Phacoemulsification and +14 diopter intraocular lens placement in a Saddlebred foal

A 2‐month‐old, 110‐kg Saddlebred filly presented for evaluation of bilateral cataracts. A hypermature cataract in the left eye (OS) and an incipient nuclear cataract in the right eye (OD) were diagnosed. Electroretinography and ocular ultrasound revealed no contraindications for surgical removal of the cataractous lens OS. Phacoemulsification and implantation of a +14 diopter (D) intraocular lens (IOL) OS were performed at 4 months of age without complication, with the exception of a partial iridectomy performed on a small iris section that prolapsed through the corneal incision. Complete ophthalmic examinations, including ocular ultrasound and streak retinoscopy, were performed 1, 2, 6 weeks, 4 months, 1, and 2 years postoperatively. Diffuse corneal edema and a superficial corneal ulcer developed OS during the early postoperative period and resolved without complication. Dyscoria was identified owing to anterior synechia of the dorsomedial iris at the incision site. Two years after surgery, menace response, palpebral reflex, dazzle reflex, and pupillary light reflexes were present in both eyes (OU). The IOL remained centrally positioned within the capsule, with mild anterior tilting of the superior portion of the IOL and mild fibrosis of the lens capsule. The postoperative net refractive error was +0.31 D OS. Based on this report, a +14 D IOL may be the appropriate choice following lens extraction in a foal to achieve refraction near emmetropia at maturity. To our knowledge, this is the first report of phacoemulsification and IOL implantation in a foal with long‐term follow‐up.     

Penetrating ocular gunshot injury in a Labrador Retriever

A 3½‐year‐old, female (spayed) working black Labrador Retriever was referred to the Unit of Comparative Ophthalmology at the Animal Health Trust after a penetrating lead gunshot injury to the right eye. Clinical examination revealed penetrating injuries to the right cornea, left lateral canthus, and left forelimb. Radiography revealed the presence of multiple metallic foreign bodies in the head and one in the left forelimb. B‐mode ocular ultrasonography confirmed the presence of an intraocular metallic foreign body within the posterior tunics of the right eye. Medical treatment of the right eye over a period of 1 month resulted in a comfortable, visual eye. Long‐term follow‐up over 4½ years revealed a slow deterioration in vision because of progressive lens opacification and the presence of a localized area of chorioretinopathy.     

Congenital ocular anomalies and ventricular septal defect in a dromedary camel (Camelus dromedarius).

A 5-wk-old female dromedary camel (Camelus dromedarius) was clinically diagnosed with bilateral corneal dermoids, incomplete congenital cataracts, a left persistent hyaloid artery (PHA), and a ventricular septal defect (VSD). The corneal dermoids were removed by lamellar keratectomy, and vision improved in the left eye. Thirteen months after dermoid surgery, the calf was presented for enlargement of the right eye. Glaucoma was confirmed in the right eye, and corneal fibrosis and cataract were noted in the left eye. Persistence of the VSD was confirmed by cardiac ultrasonography. The calf was euthanized, and necropsy findings confirmed VSD. Histopathologic examination revealed bilateral corneal thinning and fibrosis, cataracts with retrolental fibroplasia, and retinal dysplasia. Additional changes in the right globe were anterior segment dysgenesis, ruptured lens capsule, chronic phacoclastic uveitis, and retinal separation. The PHA was confirmed in the left eye.     

Phacoemulsification and intraocular lens implantation in a Canada lynx with phacoclastic uveitis

A 4-year-old male Canada lynx (Lynx canadensis) was referred to the ophthalmology service at the University of Saskatchewan with a 7-month history of cataract and chronic phacoclastic uveitis secondary to penetrating trauma from a lynx claw. Ophthalmic examination of the right eye revealed a corneal scar, marked aqueous flare, extensive fibrovascular membranes extending from the iris to the lens, anterior and posterior synechiae, immature cataract, and anterior vitritis; the fundus was not visible. Phacoemulsification surgery and intraocular lens implantation using a custom lens of D+46 and 14 mm (An-vision, West Jordan, Utah, USA) was performed. Post-operative medications included sub-conjunctival injections of atropine, cefazolin, and triamcinolone, and oral doxycycline and prednisolone. At the 5-month follow-up, the uveitis was controlled, and a normal fundus was visualized; at 21 mo, the eye remained comfortable and visual. This is the first case report to describe phacoemulsification in a wild felid as a treatment for a traumatic cataract and severe phacoclastic uveitis.Key clinical message:Despite chronic phacoclastic uveitis, phacoemulsification surgery can provide a positive outcome for mature wild felids with traumatic lens rupture, even when topical treatment cannot be administered.     

