Equine Glaucoma

The effect of systemic acetazolamide administration on intraocular pressure in healthy horses-A preliminary study

OBJECTIVES

In equine glaucoma, topical treatment with carbonic anhydrase inhibitors (CAIs) is recommended. Oral acetazolamide, a systemic CAI, is used in horses with hyperkalemic periodic paralysis. Information regarding its effect on equine intraocular pressure (IOP) is scarce. The aim of the study was to determine the effect of oral acetazolamide treatment on IOP in horses, in a case-control study.

ANIMALS

Ten healthy horses.

PROCEDURES

Horses were treated with oral acetazolamide (4.4 mg/kg) BID for 1 week. Serum acetazolamide concentrations were determined by liquid chromatography/tandem mass spectrometry, and IOP were measured before treatment, daily during treatment, and at 48 and 72 h after treatment.

RESULTS

Acetazolamide serum levels reached steady state at 72 h after the first oral dose. In a mixed effect model logistic regression, there was a significant decrease in IOP on the third treatment day, of 2.4 mmHg (p = .012) and 2.7 mmHg (p = .006) in the left (OS) and right eye (OD), respectively. On the seventh day, there was a decrease in 2.5 mmHg (p = .008) and 2.7 mmHg (p = .007) OS and OD, respectively. A significant increase occurred 48 h following treatment discontinuation (3.6 mmHg, p < .001 and 3.5 mmHg, p < .001 OS and OD, respectively). The area under the concentration versus time curve (AUC(0-10h)) was 1.1 ± 0.5 μg/mL*h, mean residence time 6.7 ± 4.3 h, peak plasma concentration (Cmax) 0.4 ± 0.4 μg/mL and time to reach Cmax 1.8 h. There was a significant increase in serum concentrations 1, 2, 48, 72, and 156 h following the first drug administration (p < .05).

CONCLUSIONS

Further studies are required to determine whether acetazolamide is a potential treatment for equine glaucoma.

Comparison of first, second, and third versus the average of six probe-corneal touches for intraocular measurement of two rebound tonometers in healthy horses

The aim of this study was to evaluate the intraocular pressure (IOP) measurements obtained from first, second, and third probe-cornea touch (PCT) and compare them with the average of six PCTs using two rebound tonometers in horses. This study enrolled a total of thirty-eight stallions, comprising of 24 Arabian horses and 14 cross-breeds (with an average age of 8 ± 3 years). The IOP measurements of first, second, and third, as well as the average of six PCTs were obtained using either Tonovet (TV) or Tonovet Plus (TV+) rebound tonometers. The mean differences (95% limits of agreement) between the average of six PCTs and the first, second, and third PCTs were 0.1 (-4.8 to 5), 0.2 (-4.8 to 4.5), and 0.2 (-3.6 to 4.0) mmHg with TV, respectively. With TV+, the differences were 0.3 (-6.6 to 7.2), 1.1 (-8.6 to 10.8), and -0.2 (-3.6 to 4.0) mmHg, respectively. Compared to the average of six PCTs, only 89.5%, 92.1%, and 97.4% of IOP measurements obtained from TV and 78.9%, 73.3%, and 65.8% of IOP measurements obtained from TV+ were within 4 mmHg of the average of six PCTs for first, second, and third PCTs, respectively. In conclusion, the measurement of IOP in the first PCT achieved best agreement with the IOP measurement of six average PCTs. Therefore, the first PCT could be considered as an alternative option for measuring IOP in horses when obtaining an average of six PCTs is not feasible.

The application of functional imaging in visual field defects: a brief review

Visual field defects (VFDs) represent a prevalent complication stemming from neurological and ophthalmic conditions. A range of factors, including tumors, brain surgery, glaucoma, and other disorders, can induce varying degrees of VFDs, significantly impacting patients' quality of life. Over recent decades, functional imaging has emerged as a pivotal field, employing imaging technology to illustrate functional changes within tissues and organs. As functional imaging continues to advance, its integration into various clinical aspects of VFDs has substantially enhanced the diagnostic, therapeutic, and management capabilities of healthcare professionals. Notably, prominent imaging techniques such as DTI, OCT, and MRI have garnered widespread adoption, yet they possess unique applications and considerations. This comprehensive review aims to meticulously examine the application and evolution of functional imaging in the context of VFDs. Our objective is to furnish neurologists and ophthalmologists with a systematic and comprehensive comprehension of this critical subject matter.

MicroPulse™ transscleral cyclophotocoagulation in the equine patient: A case series of four horses

OBJECTIVE

To describe the clinical application and outcome of MicroPulse™ transscleral cyclophotocoagulation (MP-TSCPC) treatment in horses with glaucoma.

