive hourly medication through a subpalpebral lavage system, with drugs including miconazole and natamycin, the cornea developed a stromal abscess. Orbital exenteration was performed after 3 weeks. The fungal isolate was later determined to be resistant to all 8 antifungal drugs tested. Microscopic examination of the cornea revealed fungal hyphae throughout the corneal stroma and penetrating the Descemet membrane. Pseudallescheria boydii has not been implicated previously as a cause of keratomycosis in horses or in other domestic animals, although cases in human beings have been described.     

Rose bengal positive epithelial microerosions as a manifestation of equine keratomycosis

Purpose To describe the clinical appearance of corneal epithelial cell microerosions associated with keratomycosis in the horse. METHODS: Retrospective clinical study. RESULTS: Multifocal, punctate, superficial corneal opacities with positive rose bengal retention were noted in six horses with presumed 'viral keratitis'. Faint fluorescein staining was also present in three cases. Equine herpesvirus tissue culture inoculation was negative for a cytopathic effect in three cases. Aspergillus (n = 3), Curvularia (n = 1), and an unidentified fungus (n = 1) were cultured in five horses, and hyphae found on corneal cytology from the sixth. Mixed bacterial infections were present in three eyes. The eyes of two horses with Aspergillus progressed to deep melting corneal ulcers that required surgical therapy. The microerosions remained superficial, but persistent in the other four eyes. Natamycin was utilized topically in all six horses. Transmission electron microscopy from case 6 revealed mucin layer disruption, an intact corneal epithelial cell layer, and fungal attachment to degenerating epithelial cells. The visual outcome was positive in all six horses, although healing was prolonged (48.5 +/- 14.5 days on average in the horses with no surgery; 62 days on average in the two horses that required surgery). CONCLUSIONS: Complete removal or full-thickness penetration of the corneal epithelial cell barrier may not be necessary to allow fungal adherence and initiation of keratomycosis in the horse. Prior to colonization and invasion of the horse cornea, fungi may induce changes in the mucin layer of the tear film that result in or are associated with rose bengal positive microerosions of the superficial corneal epithelium. Horses with painful eyes, and eyes with superficial, multifocal corneal opacities should have their corneas stained with both fluorescein and rose bengal as fungal microerosions may stain weakly, or not at all, with fluorescein, and may thus be mistaken for presumed 'viral keratitis' of the horse.     

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.     

Eosinophilic keratitis and keratoconjunctivitis in a 7-year-old domestic shorthaired cat

A 7-year-old, spayed female, domestic shorthair was presented with a several-month history of an ulcerated right cornea with marked stromal edema and inflammation that was nonresponsive to therapy. A diagnosis of eosinophilic keratitis was made, based on cytologic examination of corneal scrapings. The lesion resolved after treatment with topical corticosteroids.     

Clinical findings and outcomes of ulcerative keratomycosis in 30 horses in the mid‐Atlantic United States (2006–2007)

The purpose of this study was to determine the clinical course and outcome associated with keratomycosis in horses in the mid‐Atlantic USA. Records of horses diagnosed with keratomycosis at New Bolton Center from November 2006 to November 2007 with positive fungal culture were retrospectively studied. Neither horses with ulcerative keratitis and a negative fungal culture nor those with stromal abscesses were included. Subject details, history, clinical findings, therapy and outcome were recorded. Thirty horses fitted both inclusion criteria (diagnosis of keratomycosis and positive corneal fungal culture). Fourteen of 30 cases occurred during summer. Aspergillus was the most commonly cultured fungal genus (17/30, or 57%) followed by Alternaria (4/30). Seventeen horses had positive bacterial and fungal cultures. Fifteen of 30 horses were treated surgically by a keratectomy and amnion (8) or conjunctival (7) graft. Itraconazole was the most common topical anti‐fungal therapy and was utilised in 25/30 horses. Globe survival was 97% (29/30). All surviving globes had a positive menace response and were visual at the last examination. It was concluded that in the mid‐Atlantic USA, fungal keratitis is common, has the highest incidence in summer, and is usually associated with a positive outcome. Aspergillus may be a relatively more common corneal pathogen in this region than elsewhere in the USA. Surgical cases were more likely to have fungal hyphae identified on cytology and tended to be hospitalised longer than medical cases. There was no apparent association between surgical disease and all other patient, organism and treatment variables.     

