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Shukla AK, Kowalska ME, Arteaga K, Crasta M, Dixon C, Famose F, Hartnack S, Pot SA. Evaluation of photoactivated chromophore for keratitis-corneal cross-linking (PACK-CXL) in feline infectious keratitis-patient demographics, treatment protocols, risk factors, and treatment outcome: a retrospective study. Vet Ophthalmol 2024. [PMID: 38706148 DOI: 10.1111/vop.13228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/02/2024] [Accepted: 04/20/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVES To describe patient demographics and treatment protocols in a population of feline patients undergoing photoactivated chromophore for keratitis-corneal cross-linking (PACK-CXL) as an adjunctive treatment for infectious keratitis. Furthermore, to determine the proportion of PACK-CXL treatment success in the population studied, explore risk factors for treatment failure, and provide recommendations for future PACK-CXL clinical studies. MATERIALS AND METHODS Records from four veterinary ophthalmology practices were reviewed to identify eligible patients and extract data. Recorded variables included patient-related factors, ocular examination findings, PACK-CXL protocol parameters, and treatment outcome. RESULTS Records for 153 cats (154 eyes) were included. Median age in the treatment success group was 8 years (interquartile range (IQR) 4-12), with a median ulcer depth of 30% (IQR 30-40). Median age in the treatment failure group was 10.5 years (IQR 4.75-12) with a median ulcer depth of 45.9% (IQR 30-75). Persian cats were the most represented brachycephalic breed (52 out of 64 cats). Modified PACK-CXL protocols were used, including fast energy delivery (134 eyes), and increased fluence (52 eyes). The overall proportion of success was 88% (95% CI 84-93), which was variable between clinics. Eighty-two of 89 mesocephalic cat eyes (92%), and 54 of 65 brachycephalic cat eyes (83%) were classified as treatment successes. CONCLUSIONS PACK-CXL appeared to be a useful, adjunctive therapeutic modality for the treatment of infectious keratitis in the feline patient population presented here. Brachycephalic cats, older cats, and those with deeper ulcers may be at increased risk for treatment failure.
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Affiliation(s)
- Angelie K Shukla
- Ophthalmology Section, Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Malwina E Kowalska
- Section of Epidemiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Kevin Arteaga
- AniCura Vision Vet Veterinary Eye Clinic, Bologna, Italy
| | - Manuela Crasta
- AniCura Vision Vet Veterinary Eye Clinic, Bologna, Italy
| | | | - Frank Famose
- Clinique Vétérinaire d'Ophtalmologie Spécialisée, Blagnac, France
| | - Sonja Hartnack
- Section of Epidemiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Simon Anton Pot
- Ophthalmology Section, Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Kowalska ME, Shukla AK, Arteaga K, Crasta M, Dixon C, Famose F, Hartnack S, Pot SA. Evaluation of risk factors for treatment failure in canine patients undergoing photoactivated chromophore for keratitis - corneal cross-linking (PACK-CXL): a retrospective study using additive bayesian network analysis. BMC Vet Res 2023; 19:227. [PMID: 37919690 PMCID: PMC10621152 DOI: 10.1186/s12917-023-03779-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 10/07/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Infectious keratitis is a common ophthalmic condition in canine patients. Sequelae can include keratomalacia and corneal perforation, a vision threatening outcome. Photoactivated chromophore for keratitis - corneal cross-linking (PACK-CXL) is a non-surgical, adjunctive treatment method for infectious keratitis. The goal of this retrospective, multicenter study was to determine risk factors for treatment failure following PACK-CXL in canine patients suffering from suspected infectious keratitis. Medical records from four veterinary ophthalmology services were reviewed, and information related to patient demographics, ophthalmic findings, the PACK-CXL protocol used, and epithelialization time was collected and analyzed. Due to the potential for intervariable relationships, an additive Bayesian network (ABN) analysis was performed to evaluate these complex relationships. RESULTS Records for 671 eyes (668 dogs) were included in the analysis. Based on the ABN, in the population included here, patients who underwent an accelerated PACK-CXL protocol were less likely to experience treatment failure versus patients treated with a slow protocol. Mutual dependencies between exposure variables were identified by ABN, which would have been overlooked using classical regression. Corneal re-epithelialization time was shortened following PACK-CXL combined with topical medical therapy compared to PACK-CXL alone. CONCLUSIONS No risk factors associated with treatment failure were identified in the population included in the present study. Canine patients may benefit from the use of accelerated PACK-CXL protocols, especially when combined with topical antibiotics and anti-collagenolytic therapy. The reasons for this apparent positive impact on treatment outcome remain unclear.
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Affiliation(s)
- M E Kowalska
- Ophthalmology Section, Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.