ANIMALS STUDIED

Four client-owned horses with primary (n = 2) or secondary (n = 2) glaucoma.

METHODS

Horses were treated with MP-TSCPC under standing sedation with a minimum of 30 days of follow-up (range 30-1241 days). Affected eyes were treated with a 31.3% duty cycle and 3000 mW laser power for a total of 180 s. Data collected included signalment, pre- and post-procedure intraocular pressures (IOPs), laser settings, medications, complications, and repeat therapy.

RESULTS

Four horses (5 eyes) received at least one treatment with MP-TSCPC. Mean preoperative IOP was 44 mmHg (range 33-49 mmHg). The immediate mean postoperative IOP was 34 mmHg (4 eyes; range 19-55 mmHg). At 1 week, IOP was 38 mmHg (5 eyes; range 21-80 mmHg), at 2 weeks was 40 mmHg (3 eyes, range 17-80 mmHg), at 1 month was 35 mmHg (5 eyes; range 20-50 mmHg), at 3 months was 18 mmHg (2 eyes; range 14-21 mmHg), at 6 months was 35 mmHg (2 eyes; range 30-39 mmHg), and at >300 days was 24 mmHg (3 eyes; range 18-29 mmHg). Complications included corneal ulceration (n = 1 eye), uncontrolled IOP (n = 3 eyes), and need for repeat treatment (n = 2 eyes).

CONCLUSIONS

MP-TSCPC used with the above-described settings was unsuccessful in treating the majority of cases. Future studies should be targeted at primary glaucoma cases and with use of alternative laser settings.

Comparison of four tonometers in the measurement of intraocular pressure in healthy horses

BACKGROUND

Measurement of the intraocular pressure (IOP) is a useful diagnostic tool in equine ophthalmology. Handheld tonometers, such as Tonovet and Tonovet Plus (rebound), Tono-Pen AVIA Vet (applanation), and Kowa HA-2 (applanation using the Goldmann methodology) are used to obtain IOP measurements in veterinary medicine.

OBJECTIVES

To compare and evaluate the accuracy of four handheld tonometers in measuring IOP using different methodologies in healthy horses.

STUDY DESIGN

In vivo experiment and cross-sectional survey of healthy horses.

METHODS

Intraocular pressure was measured in 72 eyes of 36 horses. An in vivo study was conducted on sedated horses to compare the real IOP values obtained using manometry versus those obtained using tonometry, and a field study was conducted on unsedated healthy horses with normal eyes to measure the IOP values using different tonometers.

RESULTS

In the in vivo study, the mean IOP values using ocular manometry was 24.9 ± 4.0 mmHg (range, 20.0-30.0 mmHg). The mean IOP values using tonometry were: Tonovet, 25.7 ± 5.8 mmHg (range 19.5-33.0 mmHg); Tonovet Plus, 24.8 ± 7.1 mmHg (range 13.2-33.2 mmHg); Tono Pen AVIA Vet, 19.2 ± 4.7 mmHg (range 13.1-26.5 mmHg); and Kowa Ha-2, 24.1 ± 1.2 mmHg (range 22.8-25.8 mmHg). In the field study, the IOP values were: Tonovet, 30.7 ± 5.6 mmHg (range 21.7-38.0 mmHg); Tonovet Plus, 29.6 ± 6.7 mmHg (range 16.2-38.6 mmHg); Tono-Pen AVIA Vet, 27.3 ± 5.8 mmHg (range 14.6-37.1 mmHg); and Kowa HA-2, 23.4 ± 2.2 mmHg (range 20.2-28.7 mmHg).

MAIN LIMITATIONS

This study included only healthy horses and a limited number of animals in the in vivo study.

CONCLUSIONS

There was a strong correlation between the IOP values and manometry for all tonometers. IOP should be estimated using the same tonometer over time, and the bias of the tonometer used, such as overestimation (rebound tonometer) and underestimation (applanation tonometer), should be acknowledged. A normal reference value for each tonometer should be established in horses.

