Stefano Pizzirani

Cryptococcosis in domestic mammals.

Summary. After a brief review of cryptococcosis in dogs and cats from the literature from 1980 to 92, three cases in dogs (two epidemiologically strictly connected) and two in cats are reported. In the three dogs and in one of the two cats lesions were seen in many sites, but only one dog and one cat had a central nervous system localization. The cutis was affected in the three dogs and in one cat; in two of the dogs it was probably the primary lesion, and in the cat it was the only lesion. An unidentified genetic defect was probably the predisposing factor in two of the dogs of the same litter, exposed to soil cryptococcal contamination (from pigeon guano); a third dog, of different breeding, was not infected. Steroid treatment was predisposing in one cat. Flucytosine treatment was initially successful in two dogs, but in both relapses were reported; in one dog flu‐conazole treatment was successful. The isolates, before and after treatment, demonstrated a large increase in flucytosine MIC, strictly connected with the relapse.

Acute primary canine herpesvirus‐1 dendritic ulcerative keratitis in an adult dog

We present a report of dendritic ulcerative keratitis in a 4-year old locally immunosuppressed dog suspected to result from acute primary canine herpesvirus-1 (CHV-1) infection. The dog was presented for evaluation of mild blepharospasm and conjunctival hyperemia in the right eye (OD) shortly after attending a public boarding facility. For approximately 3 months, the dog had been receiving topical prednisolone acetate 1.0% and tacrolimus 0.02% in both eyes (OU) q12h for treatment of follicular conjunctivitis. Ophthalmic examination revealed three regions of corneal fluorescein retention OD. The lesions had a dendritic pattern, were approximately 2-3 mm in length, and were located at the dorsomedial, lateral, and ventromedial aspects of the cornea. No additional abnormalities were noted on complete ophthalmic and physical examinations. CHV-1 was identified in conjunctival samples OD by polymerase chain reaction, and paired CHV-1 serum virus neutralization antibody titers were positive and consistent with acute infection. Topical prednisolone acetate and tacrolimus were discontinued. The dog was treated with cidofovir 0.5% OU q12h for a period of 4 weeks, with resolution of corneal disease noted within 1 week of treatment. In conjunction with previous studies, this case report supports a central role for alterations in host immune status in the pathogenesis and clinical manifestations of CHV-1 ocular disease in dogs.

Corneal epithelial inclusion cyst in a Llama.

A 13-year-old, female Llama presented for evaluation of a limbal based corneal mass involving the OD of 4 months duration. The mass was excised en bloc by a nonpenetrating keratectomy, followed by placement of a conjunctival advancement flap covering the keratectomy site. The mass was submitted for histological evaluation. Histopathology identified the mass to be a corneal epithelial inclusion cyst filled with necrotic squamous and neutrophilic debris. Surgical excision was complete and considered curative with no signs of recurrence 3 months postoperatively. There was no known prior ocular trauma; however, a previously performed corneal biopsy for evaluation of recurrent epithelial erosions may have been an initiating cause.

Glaucoma associated with uveal cysts and goniodysgenesis in American Bulldogs: a case series

We present a series of three American Bulldogs with clinical signs of glaucoma and intraocular inflammation accompanied by bilateral uveal cysts and abnormal gonioscopic findings. All dogs proved refractory to medical management and were enucleated. Histopathologic findings were similar in all three and included significant preiridal fibrovascular membranes and mononuclear inflammatory infiltrates in the anterior uvea. On microscopic evaluation, cysts appeared to arise primarily from the ciliary body and iridociliary sulcus, with smaller cysts also budding from the posterior iris. Pigment dispersion was variable but consistent, involving deposition of a small number of pigment-laden cells in the dependent trabecular meshwork. Cataract formation was not noted. Glaucoma associated with uveal cysts has been described previously in Golden Retrievers and Great Danes, although clinical and histopathologic findings in those breeds are not identical to those described here. American Bulldogs with uveal cysts should have gonioscopy performed and should be monitored carefully for signs of increased intraocular pressure and intraocular inflammation. Furthermore, documentation of cyst-associated glaucoma in a third breed suggests clinicians should exercise caution in dismissing uveal cysts in dogs as incidental findings.

360-degree conjunctival grafting for management of diffuse keratomalacia in a dog.

We present a report describing use of a 360-degree conjunctival graft for management of progressive keratomalacia refractory to medical treatment in a 5-month-old American Cocker Spaniel. In the dog of this report, the extension of melting to nearly the entire corneal surface limited surgical options. Following surgery and later resection of the graft, the patient is visual with minimal corneal opacity. Numerous corneal grafting techniques have been described in companion animals, but require special materials and may not be possible when melting is extensive. Although older animals or animals with additional corneal pathology may have less ideal outcomes in terms of corneal clarity than the patient of this report, we believe that 360-degree conjunctival grafting offers a viable and cost-effective option for management of cases with extensive keratomalacia that may otherwise have resulted in enucleation.