- Epidemiology Section, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.
| | - A K Shukla
- Ophthalmology Section, Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - K Arteaga
- AniCura Vision Vet Veterinary Eye Clinic, Bologna, Italy
| | - M Crasta
- AniCura Vision Vet Veterinary Eye Clinic, Bologna, Italy
| | - C Dixon
- Veterinary Vision, Penrith, UK
| | - F Famose
- Clinique Vétérinaire d'Ophtalmologie Spécialisée, Blagnac, France
| | - S Hartnack
- Epidemiology Section, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - S A Pot
- Ophthalmology Section, Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Dulaurent T, Rozoy M, Steun L, Isard PF. Multidirectional corneoconjunctival transposition in the treatment of large keratomalacia in 7 dogs and 5 cats. Vet Ophthalmol 2023. [PMID: 36943897 DOI: 10.1111/vop.13086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/14/2023] [Accepted: 03/02/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE To describe the use of multidirectional corneoconjunctival transposition (CCT) as a surgical treatment for large keratomalacia. METHOD A prospective study including dogs and cats initially presenting with keratomalacia larger than 6 × 6 mm and affecting more than half of the corneal thickness. Signalment, concurrent eye diseases, ulcer size, bacterial culture and susceptibility testing results, follow-up, and outcome were recorded. The surgery consisted of harvesting of two or three opposite corneoconjunctival grafts, after removal of the malacic tissue using a square-edge keratectomy. The medical treatment consisted of administration of topical and systemic antibiotics, topical atropine, and N-acetylcysteine. Follow-up examinations were performed at D7, D14, D21, and D28, and then at various time points. The corneal clarity score (CCS) was recorded upon completion of the follow-up period. RESULTS Seven dogs and five cats were included. Brachycephalic dogs were overrepresented, with no breed predisposition in cats. Concurrent eye diseases were corneal pigmentation in three dogs, hypopyon in two dogs, nictitating membrane wound in one dog, and corneal perforation in one cat. The size of the keratomalacia ranged from 6 × 6 to 9.5 × 11.5 mm. The short-term complications were suture dehiscence (two of 12) and progression of the keratomalacia (one of 12). The long-term complications were corneal pigmentation (10 of 12), corneal epithelial inclusion cyst (two of 12), and marginal synechiae (one of 12). All animals were sighted at the last follow-up. The median CCS was G3 (range G2-G4). CONCLUSION Multidirectional CCT is an effective surgical treatment for large keratomalacia in dogs and cats.
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Affiliation(s)
- Thomas Dulaurent
- Centre Hospitalier Vétérinaire Saint-Martin, Allonzier-la-Caille, France
| | - Manon Rozoy
- Universitatea de Stiinte Agricole si Medicina Veterinara, Cluj-Napoca, Romania
| | - Laure Steun
- Centre Hospitalier Vétérinaire Saint-Martin, Allonzier-la-Caille, France
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Suter A, Schmitt S, Hübschke E, Kowalska M, Hartnack S, Pot S. The bactericidal effect of two photoactivated chromophore for keratitis-corneal crosslinking protocols (standard vs. accelerated) on bacterial isolates associated with infectious keratitis in companion animals. BMC Vet Res 2022; 18:317. [PMID: 35978428 PMCID: PMC9386977 DOI: 10.1186/s12917-022-03397-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background Bacterial corneal infections are common and potentially blinding diseases in all species. As antibiotic resistance is a growing concern, alternative treatment methods are an important focus of research. Photoactivated chromophore for keratitis-corneal crosslinking (PACK-CXL) is a promising oxygen radical-mediated alternative to antibiotic treatment. The main goal of this study was to assess the anti-bactericidal efficacy on clinical bacterial isolates of the current standard and an accelerated PACK-CXL treatment protocol delivering the same energy dose (5.4 J/cm2). Methods Clinical bacterial isolates from 11 dogs, five horses, one cat and one guinea pig were cultured, brought into suspension with 0.1% riboflavin and subsequently irradiated. Irradiation was performed with a 365 nm UVA light source for 30 min at 3mW/cm2 (standard protocol) or for 5 min at 18mW/cm2 (accelerated protocol), respectively. After treatment, the samples were cultured and colony forming units (CFU’s) were counted and the weighted average mean of CFU’s per μl was calculated. Results were statistically compared between treated and control samples using a linear mixed effects model. Results Both PACK-CXL protocols demonstrated a significant bactericidal effect on all tested isolates when compared to untreated controls. No efficacy difference between the two PACK-CXL protocols was observed. Conclusion The accelerated PACK-CXL protocol can be recommended for empirical use in the treatment of bacterial corneal infections in veterinary patients while awaiting culture results. This will facilitate immediate treatment, the delivery of higher fluence PACK-CXL treatment within a reasonable time, and minimize the required anesthetic time or even obviate the need for general anesthesia.
