Medical and Surgical Management of Equine Recurrent Uveitis

McMullen, Richard J.; Fischer, Britta

doi:10.1016/j.cveq.2017.07.003

Cited by 31 publications

(53 citation statements)

References 24 publications

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“…Many horses with ERU require additional treatment modalities in addition to medical therapy. Both the PPV and CSI placement are commonly performed in Europe and the USA, respectively [8, 15, 16, 26]. Although CSI placement can effectively suppress intraocular inflammation and prevent recurrent inflammatory bouts for several years, they are not readily available in Europe due to legal restrictions governing their importation.…”

Section: Discussionmentioning

confidence: 99%

Intravitreal injection of low-dose gentamicin for the treatment of recurrent or persistent uveitis in horses: Preliminary results.

Fischer

McMullen

Reese³

et al. 2019

BMC Vet Res

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BackgroundDespite appropriate medical therapy, many horses with equine recurrent uveitis continue to suffer from recurrent bouts of inflammation. Surgical intervention via the pars plana vitrectomy or suprachoroidal cyclosporine implant placement may control and/or prevent recurrences, however, these procedures may be contraindicated, unavailable, or declined by an owner. Thus, an effective adjunctive treatment option may help to improve the clinical outcomes in those situations. There are several anecdotal reports on the use of intravitreal gentamicin injections, but to date, no data evaluating the complication rate and/or treatment effect following this treatment have been published. Thus, the aim of this prospective study was to describe the intravitreal gentamicin injection technique, describe the associated peri-injection (within 24 h) and post-injection (30 to 780 days) complications, and to report the effects of the injection on the clinical signs of uveitis. Additionally, evaluation of the systemic and ocular Leptospira-status, and its effect on the treatment outcome was performed. A total of 86 horses of various ages, breeds, and gender presenting with recurrent or persistent uveitis were treated via intravitreal injection of 4 mg of undiluted gentamicin (0.04 ml, Genta 100, 100 mg/ml in 35 horses) or preservative-free gentamicin (0.05 ml, 80 mg/ml in 52 horses) under sedation and local anesthesia. All 86 horses were observed for immediate peri-injection and post-injection complications. Response to therapy was evaluated in 59 of the 86 horses (follow-up: 30 to 780 days).ResultsPeri-injection complications consisted of subconjunctival (26/86; 30.2%) or intracameral hemorrhage (4/86; 4.7%); both of which completely resolved within 5 days. Post-injection complications consisted of cataract formation/maturation (5/59 horses, 8.5%) and diffuse retinal degeneration (3/59 eyes 5.1%). The majority of horses 52/59 (88.1%) with a minimum follow-up period of 30 days were controlled (absence of recurrent or persistent inflammation) at their last recheck examination. Recurrent inflammation was documented in 5/59 (8.5%) horses and persistent inflammation was diagnosed in 2/59 (3.4%) horses.ConclusionsIntravitreal injection of low-dose gentamicin shows promise at controlling different types and stages of uveitis. The ability of intravitreal injections of low-dose gentamicin (4 mg) to control persistent and recurrent inflammation warrants further investigation.

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Section: Discussionmentioning

confidence: 99%

Intravitreal injection of low-dose gentamicin for the treatment of recurrent or persistent uveitis in horses: Preliminary results.

Fischer

McMullen

Reese³

et al. 2019

BMC Vet Res

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“…Mydriatics‐cycloplegics and a wide variety of anti‐inflammatory treatments, such as corticosteroids, nonsteroidal anti‐inflammatories and cyclosporine implants have been used in North American horses with Leptospira associated ERU in hope of decreasing the inflammatory response but, horses with uncontrolled inflammation usually progress to develop blindness caused by any combination of synechia, pupil seclusion, cataracts, and/or glaucoma, with or without intractable pain often leading to globe loss and potential loss of athletic use . Chronic Leptospira infection of the eye is believed to be present in a number of horses with ERU in North America and therefore treating the possible persistent intraocular infection may be prudent .…”