Effect of Volumes of Solutions on Intraocular Pressure During Intravitreal Injection of Low Dose Gentamicin in Horses With Recurrent Uveitis: A Randomized Controlled Study

Horses with recurrent uveitis can be treated by intravitreal injection of low dose gentamicin under sedation and after local anesthetic techniques including the retrobulbar nerve block. Since it is reported that retinal degeneration can be secondary to an acute increase of intraocular pressure (IOP), the current randomized controlled study was carried out in order to investigate the changes in IOP following retrobulbar anesthesia, with two different volumes of local anesthetic (lidocaine) solution (10 and 5 mL), and intravitreal injection of 6 mg gentamicin in two different volumes of solution (0.3 and 0.15 mL). Multivariate regression showed that IOP was significantly lower in the pathologic eye at baseline (estimated effect size -6.1 mmHg; P = .0001) and after sedation (estimated effect size -9.4 mmHg; P < .0001). The IOP was significantly higher after a 10 mL block (P .0002) but this effect was very small (+0.5 mmHg). There was no significant difference in IOP after the injection of 0.15 or 0.3 mL solution of gentamicin. There was no significant combined effect of the volume of local anesthetic used for the block and the volume of the gentamicin solution. Since the expected anesthetic effects (desensitization and akinesia) were met in all cases, the smaller volume of 5 mL of lidocaine solution would be preferable for retrobulbar block for intravitreal injections, while intravitreal injections volumes of 0.15 and 0.30 mL can be used indifferently.

Effects of 0.0015% preservative-free tafluprost on the equine eye

OBJECTIVE

The purpose of this study was to determine the effects and potential side effects of topical preservative-free (PF) tafluprost 0.0015% in ophthalmologically normal horses.

ANIMALS

Five adult grade horses.

PROCEDURES

One of the eyes of each horse was randomly chosen as the "treatment" eye, and consequently, the contralateral eye served as the "control." A single dose of PF tafluprost 0.0015% (0.2 mL) was instilled in the treated eye of each horse. Intraocular pressure (IOP), Schirmer's tear test (STT) levels of each eye, and an ophthalmic examination were performed at T0 (baseline), T30, T120, T24 h, and T48 h.

RESULTS

The mean IOP values of the treated eyes at baseline (T0), T30, T120, T24 h, and T48 h were 25.4 ± 4.8 mmHg, 21.2 ± 1.92 mmHg, 15.20 ± 2.48 mmHg, 18.40 ± 1.51 mmHg, and 24.60 ± 1.94 mmHg, respectively. Significant differences were observed between the mean baseline IOP level and the T120 and T24 h time points (p = .001 and p = .009). The mean STT levels at each time point showed insignificant fluctuations during the study (p = .140). Adverse effects such as chemosis and episcleral injection were observed 30 min after the instillation of tafluprost 0.0015% (T30). Blepharospasm and conjunctival hyperemia were observed 120 min (T120) after the administration of the medication.

CONCLUSION AND CLINICAL RELEVANCE

Tafluprost 0.0015% showed potential in reducing IOP, but due to its local side effects, it is not a good candidate for management of glaucoma in horses. Tafluprost did not notably affect STT.

Histologic effects of MicroPulse™ transscleral cyclophotocoagulation in normal equine eyes

OBJECTIVE

Determine the immediate post-operative effects of MicroPulse^™ transscleral cyclophotocoagulation (MP-TSCPC) in healthy equine eyes.

ANIMALS STUDIED

Ten adult horses.

METHODS

MP-TSCPC was performed on sedated horses in 12 eyes (4 groups) using the following parameters (power, duration, duty cycle): (1) 2000 mW, 180 seconds, 31.3%; (2) 3000 mW, 180 seconds, 31.3%; (3) 3000 mW, 270 seconds, 31.3%; and (4) 3000 mW, 270 seconds, 50%. Three additional eyes were left untreated (control). Eyes were monitored clinically until euthanasia (mean = 3 hours post-procedure). Histologic sections were assessed with light microscopy and transmission electron microscopy (TEM).

RESULTS

MP-TSCPC was well tolerated by sedated horses. Adverse effects were only noted in Group 4: ocular hypertension (n = 3/3), conjunctival burns (3/3), aqueous flare (2/3), and a corneal erosion (1/3). Histologic scoring of Group 4 was statistically greater than other treated groups (1-3) and control eyes (P ≤ .021). TEM showed subtle changes to the mitochondria and plasma membrane infoldings of the basilar surface of the nonpigmented epithelium in all treated eyes.

CONCLUSIONS

MP-TSCPC does not cause immediate post-procedure adverse clinical effects or pronounced morphological changes to the ciliary body, except with the highest laser settings evaluated (power 3000 mW, duration 270 seconds, duty cycle 50%).

Intraocular pressure following four different intravenous sedation protocols in normal horses

BACKGROUND

Intravenous sedation is frequently necessary for ophthalmic examination in horses. Common sedation protocols have not been directly compared in terms of relative intraocular pressure (IOP) reduction, duration of IOP reduction and time to maximum IOP reduction.