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Affiliation(s)
- Anja Suter
- Ophthalmology Section, Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.
| | - Sarah Schmitt
- Veterinary Bacteriology Section, Institute for Food Safety and Hygiene, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Ella Hübschke
- Veterinary Bacteriology Section, Institute for Food Safety and Hygiene, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Malwina Kowalska
- Epidemiology Section, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Sonja Hartnack
- Epidemiology Section, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Simon Pot
- Ophthalmology Section, Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Large TP, Mack S, Villiers E, Oliver J. In vitro susceptibility of canine corneal bacterial pathogens to three cross-linking protocols. Vet Ophthalmol 2022; 26 Suppl 1:134-142. [PMID: 35713165 DOI: 10.1111/vop.13006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess in vitro antibacterial efficacy of three cross-linking (XL) protocols on bacteria associated with canine ulcerative keratitis. METHODS Three XL protocols: UVA 3 mW/cm2 for 60 min, UVA 3 mW/cm2 for 30 min, and UVA 30 mW/cm2 for 3 min with and without application of riboflavin and a riboflavin-only protocol were performed in vitro on the four most common bacterial genera isolated from cases of canine ulcerative keratitis treated at Dick White Referrals, UK. Zones of bacterial growth inhibition (GIZ) associated with treatment were measured and compared. RESULTS The four most common isolates were Pseudomonas aeruginosa (PA) (48/140, 34.3%), Streptococcus spp. (32/140, 22.9%), Staphylococcus spp. (24/140, 17.1%) and Escherichia coli (EC) (11/140, 7.9%). PA, EC, Streptococcus canis (SC), and Staphylococcus pseudintermedius (SP), isolated from canine corneas, were selected for testing. EC and SC demonstrated growth inhibition following all UVA/riboflavin protocols. PA and SP only displayed growth inhibition following the 60 min UVA/riboflavin protocol. GIZ areas for 60 min UVA/riboflavin protocols were significantly greater than 30 and 3 min UVA/riboflavin protocols (p < .01) and there was no significant difference between 30 and 3 min UVA/riboflavin protocols. In respect to GIZ areas, EC was significantly more susceptible to XL than SP (p = <.01). CONCLUSIONS All UVA/riboflavin XL protocols caused growth inhibition of EC and SC in vitro. PA and SP did not show clear growth inhibition in vitro following exposure to XL protocol settings of UVA 3 mW/cm2 for 30 min and UVA 30 mW/cm2 for 3 min.
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Affiliation(s)
- Thomas P Large
- Dick White Referrals, Six Mile Bottom, Cambridgeshire, UK
| | - Sarah Mack
- Dick White Referrals, Six Mile Bottom, Cambridgeshire, UK
| | | | - James Oliver
- Dick White Referrals, Six Mile Bottom, Cambridgeshire, UK
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Fontanella CG, Carniel EL, Corain L, Peruffo A, Iacopetti I, Pavan PG, Todros S, Perazzi A. Mechanical behaviour of healthy versus alkali-lesioned corneas by a porcine organ culture model. BMC Vet Res 2021; 17:340. [PMID: 34711207 PMCID: PMC8555156 DOI: 10.1186/s12917-021-03050-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cornea is a composite tissue exhibiting nonlinear and time-dependent mechanical properties. Corneal ulcers are one of the main pathologies that affect this tissue, disrupting its structural integrity and leading to impaired functions. In this study, uniaxial tensile and stress-relaxation tests are developed to evaluate stress-strain and time-dependent mechanical behaviour of porcine corneas. RESULTS The samples are split in two groups: some corneas are analysed in an unaltered state (healthy samples), while others are injured with alkaline solution to create an experimental ulcer (lesioned samples). Furthermore, within each group, corneas are examined in two conditions: few hours after the enucleation (fresh samples) or after 7 days in a specific culture medium for the tissue (cultured samples). Finally, another condition is added: corneas from all the groups undergo or not a cross-linking treatment. In both stress-strain and stress-relaxation tests, a weakening of the tissue is observed due to the imposed conditions (lesion, culture and treatment), represented by a lower stiffness and increased stress-relaxation. CONCLUSIONS Alkali-induced corneal stromal melting determines changes in the mechanical response that can be related to a damage at microstructural level. The results of the present study represent the basis for the investigation of traditional and innovative corneal therapies.