Success of Anterior Chamber Paracentesis as a Treatment for Ocular Setariasis in Equine Eye: Case Report

A 7-year-old, male pony was presented to our facility with progressive corneal opacity and blepharospasm in the right eye. Vision could not be determined. A thread-like parasite was found in the anterior chamber of the eye. Removal of the parasite through the cornea using the aspiration technique could not be accomplished. The parasite was successfully removed by making a stabbing incision, as an alternative, and was identified as belonging to the genus Setaria. In this report, details of the surgical procedures used together with surgical complications have been discussed. Vision was restored in the right eye postoperatively, though local corneal opacity still persists.     

Equine keratomycosis in Japan

Objective To describe the incidence, clinical progress, visual outcome, and laboratory findings of equine keratomycosis in Japan. Procedure Retrospective study of the medical records of horses clinically and mycologically diagnosed with keratomycosis at the Equine Hospitals of the Japan Racing Association from 2005 to 2011. Results The diagnosis of keratomycosis was confirmed in eight horses (40.0% of the 20 horses with infectious keratitis from which fungi and/or bacteria were isolated). Fungi recovered from corneal swabs were identified as Aspergillus flavus (4), Aspergillus niger (1), Fusarium solani (1), and Mortierella wolfii (2). All horses were treated medically with topical antifungals, and one horse was also treated surgically. The median of treatment period was 40 days. Two horses were rendered blind in the affected eye and the others retained vision. Conclusions Equine keratomycosis comprises a considerable portion of infectious keratitis in Japan, and the causative fungi that we isolated had been isolated previously from horses with keratomycosis in other regions with the exception of M. wolfii. Culture and cytological examination of corneal lesions should be immediately performed on eyes with signs of keratitis, particularly on those not improving with antibacterial medication, as early initiation of aggressive antifungal treatment tended to result in better outcome and shorter treatment period.     

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.     

A retrospective study of 30 cases of frozen lamellar corneal graft in dogs and cats

Frozen lamellar corneal grafts and nictitating membrane flaps were used in 18 dogs and 12 cats to repair deep corneal defects. In all dogs either melting corneal ulcers or descemetoceles were present. In the 12 cats, nine had either a melting corneal ulcer or descemetocele, two animals had acute bullous keratopathy, and one cat had corneal sequestrum. Initial vascularization with gradual clearing of the graft occurred during the first 45 days postoperatively. At 60 days postoperatively, all eyes were visual. Frequent postoperative complications included: focal dehiscence of the wound ( n  = 9); melting of part of the graft ( n  = 7); and pigmentation of the graft ( n  = 4). The frozen lamellar corneal graft was a very safe technique, and restored the tectonic and the optical function of the cornea. It provided the best results in corneas with nonperforating corneal defects. This technique provides poorer results when the cornea was perforated prior to surgery or during the surgical procedure.     

Ocular and orbital porcupine quills in the dog: a review and case series.

A retrospective evaluation of 5 cases of orbital or intraocular porcupine quills in the dog and a literature review from MEDLINE (1983-1995) is presented. This paper reviews the diagnosis, therapy, and visual prognosis of ocular and orbital quills in the dog. Distinguishing penetration and perforation of the eye and intraocular structures is paramount in establishing a visual prognosis and appropriate therapy. Perforation of the cornea or sclera, lens, or the uvea and retina necessitates prompt specialized surgical therapy to save vision. The diagnosis of orbital quills can be readily confirmed with ultrasonography. The characteristic sonographic appearance of a double-banded, linear, hyperechoic object allows accurate localization of the quill, which aids surgical removal.     

Tissue distribution of dexamethasone in canine ocular compartments following topical application of dexamethasone-21-isonicotinate and oxytetracycline HCl

Objective  To study the dexamethasone (DXM) concentration at different time points in various compartments of the canine eye following topical application of DXM-21-isonicotinate and oxytetracycline hydrochloride
Animals studied  Thirty dogs to be euthanized for reasons not related to this study were selected and their ocular health status evaluated. Selected animals were treated with DXM-oxytetracycline ointment and euthanized after 6, 11 or 16 h.
Procedure  The concentration of DXM was determined in the following compartments of the eye: third eyelid, cornea, aqueous humor, iris, lens, vitreous body and choroid/retina. The DXM concentration in the eye was measured by radioimmunoassay. The applied amount of DXM was 0.04 mg in 0.2 mL ointment. Dogs were treated once with Corti Biciron^® eye ointment (DXM-21-isonicotinate and oxytetracycline hydrochloride, S & K Pharma, Perl, Germany) and were euthanized 6, 11 and 16 h after treatment.
Results  At 6 h following topical application the mean DXM concentration was highest in the anterior structures of the eye (third eyelid: 18 ng/g, cornea: 36 ng/g). The concentration in the posterior structures was below detection level. A decreased DXM concentration in the anterior structures was measured 11 and 16 h after treatment.
Conclusion  It could be demonstrated that therapeutically relevant concentrations of DXM after a single topical administration are only achieved in anterior structures of the eye. A dosing interval of 6–11 h is recommended to achieve therapeutic drug concentration in those structures. The posterior structures of the eye are not reached by topical administration.     