OBJECTIVES

To compare the effects of standing sedation protocols on IOP.

STUDY DESIGN

Randomised cross-over experiment.

METHODS

Twelve healthy horses received four intravenous sedation protocols with a 48 hours washout: 0.5 mg/kg xylazine and 0.01 mg/kg butorphanol (SED1); 10 µg/kg detomidine and 0.01 mg/kg of butorphanol (SED2); 10 µg/kg detomidine (SED3); 0.5 mg/kg xylazine (SED4). IOP was measured with rebound tonometry before sedation (Tpre) and 5, 10, 15, 30, 45 and 60 minutes post-sedation (Tpost). Post-sedation readings were taken with the head elevated to the Tpre position. Separately, IOP readings were also obtained following sedation with the head not elevated (TpostHeadDown). IOP values were compared using mixed ANOVA and ANCOVA models respectively with significance at P < .05.

RESULTS

All protocols decreased IOP compared with baseline with greatest reduction at Tpost5. IOP at Tpre (mean ± SD) was 21.8 ± 4.4 mm Hg. At Tpost5, IOP was 16.3 ± 3.8 mm Hg (SED1), 14.5 ± 2.9 mm Hg (SED2), 17.1 ± 3.8 mm Hg (SED3) and 16.9 ± 4.2 mm Hg (SED4). SED2 Tpost5 IOP was lower than other treatments. Considering all time points following sedation, SED3 IOP readings were higher than other treatments. TpostHeadDown IOPs were higher than readings taken with the head elevated (P < .001).

MAIN LIMITATIONS

Animals with ocular disease were not studied. No animals received mock sedation or equivalent.

CONCLUSIONS

A combination of detomidine and butorphanol causes greater IOP reduction 5 minutes following sedation than other commonly used sedation protocols. IOP reduction is less pronounced when detomidine is used alone. Consideration of head height is important when performing IOP measurements in horses.

Comparison of two rebound tonometers in healthy horses

Objective

To obtain a reference range for evaluation of intraocular pressure (IOP) in horses using Tonovet Plus^®, to compare the IOP readings obtained with Tonovet^® and Tonovet Plus^®, and to evaluate the repeatability of readings.

Animals studied and Procedures

Intraocular pressure of 30 client‐owned horses (60 eyes) with no signs of illness or ocular disease was evaluated using Tonovet^® and Tonovet Plus^® rebound tonometers. Horses’ mean age was 10.7 (range 6‐17) years. Triplicate measurements were performed without using sedatives or local anesthetics, with minimal restraint.

Results

Calculated reference intervals (the CLSI robust method) were 14.4‐27.2 mmHg for Tonovet^® and 16.0‐26.1 mmHg for Tonovet Plus^®. Mean values (± standard deviation, SD [± coefficient of variation, CV]) obtained with Tonovet Plus^® (21.6 ± 2.45 mmHg [11.3%]) were on average 0.6 mmHg higher than with Tonovet^® (21.0 ± 3.14 mmHg [15.0%]), and a negligible statistical difference between the devices was found using the paired sample t test (P = .049). The correlation coefficient for the averaged triplicate measurements was 0.73. The average CV was 4.6% and 4.4% for Tonovet^® and Tonovet Plus^®, respectively.

Conclusions

The repeatability of measurements was very good with both devices. The readings between the two devices differed statistically significantly, but the correlation was considered good and the variation was numerically small, and thus, the difference was considered clinically irrelevant. When monitoring disease process or treatment response in an individual patient, repeated readings are best performed using a similar device to avoid false interpretation of results.

Inter-user and intra-user variation of two tonometers in horses

BACKGROUND

It is currently unknown which of the two devices most commonly used in equine ophthalmology for intraocular pressure (IOP) estimation demonstrates the lowest inter-user and intra-user variation.

OBJECTIVES

To assess the inter-user and intra-user variation of two tonometers in sedated and unsedated horses.

STUDY DESIGN

Randomised masked cross-over trial.

METHODS

Four examiners used the rebound (ICare^® TonoVet) and applanation (TonoPen^® ) tonometers to measure the intraocular pressure (IOP) in triplicate in 10 normal horses before and after sedation with xylazine. For inter-user variation, coefficient of variation (CV) values were calculated from the mean of each examiner for each condition combination. For intra-user variation, CV values were calculated from the individual measurements of each examiner for each condition combination. CV values were also assessed in relation to other variables using ANOVA.

