Alison B. Clode

Epibulbar melanoma in a foal.

A case of epibulbar melanoma in a 6-month-old, gelded, chestnut Hanoverian foal is reported. The location and clinical appearance upon initial presentation led to the tentative diagnosis of staphyloma or a congenital mass of unknown origin. An attempt was made to surgically excise the mass under general anesthesia, but due to its infiltrative nature and intraoperative appearance, most, but not all was removed without compromising the integrity of the globe. Histopathological evaluation revealed a multinodular to packeted, poorly demarcated, unencapsulated, infiltrative exophytic melanocytic neoplasm composed of bundles and nests of plump spindloid to polygonal heavily pigmented epithelioid neoplastic cells interspersed with pigment-laden macrophages within a fine fibrovascular stroma. Upon examination after enucleation, neoplastic cells were found to infiltrate into the lateral cornea, sclera and the choroid. This is a unique case of an epibulbar melanoma with choroidal invasion in a foal. Based on the sudden onset and rapid growth as well as the histological evidence of invasion, well-differentiated features, heavy pigmentation, and no apparent mitoses, this neoplasm was considered to be a low-grade malignant melanoma. At 14 months after excision there is no evidence of recurrence.

A retrospective comparison of surgical removal and subsequent CO2 laser ablation versus topical administration of mitomycin C as therapy for equine corneolimbal squamous cell carcinoma

OBJECTIVE   To compare the complications and nonrecurrence rate following topical mitomycin C (MMC) therapy vs. CO(2) laser ablation for treating equine corneolimbal squamous cell carcinoma (SCC). STUDY DESIGN   Retrospective study. SAMPLE POPULATION   Twenty-five horses with corneolimbal SCC. PROCEDURES   Medical records of horses undergoing surgical tumor resection followed by either topical MMC therapy (0.04%) or CO(2) laser ablation between the years of 2004 and 2010 were reviewed. Recurrence and complications were compared between groups and within MMC subgroups defined by the time at which treatment was initiated relative to surgery. RESULTS   Therapy with topical MMC resulted in a nonrecurrence rate comparable to that achieved with CO(2) laser ablation (82.4% vs. 85.7%, respectively). Initiation of MMC following epithelialization of the surgical site a mean of 15 days postoperatively did not result in increased recurrence rates relative to treatment in the immediate postoperative period. Vision- or globe-threatening complications tended to occur with greater frequency in horses receiving topical MMC in the immediate postoperative period (5 of 6 major complications) relative to following epithelialization of the surgical site (1 of 6 major complications). CONCLUSIONS   Horses receiving adjunctive topical MMC therapy were no more likely to experience tumor recurrence than were horses undergoing CO(2) laser ablation in the horses in this study. Initiation of two to three rounds of MMC following epithelialization of the surgical site results in fewer major complications and achieves comparable disease resolution relative to treatment in the immediate postoperative period.

Effect of three treatment protocols on acute ocular hypertension after phacoemulsification and aspiration of cataracts in dogs.

OBJECTIVE To compare the effect of topical latanoprost, intracameral carbachol, or no adjunctive medical therapy on the development of acute postoperative hypertension (POH) and inflammation after routine phacoemulsification and aspiration (PA) of cataracts in dogs. DESIGN Retrospective study. PROCEDURES Dogs received either one drop of topical 0.005% latanoprost (21 dogs, 39 eyes), an intracameral injection of 0.3 mL of 0.01% carbachol (15 dogs, 30 eyes), or no adjunctive therapy (46 dogs, 90 eyes) immediately following PA of cataract(s). Intraocular pressure (IOP) was measured in all dogs 2 and 4 h after surgery. IOP was measured and aqueous flare assessed at 8 am the day after surgery. RESULTS Carbachol-treated dogs had significantly higher mean IOP (33.2 +/- SD 20.8 mmHg) 2 h after surgery than dogs receiving no adjunctive therapy (22.0 +/- SD 14.1 mmHg) (P = 0.049). There were no significant differences in IOP among groups at any other time point. There were no significant differences in number of POH episodes between dogs treated with carbachol (47%), latanoprost (29%), or dogs that received no adjunctive therapy (33%). There were no significant differences in mean aqueous flare grade between eyes treated with latanoprost (1.7 +/- SD 0.4) or carbachol (1.4 +/- SD 0.6), and eyes that received no adjunctive therapy (1.7 +/- SD 0.4). CONCLUSIONS Topical 0.005% latanoprost or intracameral injection of 0.3 mL of 0.01% carbachol after PA in dogs did not reduce POH or increase intraocular inflammation compared to dogs not receiving adjunctive therapy after PA of cataracts.

