Subcutaneous administration of triamcinolone as part of the management of feline eosinophilic keratoconjunctivitis

Abstract

Objectives The aim of this retrospective case-control study was to report the efficacy of subcutaneous triamcinolone as part of a regimen for feline eosinophilic keratoconjunctivitis (FEK). Methods Records and clinical photographs were reviewed and lesions semi-quantitatively graded for cats with cytologically confirmed FEK. Clinical data were compared between a study population of nine cats (11 eyes) treated with, and a reference population of seven cats (eight eyes) treated without, a median 0.11 mg/kg (range 0.10–0.20 mg/kg) of triamcinolone acetonide subcutaneously. Results Breed, sex, age and prevalence of corneal ulceration at presentation; corneal disease severity before and at the initiation of immunomodulation; and duration of antiviral treatment before immunomodulation did not differ significantly between populations ( P ⩾0.059). Corneal plaques resolved in five cats each from the study and reference populations ( P = 0.366). Median (range) time from immunomodulation to corneal plaque resolution did not significantly differ ( P = 0.246) between the study (median 14 days; range 8–38 days) and reference (median 28 days, range 14–46 days) populations. No adverse reactions were attributed to triamcinolone administration, and all corneal ulcers in the study population re-epithelialized within 14 days (range 8–38 days) following triamcinolone injection. Time to corneal ulcer re-epithelialization following triamcinolone injection varied minimally in those receiving antivirals prior to (8 or 30 days until re-epithelialization), simultaneously with (38 days) or after (14 or 24 days) triamcinolone. Conclusions and relevance In otherwise healthy cats with FEK, subcutaneous administration of triamcinolone appears to be well tolerated and as efficacious as conventional topical immunomodulatory therapies. It may be especially useful in ulcerated eyes where topical immunomodulation is contraindicated.

Case Report: Clinical Remission in a Cat With Severe Bilateral Eosinophilic Keratitis Receiving Combined Immunosuppressive Therapy (Triamcinolone Acetonide and Tacrolimus)

“…Similar to other reports of cats receiving triamcinolone acetonide for EK or other conditions (13,19), our patient did not experience notable adverse effects from systemic corticotherapy. However, this observation should be verified in future prospective studies that include systemic workup and diagnostic testing.…”

“…Our findings are consistent with a study of EK in horses, where systemic corticosteroid use was associated with a significantly shorter time for resolution of clinical signs (4). Our work is also complementary to the recent study by Lucyshyn et al, in which subcutaneous administration of triamcinolone was deemed safe and as efficacious as conventional topical immunomodulation in cats with eosinophilic keratoconjunctivitis (13). However, two main differences exist between the two reports: (i) First, clinical remission (noted in our patient) was not described in any cat reported by Lucyshyn et al, a finding that could be partly explained by the higher intensity of topical therapy in this case report (i.e., high concentration and frequency of tacrolimus); (ii) Second, triamcinolone was administered at time of diagnosis in our feline patient, whereas triamcinolone was preceded by a course of antiviral therapy with famciclovir or 0.5% cidofovir (median 17 days, range 0-63 days) in Lucyshyn's study.…”

Complex Feline Disease Mapping Using a Dense Genotyping Array

“…FEK is a corneal/conjunctival disease characterized by vascularized white-to-pink plaques on the cornea and bulbar conjunctiva. In the majority of cats, previous corneal ulceration has been diagnosed and an association with feline herpesvirus type 1 (FHV-1) infection has been proposed ( 73 ). The diagnosis of FEK was made according to the following criteria: affected cats had signs of the disease during ophthalmologic exam performed by a board-certified veterinary ophthalmologist, including proliferative vascularized lesions affecting peripheral corneal/bulbar conjunctiva and the presence of eosinophils in the ocular cytology.…”

Complex feline disease mapping using a dense genotyping array

“…FEK is a corneal/conjunctival disease characterized by vascularized white-to-pink plaques on the cornea and bulbar conjunctiva. In the majority of cats, previous corneal ulceration has been diagnosed and an association with feline herpesvirus type 1 (FHV-1) infection has been proposed [61]. The diagnosis of FEK was made according to the following criteria: affected cats had signs of the disease during ophthalmologic exam performed by a board-certified veterinary ophthalmologist, including proliferative vascularized lesions affecting peripheral corneal/bulbar conjunctiva and the presence of eosinophils in the ocular cytology.…”