Equine immune‐mediated keratopathies

Abstract

Equine immune mediated keratopathies are common in both Europe and the USA. This review article will compare the clinical differences in horses with this disease and also review the current theories on pathogenesis and treatment of equine IMMK.

Treatment of immune‐mediated keratitis in horses with episcleral silicone matrix cyclosporine delivery devices

“…1,2,4,5 Briefly, IMMK was characterized by corneal opacification localized to the superficial stromal, middle stroma, or endothelium; corneal vascularization; mild or lack of ocular pain; no etiologic organisms identified; and favorable response to immunosuppressive therapy. 1,2,4,5 Pigmentary keratouveitis (PK), a disease that is similar to IMMK, was diagnosed based on clinical criteria described recently, which included signs of corneal edema, pigmented keratic precipitates, anterior uveitis, and iridal depigmentation. 6 Selection of cases that received ESMC implants was based solely on the discretion of the ophthalmologist, but the most common indications considered for implantation were favorable disease response to topical CsA (Optimmune, Schering-Plough Animal Health, Union, NJ or compounded 1-2% CsA) and inability of the owner to provide ongoing topical therapy.…”

“…The IMMK was considered 'controlled' if the disease was considered inactive (i.e., receded vascularization, clearing of corneal cellular infiltrate, improvement in or elimination of corneal edema) when medications were tapered to one topical medication or less administered. 2,4,5 Outcome measures and end points regarding clinical improvement are difficult to define in retrospective studies; however, in this study, postimplant 'treatment success' was defined as improvement from preimplant corneal vascularization, cellular infiltrate, corneal edema, and signs of ocular discomfort. In the horses of this report, 'treatment failure' after the implant was defined as those horses that did not have an improvement in clinical signs of IMMK (i.e., no reduction in vascularization, no clearing of corneal cellular infiltrate, or persistent corneal edema), developed corneal perforation, or required the eye to be enucleated.…”

“…[1][2][3] Several types of equine IMMK have been described, and clinical features are based on the location of inflammation within the cornea, namely superficial, stromal, endothelial, and newly described pigmentary keratouveitis. [1][2][3][4][5][6] Treatment for IMMK differs somewhat based on the location of the inflammation; however, the mainstay of therapy is topical immunosuppressant medications, especially CsA. 2 Unfortunately, topical medication is required chronically if not for the remainder of the horses' life.…”

Synopsis of Equine Veterinary Journal Supplement 37: Equine Ophthalmology III ‘Reviews in memory of Keith Barnett’. Part 2

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The Equine Veterinary Journal Supplement 37: Equine Ophthalmology III 'Reviews in memory of Keith Barnett' is a tribute to Keith written by a group of authors who represent leaders in the field of equine ophthalmology. The collective experience of these authors has been brought together to produce a special EVJ supplement, which details the 'where we are now' in relation to our understanding and treatment of equine eye disease.The first part of this synopsis [1] reviews articles covering a range of topics relevant to the equine practitioner, including equine periocular neoplasia [2], therapy of equine infectious keratitis [3], targeted lamellar keratoplasty in the horse [4], equine immune-mediated keratopathies [5] and current developments in equine cataract surgery [6].

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Clinical experience and long-term outcome after subscleral insertion of a cyclosporine A drug delivery device in horses with immune-mediated keratitis

“…Endothelial keratitis -This type comes along with an endothelial infiltrate and a diffuse superficial or midstromal corneal edema as well as mild vascularization (Brooks et al 1990, Kellner 1990, Matthews 2000, Matthews and Gilger 2009, Matthews and Gilger 2010, Toth et al 2010, Clode et al 2011). …”