Immunohistochemical and immunopathologic characterization of superficial stromal immune-mediated keratitis in horses

OBJECTIVE To describe the immunopathologic characteristics of superficial stromal immune-mediated keratitis (IMMK) immunopathologically by characterizing cellular infiltrate in affected corneas of horses. ANIMALS 10 client-owned horses with IMMK. PROCEDURES Immunohistochemical staining was performed on keratectomy samples with equine antibodies against the T-cell marker CD3 and B-cell marker CD79a (10 eyes) and the T-helper cytotoxic marker CD4 and T-cell cytotoxic marker CD8 (6 eyes). Percentage of positively stained cells was scored on a scale from 0 (no cells stained) to 4 (> 75% of cells stained). Equine IgG, IgM, and IgA antibodies were used to detect corneal immunoglobulin via direct immunofluorescence (10 eyes). Serum and aqueous humor (AH) samples from 3 horses with IMMK were used to detect circulating and intraocular IgG against corneal antigens via indirect immunofluorescence on unaffected equine cornea. RESULTS Percentage scores (scale, 0 to 4) of cells expressing CD3 (median, 2.35 [range, 0.2 to 3.7]; mean ± SD, 2.36 ± 1.08) were significantly greater than scores of cells expressing CD79a (median, 0.55 [range, 0 to 1.5]; mean, 0.69 ± 0.72). All samples stained positively for CD4- and CD8-expressing cells, with no significant difference in scoring. All samples stained positively for IgG, IgM, and IgA. No serum or AH samples collected from horses with IMMK reacted with unaffected equine cornea. CONCLUSIONS AND CLINICAL RELEVANCE Pathogenesis of superficial stromal IMMK included cell-mediated inflammation governed by both cytotoxic and helper T cells. Local immunoglobulins were present in affected corneas; however, corneal-binding immunoglobulins were not detected in the serum or AH from horses with IMMK.

Infrared digital imaging of the equine anterior segment

Ocular photographs are an increasingly important method of documenting lesions for inclusion in medical records, teaching purposes, and research. Availability of affordable high-quality digital imaging equipment has allowed for enhanced capture of desired images because of immediate on-camera viewing and editing. Conversion of the standard digital camera sensor to one that is sensitive to infrared light (i.e. > 760 nm < 1 mm wavelength) can be done inexpensively. In the equine eye, advantages of infrared digital photography include increased contrast of anterior segment images, identification and monitoring of pigmentary changes, and increased visualization of the anterior segment through a cloudy or edematous cornea.

Retrospective evaluation of phacoemulsification and aspiration in 41 horses (46 eyes): visual outcomes vs. age, intraocular lens, and uveitis status.

OBJECTIVE To determine the effect of age at the time of surgery, intraocular lens (IOL) placement, and presence of chronic uveitis on visual outcome after phacoemulsification and aspiration (PA) of cataracts in horses. ANIMALS STUDIED Records of 41 horses (46 eyes) receiving unilateral or bilateral PA. METHODS Retrospective analysis of horses receiving unilateral or bilateral PA at the NCSU-VTH (35 horses, 39 eyes) and in Northern Italy (six horses, seven eyes) was performed. Visual status at last follow-up was compared to age at the time of surgery, IOL status, and presence of chronic uveitis preoperatively. Seven horses with chronic uveitis also underwent placement of a suprachoroidal cyclosporine implant. Clinical ophthalmic examinations and owner questionnaires were used to evaluate visual status. RESULTS Twenty-one of 46 eyes (46%) received an IOL and 12 of 46 eyes (26%) had chronic uveitis. Overall, 25 of 46 eyes (54%) were visual at last follow-up (mean 35.1 ± 34.8 months). Age (mean 8.6 ± 7.7 years) was not significantly associated with visual outcome. Fourteen of 21 (67%) pseudophakic eyes and 11 of 25 (44%) aphakic eyes were visual at last follow-up (P = 0.342). Eyes with preoperative chronic uveitis were significantly less likely to be visual (3 of 12 eyes [25%]) than horses without preoperative chronic uveitis (22 of 34 eyes [65%]) (P = 0.023). CONCLUSIONS Horses with chronic uveitis had significantly less favorable visual outcome after PA. Older age at surgery and IOL use were not associated with poor visual outcome.

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.