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Affiliation(s)
- Chiara Giulia Fontanella
- Department of Industrial Engineering, University of Padova, via Venezia 1, 35131, Padova, Italy.,Centre for Mechanics of Biological Materials, University of Padova, via Marzolo 9, 35131, Padova, Italy
| | - Emanuele Luigi Carniel
- Department of Industrial Engineering, University of Padova, via Venezia 1, 35131, Padova, Italy.,Centre for Mechanics of Biological Materials, University of Padova, via Marzolo 9, 35131, Padova, Italy
| | - Livio Corain
- Department of Management and Engineering, University of Padova, stradella S. Nicola 3, 36100, Vicenza, Italy
| | - Antonella Peruffo
- Department of Comparative Biomedicine and Food Science, University of Padova, viale dell'Università 16, Legnaro, 35020, Padova, Italy
| | - Ilaria Iacopetti
- Department of Animal Medicine, Production and Health, University of Padova, viale dell'Università 16, Legnaro, 35020, Padova, Italy
| | - Piero G Pavan
- Department of Industrial Engineering, University of Padova, via Venezia 1, 35131, Padova, Italy.,Centre for Mechanics of Biological Materials, University of Padova, via Marzolo 9, 35131, Padova, Italy
| | - Silvia Todros
- Department of Industrial Engineering, University of Padova, via Venezia 1, 35131, Padova, Italy. .,Centre for Mechanics of Biological Materials, University of Padova, via Marzolo 9, 35131, Padova, Italy.
| | - Anna Perazzi
- Department of Animal Medicine, Production and Health, University of Padova, viale dell'Università 16, Legnaro, 35020, Padova, Italy
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Hartley C. Outcomes of treatments for keratomalacia in dogs and cats: a systematic review of the published literature including non-randomised controlled and non-controlled studies. J Small Anim Pract 2021; 62:840-849. [PMID: 33934337 DOI: 10.1111/jsap.13326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/14/2021] [Accepted: 02/19/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this review was to interrogate the evidence base for treatment of keratomalacia in dogs and cats, through examination of the applicable literature. MATERIALS AND METHODS Studies were screened for evidence to answer the following question Which of the treatment options for keratomalacia in dogs and cats offers the best chance of globe survival, the fastest time to resolution with globe survival, and the best visual outcome. The search utilised the PubMed (http://www.pubmed.gov/) and ISI Web of Science (http://wok.mimas.ac.uk/) databases. Databases were searched using the following terms: (keratomalacia OR corneal melt OR corneal malacia) AND (dog OR canine OR canid OR cat OR feline OR felid) AND (treatment OR outcome OR morbidity OR complications). Studies were assessed by one author (CH) and excluded if they related to less than three keratomalacia cases, experimental treatments, in vitro studies, or did not provide information regarding outcome. Studies were classified to a level of evidence according to the system described by the Oxford Centre for EvidenceBased Medicine. RESULTS Eighteen (18) studies were identified as providing information to answer the proposed question, one as level 3, 10 as level 4 and seven as level 5 evidence. Only one study compared two treatments, the remaining were prospective or retrospective case series of a single treatment intervention. Study design was highly variable with respect to population size, followup and outcome assessment, making direct comparison difficult, and metaanalysis was not applied. CLINICAL SIGNIFICANCE Overall, the evidence for improved outcome of one proposed treatment over another proposed treatment for keratomalacia in dogs and/or cats is very weak.
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Affiliation(s)
- C Hartley
- Langford Vets, University of Bristol Veterinary School, Bristol, BS40 5DU, UK
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Tsvetanova A, Powell RM, Tsvetanov KA, Smith KM, Gould DJ. Melting corneal ulcers (keratomalacia) in dogs: A 5-year clinical and microbiological study (2014-2018). Vet Ophthalmol 2021; 24:265-278. [PMID: 33794048 DOI: 10.1111/vop.12885] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To identify bacterial microorganisms associated with canine keratomalacia, review their antimicrobial sensitivity, and evaluate clinical outcomes compared to results of microbial culture. METHODS Retrospective analysis of clinical records of dogs diagnosed with a melting corneal ulcer presented to a referral hospital in Hertfordshire, UK between 2014 and 2018. RESULTS One hundred and ten melting corneal ulcers were sampled in 106 dogs. The most common pure bacterial isolate was Pseudomonas aeruginosa (n = 26) followed by β-hemolytic Streptococcus (n = 12). Melting corneal ulcers that cultured coagulase-positive Staphylococcus, coliform bacteria, Pasteurella multocida, Enterococcus, and Streptococcus viridans presented in smaller numbers and were analyzed together (n = 16). Multiple cultures were identified in nine cases (n = 9). Forty-seven cultures yielded no bacterial growth (n = 47). The susceptibility to fluoroquinolones remained high with the exception of β-hemolytic Streptococci. There was no significant difference in the ulcer severity at presentation in regard to the cultured bacteria. Overall, 63 eyes (57%) received surgical grafting in addition to medical treatment. In 14 cases (13%), the progression of corneal melting despite medical ± surgical treatment resulted in enucleation. Fifty-seven percent (8/14) of the enucleated eyes cultured pure Pseudomonas aeruginosa isolates. In contrast, all β-hemolytic Streptococcus-associated ulcers healed. CONCLUSIONS The most common bacterial species associated with canine keratomalacia were Pseudomonas aeruginosa and β-hemolytic Streptococcus. Because of the variation in antibacterial sensitivity between these two species, bacterial culture and sensitivity testing should be performed in all dogs presenting with keratomalacia. Melting corneal ulcers associated with pure Pseudomonas infection were significantly more likely to result in globe loss than melting corneal ulcers associated with other cultures.