Management of bilateral uveitis in a Toxoplasma gondii-seropositive cat with histopathologic evidence of fungal panuveitis

A 5-year-old, neutered male Domestic Short-haired cat was referred with a 5-month history of anterior uveitis and cataract in the right eye. Clinical examination confirmed anterior uveitis and immature cataract in the right eye and chorioretinitis in the left eye. Ocular ultrasound showed a retinal detachment in the right eye. Diagnostic testing revealed elevated serum titers for Toxoplasma gondii. Anterior uveitis in the right eye and chorioretinitis in the left eye progressed, resulting in blindness despite a 21-day course of clindamycin and aggressive topical medical management of uveitis. The right eye was enucleated and histopathologic evaluation of the globe revealed panuveitis and multiple organisms morphologically consistent with Histoplasma capsulatum. Systemic treatment with itraconazole was initiated. Vision returned after 3 months of treatment and complete resolution of the retinal hemorrhages with formation of a flat chorioretinal scar was noted after 6 months of therapy. Itraconazole was discontinued 7 months after starting therapy, at which time the funduscopic appearance of the chorioretinal scar had remained static for 1 month. The cat has remained visual without evidence of disease progression for 6 months following discontinuation of itraconazole.     

Lens morphometry determined by B-mode ultrasonography of the normal and cataractous canine lens

Purpose To determine axial lens thickness, anterior chamber depth and axial globe length in canine eyes with normal lenses and in eyes with immature, mature, congenital, posterior polar and diabetic cataract. Methods B‐mode ultrasonography was performed in 50 normal dogs and, as a prephacoemulsification screening procedure, in 100 dogs with cataract. Axial B‐mode ultrasonograms were used to determine lens thickness, anterior chamber depth and globe diameter. Statistical comparisons between groups were made by analysis of variance and multivariate analysis, with a significance level of P < 0.05. Results Axial globe lengths were not statistically significantly different between groups apart from the smaller globes in younger dogs with congenital cataract. Axial lens thickness in diabetics (8.4 ± 0.9 mm) was statistically significantly different from the lens thickness in normal eyes (6.7 ± 1.0 mm), eyes with immature cataract (6.4 ± 0.8 mm) and eyes with mature cataract (7.4 ± 0.9 mm) although these groups, while varying in thickness, were not statistically significantly different from each other. Anterior chamber depth was statistically significantly reduced in eyes with diabetic cataract (2.9 ± 0.1 mm) from that in normal eyes (3.8 ± 0.1 mm), eyes with immature cataract (3.5 ± 0.1 mm) and eyes with mature cataract (3.2 ± 0.6 mm) although these groups, while varying in chamber depth, were not statistically significantly different from each other. Conclusions Lenses with diabetic cataracts were significantly increased in axial thickness compared to lenses in other eyes, although lenses with mature cataracts showed a trend towards increased axial thickness and immature cataracts demonstrated a trend towards reduced thickness. While previous studies on cataract pathobiology have suggested a reduction in lens thickness in immature cataract through lens protein loss and an increase in thickness in mature cataracts through intumescence, this study is the first to document these changes in the canine lens.     

