Nonulcerative keratouveitis as a manifestation of Leptospiral infection in a horse

Prognosis and impact of equine recurrent uveitis

REASONS FOR PERFORMING STUDY

Equine recurrent uveitis (ERU) is a leading cause of vision loss in horses.

OBJECTIVES

To assess the prognosis and impact of ERU on affected horses and their owners by evaluating the signalment, treatment and outcome (including the loss of use, vision assessment and economic loss).

STUDY DESIGN

Retrospective impact study.

METHODS

Medical records of horses presenting to the North Carolina State University Veterinary Health Complex (NCSU-VHC) with ERU between 1999 and 2014 were reviewed. Signalment, clinical signs, ophthalmic examination findings, treatments and outcomes were evaluated. Owner questionnaires were completed regarding vision, job/role, monetary value, diagnostic and treatment costs, concurrent illness and outcomes.

RESULTS

Records of 224 horses (338 eyes) with ERU were reviewed. There was an overrepresentation of Appaloosas (54; 24.1%), Hanoverians (11; 4.9%) and other Warmbloods (13; 5.8%). Ninety-six eyes (28.4%) were diagnosed as blind and 38 eyes (11.2%) with glaucoma on initial evaluation. Leptospirosis titres of serum and/or aqueous humour were obtained in 88 horses and were positive in 40 horses (45.5%), with L. pomona being the most frequently isolated serovar. Globe loss at the NCSU-VHC occurred in 41 ERU eyes (12.1% of total). Owner questionnaires were evaluated in 194 horses (86.6%) and 91 horses (46.9%) were reported blind in the affected eye(s). Fifty-seven horses (29.4%) did not return to their previous role, while 61 (31.4%) performed at a reduced level. Equine recurrent uveitis decreased the monetary value of 164 horses. Twenty-nine horses (14.9%) were euthanised and 37 (19.1%) underwent change in ownership as a direct result of ERU.

CONCLUSIONS

The impact of ERU is attributed to the high frequency of blindness, globe loss and loss of function. Euthanasia and change of ownership are common sequelae to the progressive nature of ERU. These factors, along with financial costs of the disease, have a significant impact on affected horses and their owners.

Equine immune-mediated keratopathies

Immune mediated keratopathies (IMMKs) are a relatively commonly occurring group of heterogeneous corneal disorders. This paper describes the currently recognised clinical presentations of the IMMKs in the USA and in the UK. Although a clinical diagnosis is relatively straightforward in most cases, the specific aetiopathogeneses of the IMMKs remains elusive and largely speculative, but are thought to be based upon upregulated immunoreactivity in the normally immunologically passive cornea. Treatment protocols, both medical and surgical, are based primarily on collective clinical experience and are variably successful, and in some cases recurrence or refractoriness to treatment is possible.

Pathophysiology, Diagnosis, and Management of Urinary Tract Infection in Horses

Equine urinary tract infection (UTI) most commonly occurs as a sequela to structural or functional inhibition of normal urine flow. Although it is an infrequent diagnosis in equids, the incidence of UTI in human beings is high and has inspired great investigative effort. The resultant findings with potentially broad application as well as current equine studies are reviewed here. Recent developments in the understanding of host-agent interactions and renal defense mechanisms, emerging antimicrobial resistance, and novel therapeutic alternatives to prophylactic antibiotic use are emphasized.

Immune-mediated keratitis in horses: 19 cases (1998-2004)

OBJECTIVE

The purpose of this study is to describe clinical and histologic findings, treatment, and outcome of horses with suspected immune-mediated keratitis (IMMK).

DESIGN

Retrospective study.

ANIMALS

Nineteen horses that presented to NCSU-VTH from 1998 to 2004 with IMMK. Procedures Information retrieved from the medical records included signalment, duration of clinical signs, therapy prior to initial examination, ophthalmic abnormalities, diagnostics performed, therapy instituted, and long-term vision.

RESULTS

Nineteen horses (22 eyes) were diagnosed with IMMK. Three distinct clinical groups were identified based on the depth of the lesion in the cornea: superficial stromal (n = 11 eyes), midstromal (n = 6 eyes), or endothelial (n = 5 eyes). Horses ranged from 5 to 19 years of age, with a mean age +/- SD of 11.9 +/- 3.6 years. Eleven horses had 12 months or greater duration of clinical signs of corneal disease prior to referral. Overall there was a mean duration of 11.8 +/- SD 8.3 months. Superficial stromal keratitis appeared as a superficial stromal cellular infiltrate with diffuse vascularization. Midstromal keratitis appeared as midstromal cellular infiltrate with mild, surrounding corneal edema and vascularization. Endothelial disease appeared as endothelial cellular infiltrate with diffuse corneal edema. In all types of IMMK, signs of uveitis or severe discomfort were not observed.

CONCLUSIONS AND CLINICAL RELEVANCE

Horses with superficial IMMK responded to topical medical therapy, but responded best to surgical removal of the lesion. Horses with midstromal keratitis responded to topical cyclosporine therapy. Endothelial disease was the least amenable to therapy.