Measurement of corneal sensitivity in 20 ophthalmologically normal alpacas

OBJECTIVE To determine corneal sensitivity in 20 healthy adult alpacas (40 eyes) in order to establish reference values. DESIGN Prospective study. ANIMALS Twenty healthy, adult alpacas. PROCEDURES Corneal sensitivity was determined by the corneal touch threshold (CTT) using a Cochet-Bonnet esthesiometer. Five different regions of the cornea were evaluated (nasal, ventral, lateral, dorsal, and central). RESULTS Corneal touch threshold values (in mm filament length) obtained from five corneal regions demonstrated varying corneal sensitivities. The central region (34.5 ± 7.1 mm) was the most sensitive, followed by the ventral (29.5 ± 7.2 mm), medial (29.3 ± 7.3 mm), dorsal (25.6 ± 6.3 mm), and lateral (21.8 ± 5.7 mm) regions. All pairwise comparisons of regional differences were statistically significant (P < 0.05), except for the comparison between the ventral and medial regions (P = 0.88). Evaluation of the CCT while controlling for age (2-5 years vs. 6-10 years) demonstrated an increased CTT with an increasing age for the central, ventral, medial and lateral regions. A decrease in the CTT of the dorsal region was noted with increasing age. CONCLUSION AND CLINICAL RELEVANCE Corneal touch threshold values in 40 eyes of 20 healthy adult alpacas were determined using a Cochet-Bonnet esthesiometer. This study demonstrated the central corneal region to be most sensitive. Values obtained may serve as reference values in subsequent studies.

Surgical treatment of epibulbar melanocytomas by complete excision and homologous corneoscleral grafting in dogs: 11 cases

OBJECTIVE The aim of the study was to evaluate the efficacy, outcome, and complications following penetrating sclerokeratoplasty and frozen homologous corneoscleral grafting for the management of extensive canine epibulbar melanocytomas. METHODS Medical records of canine patients treated at three different veterinary hospitals between 1999 and 2010 were reviewed. Signalment, location and extent of melanocytomas, recurrence rate, and early and late complications were reported. Patients were re-examined postoperatively to provide follow-up information. RESULTS Patients included one intact male, three castrated males, six intact females, and one spayed female, with a median age of 5 years (range, 3-9). German Shepherds were overrepresented. Tumors extended from 2 to 4 clock hours at the limbus and up to 17 mm from clear cornea to globe equator. One case showed iridocorneal angle invasion; corneal involvement was present in all cases, and lipid keratopathy was present in four cases. In two cases, there was incomplete resection owing to tumor extent. Follow-up time ranged from 3 to 72 months (median, 17 months), with one case of intraocular tumor progression. Early complications included anterior uveitis (11/11), intracameral fibrin (5/11), hyphema (4/11), corneal edema (4/11), exuberant corneal granulation tissue (2/11), focal retinal edema (1/11), dyscoria (1/11), and partial suture dehiscence (1/11). Late complications included corneal fibrosis and/or pigmentation (11/11), faint anterior cortical cataracts (3/11), and lipid keratopathy (1/11). Vision was retained in all cases. CONCLUSIONS This technique offers a surgically challenging but effective treatment for extensive epibulbar melanocytomas. In this case series, complications were mild and transient, with preservation of ocular anatomy and function.

Anterior and posterior segment photography. An alternative approach using a dSLR camera adaptor

PURPOSE   To describe a novel digital single lens reflex (dSLR) camera adaptor for anterior and posterior segment photography. METHODS   The adaptor was used to evaluate canine, feline, and equine patients presenting to Tufts Ophthalmology service. Anterior segment imaging was conducted with the adaptor mounted between a dSLR camera body (Canon 7D) and a macro lens (Canon EF-S 60mm/f2.8). Posterior segment imaging was performed with the aid of an indirect ophthalmic lens mounted in front of the macro lens. Coaxial illumination during viewing was provided by a single white light-emitting diode (LED) within the adaptor, while illumination during exposure was provided by the pop-up flash or an accessory flash. Corneal and/or lens reflections were eliminated using a pair of linear polarizers, having their azimuths at right angles to one another. RESULTS   This dSLR camera adaptor provides quality high-resolution, reflection-free, images of both the anterior and posterior segments. It was easy to transport, assemble, and handle. The necessary adjustments, positioning, and focusing required for quality images were easily performed. CONCLUSION   The described dSLR camera adaptor provides an alternative to existing imaging systems. High-resolution image acquisition occurred at a fraction of the cost of established imaging system, particularly those devoted to the posterior segment.

Functional Anatomy of the Outflow Facilities

In order to understand the pathophysiology, select optimal therapeutic options for patients and provide clients with honest expectations for cases of canine glaucoma, clinicians should be familiar with a rational understanding of the functional anatomy of the ocular structures involved in this group of diseases. The topographical extension and the structural and humoral complexity of the regions involved with the production and the outflow of aqueous humor undergo numerous changes with aging and disease. Therefore, the anatomy relative to the fluid dynamics of aqueous has become a pivotal yet flexible concept to interpret the different phenotypes of glaucoma.

Mast cell tumor invading the cornea in a horse

A 3-year-old Marwari mare was presented for evaluation of an irregular, reddish mass protruding from behind the right third eyelid. The mass appeared to arise at the ventral limbal area, involved the perilimbal bulbar conjunctiva and widely extended into corneal tissue. No other ocular or systemic abnormalities were detected at the time of presentation. The mass was surgically removed by lamellar keratectomy, with defocused CO(2) laser used as adjunctive therapy to treat the surgical exposed area and its surroundings. Histopathologic evaluation showed sheets of densely packed, well-differentiated neoplastic mast cells separated by fibrovascular connective tissue. Nuclear staining for Ki-67 was performed, and an average of 370 cells were positive per 1000 counted cells. Two months postoperatively, the surgical site was filled with flat fibrovascular and pigmented tissue, while the surrounding cornea was transparent with no superficial vascularization around the fibrotic scar. Thirty-two months after treatment, no recurrence of the neoplasia was reported.