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Affiliation(s)
- Agata Tsvetanova
- Davies Veterinary Specialists, Manor Farm Business Park, Hertfordshire, UK
| | | | - Kamen A Tsvetanov
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Kerry M Smith
- Davies Veterinary Specialists, Manor Farm Business Park, Hertfordshire, UK
| | - David J Gould
- Davies Veterinary Specialists, Manor Farm Business Park, Hertfordshire, UK
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Knyazer B, Krakauer Y, Tailakh MA, Achiron A, Hecht I, Lifshitz T, Torres-Netto EA, Hafezi NL, Hafezi F. Accelerated Corneal Cross-linking as an Adjunct Therapy in the Management of Presumed Bacterial Keratitis: A Cohort Study. J Refract Surg 2021; 36:258-264. [PMID: 32267957 DOI: 10.3928/1081597x-20200226-02] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 02/25/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the outcomes of accelerated photoactivated chromophore for keratitis corneal cross-linking (PACK-CXL) as an adjunct treatment for bacterial keratitis (PACK-CXL plus standard antibiotic therapy) for patients receiving only standard antibiotic therapy. METHODS Retrospective cohort study of outcomes of patients with moderate infectious presumed bacterial keratitis (ulcer diameter 2 to 7 mm and stromal depth < 300 µm) were compared before and after initiation of a new treatment protocol of PACK-CXL in addition to standard antibiotic treatment. RESULTS A total of 70 eyes of 70 patients were included: 39 eyes in the PACK-CXL plus antibiotic (PACK-ABX) group and 31 eyes in the antibiotic only (ABX) control group. The PACK-ABX group showed shorter times to complete reepithelialization (9.3 ± 6.0 vs 16.0 ± 12.7 days, P = .01) and did not require tectonic emergency keratoplasty (0% versus 19.4%, P = .006). The PACK-ABX group also showed a higher percentage of eyes with complete reepithelialization in 6 days or less (46.2% vs 6.5%, P < .001) and a trend for shorter hospitalizations (6.3 ± 5.0 vs 8.5 ± 4.5 days, P = .06). A multivariate analysis controlling for age showed that PACK-ABX treatment remained significantly associated with early ulcer reepithelialization (odds ratio = 0.09, 95% confidence interval = 0.02 to 0.48, P = .005). CONCLUSIONS This study validates previous findings regarding the use of accelerated PACK-CXL in the treatment of bacterial keratitis. Adding PACK-CXL improved clinical outcomes (reducing healing time) when compared to antibiotics alone. [J Refract Surg. 2020;36(4):258-264.].
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Zibura AE, Cullen MA, Rutledge H, Lassalle L, Salmon JH, Gilger BC, Westermeyer HD. Optimizing corneal riboflavin administration in ex vivo horse, dog, rabbit, and pig samples for use in corneal collagen cross-linking. Vet Ophthalmol 2020; 23:840-848. [PMID: 32702180 DOI: 10.1111/vop.12807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Determine optimal iontophoresis times for riboflavin delivery to the corneal stroma across different species and compare these to corneal injection. METHODS Ex vivo horse, dog, rabbit, and pig globes were treated with riboflavin administered with either iontophoresis for 2.5-20 minutes with or without corneal epithelium; or with purpose-designed precise corneal injection (PCI) application with intact epithelium. Immediately following riboflavin administration, samples were harvested, frozen, and sectioned. Riboflavin penetration was imaged using fluorescence microscopy. RESULTS Horse samples processed with iontophoresis without epithelium for 2.5, 5, and 7.5 minutes, and processed with intact epithelium for 20 minutes, had mean percent stromal penetration (%SPmean ) of 63.4%, 93.8%, 100.0%, and 0.0% (respectively). Dog samples processed with iontophoresis without epithelium for 2.5 and 5 minutes, had %SPmean of 60.7% and 82.1% (respectively). Pig samples processed with iontophoresis for 5 minutes without and with epithelium had %SPmean of 63.3% and 35.1% (respectively). Rabbit samples processed with iontophoresis without epithelium for 2.5 and 5 minutes, had %SPmean of 81.8% and 100.0% (respectively). For all injected volumes, riboflavin was observed spanning throughout the corneal stroma, and lamellar separation was noted surrounding all sites of injection. CONCLUSIONS Both iontophoresis and injection via PCI needles provide efficient and effective means of riboflavin administration in ex vivo horse, dog, rabbit, and pig corneas. Epithelial debridement is required for stromal delivery of riboflavin using iontophoresis in horses. Following epithelial removal, riboflavin penetrated through the horse corneal stroma faster than all other species tested.
