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

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

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

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

Use of a Baerveldt gonioimplant for secondary glaucoma in a horse

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

A promising surgical approach to equine glaucoma

The preceding case report by Wilson et al. (2015) describes the surgical placement of a Baerveldt glaucoma shunt in a glaucomatous equine eye that had been refractory to aggressive medical and repeated surgical therapies yet maintained functional vision. Shunt placement surgery successfully maintained vision and intraocular pressure in the normal range in the affected eye. This is the first report of long‐term successful glaucoma filtration surgery in a horse. Glaucoma shunt placement shows promise for maintaining vision and comfort in equine eyes affected with glaucoma. There is much to be learned in terms of the most appropriate implant type for the equine eye, the risk of complications such as ocular hypotony or tube fibrosis, and the utility of combination therapy with transcleral cyclophotocoagulation and implant placement, but with the report of one case in which gonioimplant placement has been associated with intraocular pressure control for over one year, further investigations appear warranted. This case provides a glimmer of hope for long‐term treatment of a painful, blinding disease that has traditionally carried a poor prognosis in horses.     

Diode laser endoscopic cyclophotocoagulation in the normal equine eye

Objective To determine the clinical and histologic effects of diode endoscopic cyclophotocoagulation (ECP) in the phakic equine eye. Animals studied Phase I: 10 equine cadaver eyes. Phase II: four normal adult horses. Procedures Phase I: ECP probe angle of reach (AR) was determined. Multiple ECP energy levels: 0.75, 0.90, 1.05, 1.20, 1.35, 1.50 J, and the resulting visible and histologic ciliary process changes were evaluated. Phase II: Ocular quadrants were treated with ECP at 0.90, 1.14, 1.38 J, and a control. The contralateral eye underwent a sham operation. Tissue changes (clinical and histologic) were evaluated. Results Phase I: Mean combined AR was 162 ± 29 degrees. Mean visible tissue scores: 2.60 ± 0.58 (0.75 J) to 5.04 ± 0.30 (1.50 J) from possible total of 6. Tissue ‘popping’ was observed at 1.50 J. Histologic ciliary tissue damage was present at all settings. Phase II: Mean visible tissue scores: 2.90 ± 0.48 (0.90 J), 3.61 ± 0.57 (1.14 J), and 4.52 ± 0.56 (1.38 J). Tissue ‘popping’ was observed at 1.38 J. Histologic ciliary tissue damage was present at all settings. Clinical effects included acute inflammation, intraocular pressure reduction, cataract formation, corneal edema, corneal ulceration, and postoperative ocular hypertension. Conclusions Diode ECP between 0.90 and 1.14 J is a potential treatment option for glaucoma in horses based on visible tissue effects and target ciliary epithelium damage. Iatrogenic cataract development may limit the use of an anterior chamber approach in phakic horses. Supported in part by an ACVO VAF grant.     

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

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

Equine glaucoma: Where are we now?

The following article discusses the pathophysiology, clinical signs, diagnosis, medical treatment and surgical management of glaucoma in the horse.