Successful medical treatment for globe penetration following tooth extraction in a dog

A five‐year‐old entire male Tibetan Terrier was referred for left‐sided periorbital swelling and blepharospasm 4 days following ipsilateral maxillary tooth extraction. Examination of the left eye revealed mild exophthalmos, pain on retropulsion, and absent menace response and pupillary light reflexes. Examination of the posterior segment was not possible owing to the anterior segment pathology. Differential diagnoses considered were iatrogenic globe penetration and peribulbar abscess/cellulitis. Ocular ultrasound was consistent with a penetrating wound to the globe. Treatment with systemic prednisolone and marbofloxacin, and topical atropine sulfate 1%, prednisolone acetate, and brinzolamide was started. Marked clinical improvement allowed visual confirmation of the perforation. Oral prednisolone was tapered over the following 10 weeks. At final re‐examination (10 months), the patient was visual, and fundic examination revealed an additional chorioretinal scar, most likely an exit wound that was obscured by vitreal debris on initial examinations. Neither scar was associated with retinal detachment. To the authors' knowledge, this is the first reported case of successful medical management of iatrogenic globe penetration following exodontic procedures.     

Nasal adenocarcinoma with diffuse metastases involving the orbit,cerebrum, and multiple cranial nerves in a horse

A 9-year-old Trakehner gelding was examined because of right exophthalmus. Clinical findings included a lack of menace response in the right eye, reduced direct and consensual right pupillary light reflexes, ventrolateral strabismus of the right eye, mild right-sided facial asymmetry, a head tilt to the left, and increased extensor tone in the right limbs. Findings were suggestive of a multifocal lesion affecting the right forebrain; right optic, oculomotor, and facial nerves; and left vestibulocochlear nerve. Ultrasonographic examination of the right eye revealed a vascular retrobulbar mass. Computed tomographic imaging revealed a mass that filled the nasal cavity and invaded the forebrain. Necropsy revealed an undifferentiated nasal adenocarcinoma affecting the orbit with metastases to the right parotid gland, cranial cervical lymph nodes, fascial planes of the neck, and lungs. No evidence of direct involvement of the right facial and left vestibulocochlear nerves was found, suggesting the possibility of paraneoplastic peripheral neuropathy.     

Bilateral microphthalmos with cyst in a neonatal foal

A 1‐day–old miniature horse filly was presented to the University of Florida Veterinary Ophthalmology service for evaluation of multiple ocular anomalies which were present from birth. Protruding from the right orbit was a large, fluctuant, red, dry and variably ulcerated mass. A globe could not be appreciated clinically in the left orbit. Ocular ultrasound of both orbits was performed. This revealed a lobular, hypo‐echoic structure filling the right orbit, with multiple hyperechoic septations; normal ocular structures were not identified. Ultrasound of the left orbit revealed a microphthalmic eye, with a well‐defined, hyperechoic structure in the vitreous that was thought to be the lens. Due to irreversible blindness, the foal was humanely euthanized. Histopathology and immunohistochemistry of the orbital contents revealed bilateral microphthalmos with cyst, a congenital defect rarely reported in the veterinary literature.     

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.     

Bilateral third eyelid ectopic cilia in an adult horse

A 15‐year‐old Cob mare presented with a 4‐month history of chronic epiphora and intermittent blepharospasm in the right eye. On ophthalmic examination, two translucent aberrant hairs were identified at the third eyelid margin corresponding to an area of corneal fibrosis and neovascularization. Partial excision of the third eyelid was performed, and histopathology confirmed ectopic hair follicles. Two weeks later, clinical signs recurred in the same eye. Examination revealed another pair of aberrant hairs on the bulbar surface of the third eyelid near its leading edge. This portion of the third eyelid was also excised, and histopathology confirmed two additional ectopic hair follicles. Eight months later, the horse developed similar clinical signs in the left eye. Ophthalmic examination showed a single aberrant translucent hair at the third eyelid margin associated with focal fibrosis and neovascularization of the ventromedial cornea. Partial excision of the third eyelid was performed, and histopathology confirmed an ectopic hair follicle within the third eyelid conjunctiva. Excision was curative at 4 years postoperatively with no further recurrence in either eye.     