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Affiliation(s)
- Ashley E Zibura
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Megan A Cullen
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Haley Rutledge
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Laura Lassalle
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Jacklyn H Salmon
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Brian C Gilger
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Hans D Westermeyer
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
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11
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An Assay System to Evaluate Riboflavin/UV-A Corneal Phototherapy Efficacy in a Porcine Corneal Organ Culture Model. Animals (Basel) 2020; 10:ani10040730. [PMID: 32340101 PMCID: PMC7652214 DOI: 10.3390/ani10040730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/16/2020] [Accepted: 04/19/2020] [Indexed: 12/21/2022] Open
Abstract
Simple summary The scope of this study is to quantitatively evaluate, with an automated digital image analysis method, the efficacy of riboflavin/UV-A corneal phototherapy on the cornea in a porcine corneal organ culture model of ulcerative melting keratitis. Riboflavin/UV-A corneal phototherapy provided a favorable outcome in the corneal wound healing process after chemical injury: the treatment restores the damaged corneas to the texture of healthy corneas. This automated image analysis method may be compared to clinical diagnostic methods, such as optical coherence tomography (OCT) imaging, for in vivo damaged ocular structural investigations. Positive results from this research could provide an opportunity for studying the effects of this method in other economically and emotionally valued species, such as dogs, cats, and horses. The relatively overall low treatment cost and the ease of performing the procedure make riboflavin/UV-A corneal phototherapy accessible to the veterinary market. Abstract The purpose of this study was to investigate the response of porcine corneal organ cultures to riboflavin/UV-A phototherapy in the injury healing of induced lesions. A porcine corneal organ culture model was established. Corneal alterations in the stroma were evaluated using an assay system, based on an automated image analysis method able to (i) localize the holes and gaps within the stroma and (ii) measure the brightness values in these patches. The analysis has been performed by dividing the corneal section in 24 regions of interest (ROIs) and integrating the data analysis with a “multi-aspect approach.” Three group of corneas were analyzed: healthy, injured, and injured-and-treated. Our study revealed a significant effect of the riboflavin/UV-A phototherapy in the injury healing of porcine corneas after induced lesions. The injured corneas had significant differences of brightness values in comparison to treated (p < 0.00) and healthy (p < 0.001) corneas, whereas the treated and healthy corneas showed no significant difference (p = 0.995). Riboflavin/UV-A phototherapy shows a significant effect in restoring the brightness values of damaged corneas to the values of healthy corneas, suggesting treatment restores the injury healing of corneas after lesions. Our assay system may be compared to clinical diagnostic methods, such as optical coherence tomography (OCT) imaging, for in vivo damaged ocular structure investigations.
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Guyonnet A, Desquilbet L, Faure J, Bourguet A, Donzel E, Chahory S. Outcome of medical therapy for keratomalacia in dogs. J Small Anim Pract 2020; 61:253-258. [PMID: 32065393 DOI: 10.1111/jsap.13118] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 12/22/2019] [Accepted: 01/23/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To evaluate the clinical and visual outcomes following intensive medical therapy for keratomalacia in dogs. MATERIALS AND METHODS Medical records were screened to identify dogs with corneal ulcers and keratomalacia. All patients were given the same topical treatment protocol with frequent administrations of tobramycin in combination with equine serum. Surgical treatment during the first 15 days of follow-up was considered as medical treatment failure. RESULTS We report on 57 ulcers with keratomalacia from 53 dogs. Medical treatment was successful in 31 of 57 ulcers with a median healing time of 5 days (range 2 to 15 days). At 60 days after epithelialisation, 14/15 medically-treated eyes were visual. In one case, corneal perforation was observed 1 month after healing and required surgical stabilisation. CLINICAL SIGNIFICANCE Intensive medical therapy has the potential to achieve healing of some ulcers with keratomalacia. Surgical stabilisation in response to progression of stromal loss was required in less than half of the cases.