Aspergillus flavus keratomycosis in a cat treated with topical 1% voriconazole solution

An 8-year-old male castrated Domestic Short-haired cat was examined for a 1-week history of blepharospasm and mucoid ocular discharge OS. Examination revealed ulcerative keratitis with stromal loss, stromal infiltrate, corneal edema, perilimbal vascularization and miosis. Cytology of the cornea revealed multiple dichotomously branching, septate fungal hyphae and severe, predominantly neutrophilic inflammation. PCR of the cytology samples confirmed the presence of Aspergillus flavus while fungal and bacterial cultures were negative. Treatment with topical 1% voriconazole solution was successful in resolving the keratomycosis.     

Equine keratomycoses in California from 1987 to 2010 (47 cases)

Reasons for performing study: Equine keratomycosis in the western USA has received little study, probably owing to its low prevalence. Objectives: To determine clinical features, predominant fungal isolates, treatment modalities and outcomes of horses with keratomycosis in California and compare these with results from different geographic regions. Methods: Records of horses presented to the University of California‐Davis Veterinary Medical Teaching Hospital (UCD‐VMTH) with confirmed keratomycosis between 1987 and 2010 were reviewed for this retrospective study. Information retrieved from the record included background, ophthalmic examination findings, treatment prior to and following presentation, visual outcome, and ocular survival. Results: A total of 48 eyes in 47 horses met the inclusion criteria and comprised 2% of cases presented to the UCD‐VMTH ophthalmology service. Prior to presentation, 20 horses (43%) received at least one topically administered anti‐inflammatory medication. Keratomycosis was confirmed by fungal culture in 38 horses (81%), by histopathology in 2 horses (4%) and by cytology in 7 horses (15%). Forty‐four isolates were identified in the 38 horses cultured; Aspergillus was the most common isolate (64%) and a novel isolate, Papulospora, was identified in 2 horses. Treatment consisted of medication only (73%), medical and surgical treatment (25%), or immediate enucleation (2%). Globe retention was 77% and vision retention was 53%. Corneal perforation was significantly associated with loss of vision (P<0.001). Conclusions: Keratomycosis is relatively uncommon in horses presented for ophthalmic conditions at UCD‐VMTH. Corneal perforation was a negative prognostic indicator for vision in this population of northern Californian horses.     

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 the normal equine cornea and limbus

Objective  To describe morphologic features, pachymetry and endothelial cell density of the normal equine cornea and limbus by in vivo confocal microscopy.
Animals studied  Ten horses without ocular disease.
Procedure  The central and peripheral corneas were examined with a modified Heidelberg Retina Tomograph II and Rostock Cornea Module using a combination of automated and manual image acquisition modes. Thickness measurements of various corneal layers were performed and endothelial cell density determined.
Results  Images of the constituent cellular and noncellular elements of the corneal epithelium, stroma, endothelium, and limbus were acquired in all horses. Corneal stromal nerves, the subepithelial nerve plexus, and the sub-basal nerve plexus were visualized. Cells with an appearance characteristic of Langerhans cells and corneal stromal dendritic cells were consistently detected in the corneal basal epithelium and anterior stroma, respectively. Median central total corneal thickness was 835 μm (range 725–920 μm) and median central corneal epithelial thickness was 131 μm (range 115–141 μm). Median central endothelial cell density was 3002 cells per mm² (range 2473–3581 cells per mm²).
Conclusions  In vivo corneal confocal microscopy provides a noninvasive method of assessing normal equine corneal structure at the cellular level and is a precise technique for corneal sublayer pachymetry and cell density measurements. A resident population of presumed Langerhans cells and corneal stromal dendritic cells was detected in the normal equine cornea. The described techniques can be applied to diagnostic evaluation of corneal alternations associated with disease and have broad clinical and research applications in the horse.