Presumed post‐traumatic ocular chondrosarcoma with intrathoracic metastases in a cat

An indoor‐only, 5‐year‐old, spayed female domestic shorthair cat presented for an ophthalmic examination of the left eye. An intraocular tumor with secondary glaucoma and blindness was diagnosed; the globe was enucleated and sent for histopathological examination. Gross examination revealed a solid white mass filling the entire vitreous space and replacing the iris and ciliary body. The lens and retina appeared to be similarly replaced by the neoplasm. Histological examination revealed a complete loss of the internal ocular structures, with a ruptured capsule as the only remnant of the lens within an extensive malignant mesenchymal neoplastic cell proliferation. The cells were polygonal, with well‐defined cytoplasmic borders and abundant weakly basophilic cytoplasm, embedded within the islands of chondroid matrix. No neoplastic invasion of the sclera was apparent. The animal died 6 months after the enucleation due to respiratory distress. Gross examination revealed numerous firm, white to tan nodular masses with smooth to mildly irregular surfaces dispersed throughout the parietal pleura, thoracic surface of the diaphragm, tracheobronchial and mediastinal lymph nodes, pericardium, and lungs. On cross‐section, the neoplastic nodules were solid and variably translucent, resembling hyaline cartilage. Histologically, these nodules were similar to the neoplasm identified earlier in the left globe. Metastasis of post‐traumatic ocular chondrosarcoma has not yet been described in cats. This is therefore believed to be the first report of metastases of this type of neoplasm in cats. This case adds to the limited set of data on the outcome of this type of tumor.     

Chronic ocular lesions associated with bi-directional microbeam radiation therapy in an experimental rat study for therapy of C6 and F98 gliomas

Objectives  To describe the chronic ocular lesions associated with microbeam radiation therapy (MRT) in an experimental rat study.
Procedures  MRT was administered bi-directionally with a skin entry dose of 350 Gy. During laterally directed irradiation, the beam entered the head on the right with the center of the beam array 3 mm posterior to the center of the right eye. During irradiation in anterior-posterior direction, the right eye was almost completely in the path of the beam array. Twelve months after MRT ophthalmic examinations were completed on 37 treated (MRT+) and 16 control (MRT–) rats. Electroretinography (ERG) was completed in two MRT+ and one MRT– rat. Histopathology was performed on eyes of 16 MRT+ and 9 MRT– rats, and retinal and choroidal thicknesses were measured.
Results  Biomicroscopic and indirect ophthalmoscopic examinations revealed fundus pallor and retinal vascular attenuation in 33 of 37 right and 2 of 37 left eyes of MRT+ rats. Cataracts were present in the right eyes of 12 of 37 MRT+ rats. ERG amplitudes were reduced in the eyes of MRT+ rats. Light microscopy revealed retinal lesions ranging in severity with loss of outer to inner retinal cell layers, in 16 of 16 right and of 8 of 16 left eyes MRT+ rats. The mean right retinal thickness of MRT+ rats was reduced.
Conclusions  Eyes within the field treated with MRT at a dose of 350 Gy develop retinal degeneration and occasionally, cataract.     

Bilateral uveal metastasis of a subcutaneous fibrosarcoma in a cat

A 6‐year‐old neutered male domestic short‐haired cat was presented to the Comparative Ophthalmology service at Michigan State University with a 3‐week history of decreased appetite and redness of the left eye. The left forelimb had been removed 15 months previously because of the presence of a subcutaneous fibrosarcoma. In the left globe, a large iridal mass was associated with increased intraocular pressure and retinal detachment. A smaller mass involving the right iris was also present. Imaging revealed a 2‐cm mass in the left caudodorsal lung lobe, and abdominal ultrasound showed multifocal bilateral renal masses. Aspirates of these masses were nondiagnostic. The left globe was removed for palliative reasons, and histopathology showed that fibrosarcoma was infiltrating the iris, choroid, and optic nerve. Despite systemic chemotherapy with doxorubicin, the animal died 4 months after initial presentation. Histopathology confirmed highly angioinvasive metastatic fibrosarcoma also in the right uveal tract, the lungs, and both kidneys.     