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

PURPOSE To describe the use of episcleral silicone matrix cyclosporine (ESMC) drug delivery devices in horses with immune-mediated keratitis (IMMK) with evaluation of tolerability and efficacy in long-term control of inflammation. METHODS Retrospective study. ESMC implants (1.2 cm length, 30% wt/wt cyclosporine (CsA) in silicone; with approximately 2 μg/day steady-state release for at least 400 days) were used. RESULTS Nineteen horses (20 eyes) received two or more ESMC implants for superficial stromal (n = 9), midstromal (n = 3), or endothelial (n = 5) IMMK. Three additional horses received two or more ESMC implants for pigmentary keratouveitis (PK). Nine eyes of eight horses with superficial and five eyes of five horses with endothelial IMMK were well controlled after placement of ESMC implants (mean follow-up 176.8 and 207.2 days, respectively). Horses with midstromal IMMK and PK were not controlled with ESMC implants alone, but instead required frequent use of other medications or surgery to control the disease. The mean duration of disease prior to ESMC implantation of horses with midstromal IMMK was 495 ± 203.9 days, compared with 121.6 ± 92.7 days with superficial IMMK. ESMC implants were well tolerated by all horses without documented loss of the device. CONCLUSIONS Results from this preliminary retrospective study suggest that the ESMC implants were well tolerated and associated with treatment success with superficial and endothelial IMMK, especially if placed early in the disease process. Further study is needed to determine the duration of efficacy, number of implants required, and better therapies for chronic midstromal IMMK and pigmentary keratouveitis.

Aqueous humor and plasma concentrations of a compounded 0.2% solution of terbinafine following topical ocular administration to normal equine eyes

OBJECTIVE To determine the transcorneal penetration and systemic absorption of a compounded 0.2% terbinafine solution following repeated topical administration to normal equine eyes. Sample population  Six healthy adult horses with normal ocular examinations. PROCEDURES One eye of each horse received 0.2 mL of a compounded 0.2% terbinafine solution every 4 h for seven doses. During the 1 h following administration of the final dose, multiple peripheral blood samples were obtained, and a single aqueous humor (AH) sample was collected at the end of the hour. AH and plasma concentrations of terbinafine were determined using high pressure liquid chromatography (HPLC). Stability of the formulation was assessed with HPLC analysis over a 14-day time period. RESULTS Terbinafine was not detected in the AH or plasma of any horse at any time point. No signs of ocular irritation or systemic toxicity were noted in any horse at any time point. The solution was stable over 14 days. CONCLUSION Topical ocular administration of compounded 0.2% terbinafine solution does not result in detectable AH or plasma levels following administration to normal equine eyes, suggesting its use for deep corneal or intraocular fungal infections in equine ophthalmology may be limited.

Aqueous humor and plasma concentrations of ciprofloxacin and moxifloxacin following topical ocular administration in ophthalmologically normal horses

OBJECTIVE To determine the degree of ocular penetration and systemic absorption of commercially available topical ophthalmic solutions of 0.3% ciprofloxacin and 0.5% moxifloxacin following repeated topical ocular administration in ophthalmologically normal horses. ANIMALS 7 healthy adult horses with clinically normal eyes as evaluated prior to each treatment. PROCEDURES 6 horses were used for assessment of each antimicrobial, and 1 eye of each horse was treated with topically administered 0.3% ciprofloxacin or 0.5% moxifloxacin (n = 6 eyes/drug) every 4 hours for 7 doses. Anterior chamber paracentesis was performed 1 hour after the final dose was administered, and blood samples were collected at 24 (immediately after the final dose), 24.25, 24.5, and 25 hours (time of aqueous humor [AH] collection). Plasma and AH concentrations of ciprofloxacin or moxifloxacin were determined by use of high-performance liquid chromatography. RESULTS Mean +/- SD AH concentrations of ciprofloxacin and moxifloxacin were 0.009 +/- 0.008 microg/mL and 0.071 +/- 0.029 microg/mL, respectively. The AH moxifloxacin concentrations were significantly greater than those of ciprofloxacin. Mean +/- SD plasma concentrations of ciprofloxacin were less than the lower limit of quantification. Moxifloxacin was detected in the plasma of all horses at all sample collection times, with a peak value of 0.015 microg/mL at 24 and 24.25 hours, decreasing to < 0.004 microg/mL at 25 hours. CONCLUSIONS AND CLINICAL RELEVANCE Moxifloxacin was better able to penetrate healthy equine corneas and reach measurable AH concentrations than was ciprofloxacin, suggesting moxifloxacin might be of greater value in the treatment of deep corneal or intraocular bacterial infections caused by susceptible organisms. Topical administration of moxifloxacin also resulted in detectable plasma concentrations.