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Affiliation(s)
- A Guyonnet
- Unité d'Ophtalmologie, CHUVA, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, F-94700, France
| | - L Desquilbet
- BioPôle, Unité de Biostatistique et d'épidémiologie, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, F-94700, France
| | - J Faure
- Unité d'Ophtalmologie, CHUVA, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, F-94700, France
| | - A Bourguet
- Unité d'Ophtalmologie, CHUVA, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, F-94700, France
| | - E Donzel
- Unité d'Ophtalmologie, CHUVA, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, F-94700, France
| | - S Chahory
- Unité d'Ophtalmologie, CHUVA, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, F-94700, France
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Case Reports for Topical Treatment of Corneal Ulcers with a New Matrix Therapy Agent or RGTA ® in Dogs. Vet Sci 2019; 6:vetsci6040103. [PMID: 31847217 PMCID: PMC6958328 DOI: 10.3390/vetsci6040103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 11/30/2022] Open
Abstract
Superficial corneal ulcers that fail to heal within a normal time period and are refractory to conventional therapy in dogs are common in veterinary practice. Different etiologies can lead to this result, including spontaneous chronic corneal epithelial defects (SCCEDs) and ulcerative keratitis associated with bullous keratopathy. Thus, there is an urgent need to find new therapeutic approaches such as matrix therapy replacement. To determine the efficacy of a new ophthalmic treatment (Clerapliq®) for SCCEDs and ulcerative keratitis associated with bullous keratopathy, a total of 11 dogs referred to the clinic because of nonhealing erosive ulcers after a classic primary treatment were enrolled to get this new treatment. Dogs underwent ophthalmic exams and 7 dogs (10 eyes) were diagnosed with superficial ulceration and 4 dogs (5 eyes) with bullous keratopathy due to endothelial dystrophy/degeneration. They received eye drops of Clerapliq® every 3 days until recovery. The results showed that the corneas with recurrences of the ulcers were resolved predominantly by using Clerapliq® every 3 days in 83.3% of the cases during a period of treatment ranging between 6 to 35 days. Therefore, this new approach using matrix therapy regenerating technology in treating superficial ulcers and bullous keratopathy in dogs can be successfully considered as an adjunctive therapy.
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Hellander Edman A, Ström L, Ekesten B. Corneal cross-linking (CXL)-A clinical study to evaluate CXL as a treatment in comparison with medical treatment for ulcerative keratitis in horses. Vet Ophthalmol 2019; 22:552-562. [PMID: 31012258 DOI: 10.1111/vop.12662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/17/2019] [Accepted: 02/20/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Compare CXL treatment with medical treatment alone in horses with stromal, ulcerative keratitis. ANIMALS STUDIED 24 horses (24 eyes) with stromal, ulcerative keratitis were included. PROCEDURE 12 horses were initially treated with CXL, and 12 horses were given conventional medical treatment. Topical medical treatment was added to horses in the CXL group if necessary. Parameters including cytology, microbial growth, time to fluorescein negativity, and time to inhibition of stromal melting were evaluated. RESULTS After the first day of treatments, a decrease in inflammatory signs and pain from the eye was observed in both groups. Stromal melting ceased within 24 hours regardless of treatment. CXL treatment alone was sufficient in 3 horses with noninfectious, superficial stromal ulcerations. Clinical signs of impaired wound healing were seen after 3-14 days in corneas with suspected or proven bacterial infection treated with CXL only, most likely because of insufficient elimination of bacteria deeper in the corneal stroma or because of re-infection from bacteria in the conjunctiva. The average decrease in stromal ulcer area per day after onset of treatment was almost identical between the groups, and no significant difference in time to fluorescein negativity was found. CONCLUSIONS We consider CXL a possible useful adjunct treatment of corneal stromal ulcers in horses, especially for melting ulcers and as a potential alternative to prophylactic antibiotic treatment for noninfected stromal ulcers. However, CXL should not be used alone for infected or suspected infected stromal ulcers, because topical antibiotics were required in all horses with proven infectious keratitis.