Section: Treatmentmentioning

confidence: 99%

Leptospirosis: An important infectious disease in North American horses

Divers

Chang

Irby

et al. 2019

Equine Veterinary Journal

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Summary North American horses are commonly exposed to Leptospira organisms. Leptospira Bratislava is the most common infecting serovar but this serovar has not been confirmed to cause clinical disease in North American horses. Leptospira Pomona type kennewicki is responsible for most of the clinical diseases (leptospirosis) in North American horses. Leptospirosis is most commonly associated with diseases of the placenta and fetus, the kidneys and the eyes in horses. In‐utero infections in pregnant mares may result in abortion, neonatal illness or birth of an antibody positive healthy foal. Acute renal failure in younger horses and recurrent uveitis in adult horses are other well documented clinical syndromes of leptospirosis. Abortions, neonatal disease and acute renal failure are caused by a subacute infection, while horses with Leptospira associated recurrent uveitis develop ocular disease months or years after the initial Leptospira infection. Diagnosis of Leptospirosis is made by a combination of antigen or antibody testing methods. Mares that abort following Leptospira infection have no additional clinical signs at the time of abortion but may shed the offending Leptospira spp. in the urine for several weeks. Antibiotic treatments are sometimes used in hopes of decreasing Leptospira shedding in infected horses or prophylactically in exposed pregnant mares but documentation of efficacy is lacking. Horses with Leptospira ‐ associated acute renal failure can be successfully treated with antibiotics and supportive care. Recurrent uveitis is commonly associated with leptospirosis in North American horses and although horses may have chronic intraocular infection triggering an immune disease, systemic antimicrobial therapy has not been effective in eliminating the organism from the eye. An equine approved Leptospira Pomona type kennewicki vaccine is now available in North America.

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“…The medical history and clinical and ophthalmological examinations (Yager et al 1950, Severin 1986, Miller and Whitley 1987, Lavach 1990, Davidson 1991, 1992, Spiess 1997, Curling 2011, McMullen and Fischer 2017 are usually decisive for suspecting leptospirainduced uveitis . In these cases, vitrectomy is indicated without performing any laboratory tests.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of “SNAP® Lepto”-ELISA and comparison with MAT and PCR results for diagnosis of leptospiral uveitis in horses using intraocular samples

Wollanke¹,

Geiger²,

Gerhards³

2018

PHK

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Chronic intraocular leptospiral infection is the most common cause for recurrent uveitis in equids. History and a combination of typical ophthalmological findings can lead to suspected diagnosis of leptospiral induced uveitis. Testing intraocular fluids had been shown to be the most valuable tool for providing evidence of an intraocular leptospiral infection. The most appropriate treatment for recurrences of leptospiral uveitis is vitrectomy, whereas vitrectomy in non-leptospiral uveitis cases is less successful in regard of avoiding further damage to effected eyes. However, in cases in which clinical and ophthalmological findings are not typical for leptospiral induced uveitis, preoperative testing of aqueous fluid can be indicated to evaluate an indication for vitrectomy. Until now, for save sampling of aqueous humour, a general anaesthesia was necessary for paracentesis of the anterior chamber, and a second was necessary for vitrectomy in case of leptospira-positive laboratory results (either antibodies using microscopic agglutination tests (MAT), enzyme-linked immunosorbent assays (ELISA) or polymerase chain reactions (PCR) detecting LipL32). A quick ELISA test, the SNAP ® Lepto, has recently been made available to detect antibodies directed against LipL32 of pathogenic leptospires in any species. In order to evaluate the SNAP ® Lepto and to test whether it is effective with intraocular samples (aqueous and vitreous humour) from horses, 118 samples from equine eyes suffering from recurrent uveitis and 120 samples from equine control eyes were taken and tested with SNAP ® Lepto (detecting antibodies directed against LipL32), MAT (detecting antibodies directed against ten different serovars) and PCR (detecting the LipL32 antigen). If one of these tests was positive, an intraocular leptospiral infection was assumed.The result was that SNAP ® Lepto was positive in 114 out of 118 intraocular samples (97 %) from horses suffering from recurrent uveitis. SNAP ® Lepto was even superior to MAT, with a sensitivity of 0.97 (MAT 0.93). PCR was positive with fluids from eyes suffering from uveitis in 70 % of samples. There were no positive PCR results in any SNAP ® Lepto-negative samples from uveitic eyes and the MAT was positive in four SNAP ® Lepto-negative samples. On the other hand, SNAP ® Lepto gave a positive result in eight MAT-negative samples from eyes with uveitis. Furthermore, none of the antibody tests was positive regarding any sample from the control eyes, and PCR was positive in one single sample from a control eye. It can be concluded that SNAP ® Lepto, which gives a result within 10 minutes, is a valuable test method for detecting antibodies directed against LipL32 in intraocular fluids from horses. In the case of a negative result, MAT and PCR can be performed subsequently to reduce false negative results. Keywords: chronic intraocular leptospiral infection, equine recurrent uveitis (ERU), MAT, ELISA, serum, SNAP ® Lepto, anterior chamber fluid, vitreous Citation: Wollanke B., Geiger T., Gerhards H. (2018...

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Medical and Surgical Management of Equine Recurrent Uveitis

Cited by 31 publications

References 24 publications

Intravitreal injection of low-dose gentamicin for the treatment of recurrent or persistent uveitis in horses: Preliminary results.

Intravitreal injection of low-dose gentamicin for the treatment of recurrent or persistent uveitis in horses: Preliminary results.

Leptospirosis: An important infectious disease in North American horses

Evaluation of “SNAP® Lepto”-ELISA and comparison with MAT and PCR results for diagnosis of leptospiral uveitis in horses using intraocular samples

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