RESULTS

The rebound tonometer was found to have lower inter-user (15.4% vs 21.7%, P = .01) and intra-user (9.1% vs 16.1%, P < .0001) variation in unsedated horses and lower intra-user (8.4% vs 14.7%, P < .0001) variation in sedated horses than the applanation tonometer. Both instruments had similar inter-user variation in sedated horses. For the rebound tonometer, sedation did not affect inter-user or intra-user variation, but for the applanation tonometer inter-user variation was lowest while horses were sedated (16.0% vs 21.7%, P = .03). No other variable assessed was found to have an effect on IOP.

MAIN LIMITATIONS

No animals with ocular disease were included in this study.

CONCLUSIONS

The rebound tonometer may be the preferred instrument to minimise intra-user and inter-user variation for IOP measurement in unsedated horses. The rebound tonometer is also likely to be the preferred instrument to minimise intra-user variation in sedated horses. If the applanation tonometer is used to perform IOP measurement in horses, it is recommended that this is performed while horses are sedated to minimise inter-user variation for this instrument.

Effects of topical 1% cyclopentolate hydrochloride on quantitative pupillometry measurements, tear production and intraocular pressure in healthy horses

OBJECTIVE

To evaluate the effect of topical cyclopentolate hydrochloride (CH) on quantitative pupillometric readings (PR), tear production (TP), and intraocular pressure (IOP) in healthy horses.

ANIMALS STUDIED

Fourteen client-owned horses.

PROCEDURES

In a two-phase design study, each animal received 1% CH ophthalmic solution in the left eye [treated] and 0.9% NaCl in the right eye [control] (0.2 mL each). In the first phase (n = 7), TP, IOP, and PR assessment was performed by Schirmer tear test I, rebound tonometry and static pupillometry, at 1, 8, 24, 48, 72, 96, 120, 148, 172, and 196-hours post-instillation. In the second phase (n = 7), plateau mydriasis was evaluated by assessing PR hourly for 8 hours post-instillation. For PR assessment, pupil area (PA), vertical diameter (VPD), and horizontal diameter (HPD) were recorded. All pupillometries were obtained in a room with fixed light intensity (45-60 lux). Statistical analysis was performed by generalized estimating equations method for the effect on parameters over time.

RESULTS

After topical CH, significant differences in pupil dilation were seen from 1 to 172 hours for VPD and from 8 to 24 hours for PA, without significant differences on HPD over time. In the second phase, plateau PA and VPD were reached at 3 hours, while plateau HPD at 2 hours. No significant effects were detected on TP and IOP in both eyes at any time, nor on PR of the nontreated eyes.

CONCLUSIONS

Topical 1% cyclopentolate hydrochloride could be considered an effective and safe option when a mydriatic/cycloplegic drug is needed in horses.

Clinical, ultrasonographic, and histopathologic findings in seven horses with Descemet's membrane detachment: A case series

OBJECTIVE

To describe ultrasonography as a diagnostic method of in vivo Descemet's membrane detachment (DMD) in horses.

ANIMALS STUDIED

Seven horses (three Icelandic horses, two Dutch Warmblood horses, one Appaloosa, and one Welsh Pony), presenting with moderate-to-severe focal or diffuse corneal edema, in whom DMD was suspected on ultrasonographic examination and confirmed with histopathology, were studied.

PROCEDURE

A retrospective analysis of case records of horses with suspected DMD was performed.

RESULTS

Median age at presentation was 14 years (range 11-24). Clinical signs in eyes with DMD were unilateral in all horses and included blepharospasm and epiphora (6/7), buphthalmos (5/7), moderate-to-severe focal or diffuse corneal edema (7/7), corneal epithelial bullae (4/7), corneal neovascularization (4/7), Haab's striae (2/7), corneal endothelial precipitates (1/7), fibrin in the anterior chamber (1/7), focal cataract (2/7), and pigment deposits on the anterior lens capsule (1/7). During transpalpebral ultrasonography, a distinct linear echogenic structure was noted in the anterior chamber, initially diverging from, and later running parallel to, the posterior lining of the cornea in all eyes studied. In all cases, the cornea was severely thickened and echogenic, consistent with edema, and DMD was suspected. In all horses, the clinical signs progressed and the affected eye was eventually enucleated. Histopathology revealed DMD (7/7), spindle cell proliferation (4/7), Descemet's membrane reformation (3/7), and inflammation of the anterior uvea (5/7). Overall incidence was 1.04%.

CONCLUSIONS

Ultrasonography is an adequate tool in diagnosing DMD in horses. Descemet's membrane detachment should be included in the differential diagnosis in horses with dense focal or diffuse corneal edema.