Bilateral cataract in a cynomolgus monkey

Severe bilateral cataract was found in a 7 year-old naïve female cynomolgus monkey (Macaca fascicularis) 3 months before necropsy. During macroscopic examination, severe opacity and thinning of the lens were observed in both eyes. Histopathology revealed that the lens nuclei and majority of cortex lens fibers had disappeared and become excavated, while the lens fibers in the subcapsular area were swollen and distorted. Other observations included atrophy and vacuolation in the lens epithelial cells and proliferation of spindle cells and collagen fiber beneath the anterior capsule of the right eye. Immunohistochemical staining of these spindle cells revealed the presence of vimentin, cytokeratin and α-smooth muscle actin (α-SMA), which were considered to be derived from lens epithelial cells. This is a rare case of spontaneous, bilateral, hypermature cataract in a cynomolgus monkey.     

Traumatic phacocele in an American Miniature Horse

An 18‐year‐old American Miniature Horse mare was presented with a complaint of a scleral swelling affecting the right eye and a history of suspected trauma 6 weeks prior to evaluation. Clinical findings included severe blepharospasm, a bulbous swelling of the dorsotemporal bulbar conjunctiva, and phthisis bulbi. Ocular ultrasound was recommended but declined. Enucleation was elected for the blind, painful eye and was performed standing. Gross and histopathologic examinations of the globe were consistent with extrusion of the lens to the episcleral space, which is classified as a traumatic phacocele when associated with naturally occurring trauma. The location of lens entrapment suggested globe rupture occurred at the limbus, which is described as one of the weakest points of the equine globe. Subconjunctival dislocation of the lens and development of a traumatic phacocele should be considered as a differential diagnosis for horses presenting with subconjunctival masses, apparent aphakia, and historical trauma.     

Phacoemulsification in a clouded leopard (Neofelis nebulosa)

Phacoemulsification and prophylactic retinopexy were performed on a 3‐month‐old hand‐raised clouded leopard with a unilateral mature cataract. The same procedures were repeated 3 months later when a cataract developed in the fellow eye. Examination procedures, anesthetic protocols, and surgical techniques were similar to those utilized in domestic cats. The patient retains highly functional aphakic vision at the present age of 2.5 years. An inherited basis for the cataracts is proposed. Although the cub was hand raised, the cataracts were unlike nutritional cataracts reported previously in domestic cats and dogs. To the author’s knowledge this is the first report of cataract formation and phacoemulsification in a clouded leopard.     

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.     

Granulomatous uveitis in an owl

Granulomatous lens-induced uveitis was diagnosed in a mature male barred owl. Initial ocular examination revealed a large white mass in the left eye. Differential diagnoses for the mass included intraocular granuloma, neoplasia, foreign body, bacterial or fungal enophthalmitis, and fibrotic hematoma. After enucleation of the left globe, histologic examination revealed the mass to be a granulomatous inflammatory reaction to a posteriorly luxated, traumatized lens. Lens-induced uveitis should be considered whenever a bird has suffered lenticular trauma.     

Taenia coenurus in the orbit of a chinchilla

A 4-year old, male intact, captive-bred chinchilla (Chinchilla lanigera) was presented due to progressive exophthalmos of the right eye over a 5-month period. Ophthalmic examination revealed exophthalmos with dorsal displacement of the right globe. Retropulsion was decreased and a fluctuant, subcutaneous mass could be palpated posterior and dorsal to the central aspect of the zygomatic bone. Transdermal ultrasonography revealed a fluid-filled mass consistent with a cyst located within the ventral right orbit. Computed tomography demonstrated dorsal displacement of the globe, lateral displacement of the zygomatic arch, and numerous mineral-dense foci within the lumen of the cyst. The cyst was removed en bloc by ventral transpalpebral orbitotomy. Histopathology revealed a single capsulated cyst with multiple invaginated protoscolices, characterized by a prominent scolex with refractile hooklets, suckers, and abundant calcareous corpuscles consistent with a Taenia coenurus. Exophthalmos resolved with surgical therapy and there was no evidence of recurrence or postoperative complications over a period of 2 years. To the authors' knowledge, this is the first reported case of an orbital cyst of parasitic origin in a chinchilla.