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Affiliation(s)
- Anna Hellander Edman
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Lena Ström
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Björn Ekesten
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
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Wolfel AE, Pederson SL, Cleymaet AM, Hess AM, Freeman KS. Anterior segment parameters in normal dogs using the Pentacam ® HR Scheimpflug system. Vet Ophthalmol 2019; 22:683-694. [PMID: 30715790 DOI: 10.1111/vop.12642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/22/2018] [Accepted: 11/27/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe and compare normative anterior segment parameters between canine age groups using the Pentacam® HR Scheimpflug camera (Pentacam). ANIMALS STUDIED Thirty-six sedated dogs (60 eyes) of varying ages and breeds were imaged with the Pentacam; only nondiseased anterior segments were included. PROCEDURES Dogs were divided into three age groups: Group 1 (1-5 years), Group 2 (6-10 years), and Group 3 (11-15 years). Values assessed included central corneal thickness (CCT), anterior and posterior corneal elevation (ACE/PCE), anterior and posterior corneal curvature metrics, corneal volume (CV), anterior and posterior corneal astigmatism (AA/PA), anterior chamber depth (ACD), anterior chamber volume (ACV), and anterior chamber angle (ACA). Tukey-adjusted pairwise comparisons were performed. RESULTS Overall CCT (mean ± SD) was 631.07 ± 59.91 µm. Central corneal thickness was 608.60 ± 48.63 µm for Group 1, 648.57 ± 51.06 µm for Group 2, and 635.37 ± 73.71 µm for Group 3. Anterior corneal elevation (ACE) measured 9.08 ± 0.58 mm, PCE measured 8.04 ± 0.50 mm, and CV was 58.13 ± 5.39 mm3 . Astigmatism values were 1.34 ± 0.94 D for AA and 0.46 ± 0.44 D for PA. Anterior chamber values were 3.76 ± 0.56 mm for ACD, 383.68 ± 66.24 mm3 for ACV, and 23.62 ± 29.33˚ for ACA. Significant differences were found between Groups 1 and 2 for CV (55.08 ± 4.08 mm3 and 60.32 ± 4.19 mm3 , respectively), (P = 0.02). CONCLUSIONS Corneal volume significantly increased between Group 1 and Group 2. Central corneal thickness increased from Group 1 to Group 3, but was not significant with the current sample size. There were no other differences between age groups.
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Affiliation(s)
- Allison E Wolfel
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Samantha L Pederson
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Allison M Cleymaet
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Ann M Hess
- Department of Statistics, College of Natural Sciences, Colorado State University, Fort Collins, Colorado
| | - Kate S Freeman
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
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Guyonnet A, Bourguet A, Donzel E, Bataille G, Pascal Q, Laloy E, Boulouis HJ, Milleman Y, Chahory S. Bilateral bullous keratopathy secondary to melting keratitis in a Suri alpaca ( Vicugna pacos). Clin Case Rep 2018; 6:626-630. [PMID: 29636928 PMCID: PMC5889221 DOI: 10.1002/ccr3.1389] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/17/2017] [Accepted: 01/02/2018] [Indexed: 12/13/2022] Open
Abstract
An young alpaca was evaluated for bilateral progressive melting corneal ulcers and developped secondary bullous keratopathy during hospitalization. The tragic progression of melting ulcers in both eyes observed in our case leads us to recommend a rapid intensive medical therapy in young and debilitated alpacas presenting a corneal ulcer.
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Affiliation(s)
- Alexandre Guyonnet
- CHUVA, Unité d'Opthalmologie Ecole Nationale Vétérinaire d'Alfort Université Paris - Est Maisons-Alfort F-94700 France
| | - Aurélie Bourguet
- CHUVA, Unité d'Opthalmologie Ecole Nationale Vétérinaire d'Alfort Université Paris - Est Maisons-Alfort F-94700 France
| | - Elise Donzel
- CHUVA, Unité d'Opthalmologie Ecole Nationale Vétérinaire d'Alfort Université Paris - Est Maisons-Alfort F-94700 France
| | - Guillemette Bataille
- Unité de Pathologie des Animaux de Production Ecole Nationale Vétérinaire d'Alfort Université Paris - Est Maisons-Alfort F-94700 France
| | - Quentin Pascal
- BioPôle, Unité d'Histologie et Anatomie pathologique Ecole Nationale Vétérinaire d'Alfort Université Paris - Est Maisons-Alfort F-94700 France
| | - Eve Laloy
- BioPôle, Unité d'Histologie et Anatomie pathologique Ecole Nationale Vétérinaire d'Alfort Université Paris - Est Maisons-Alfort F-94700 France
| | - Henri-Jean Boulouis
- BioPôle, Unité de Bactériologie Ecole Nationale Vétérinaire d'Alfort Université Paris - Est Maisons-Alfort F-94700 France
| | - Yves Milleman
- Unité de Pathologie des Animaux de Production Ecole Nationale Vétérinaire d'Alfort Université Paris - Est Maisons-Alfort F-94700 France
| | - Sabine Chahory
- CHUVA, Unité d'Opthalmologie Ecole Nationale Vétérinaire d'Alfort Université Paris - Est Maisons-Alfort F-94700 France
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Oriá AP, Gomes Junior DC, Raposo ACS, Libório FA, Schäffer DP, Dórea Neto FA. Bullous keratopathy in a yellow-headed caracara (Milvago chimachima) treated with a modified third eyelid flap. PESQUISA VETERINÁRIA BRASILEIRA 2016. [DOI: 10.1590/s0100-736x2016001200009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT: A Yellow-headed Caracara (Milvago chimachima) was submitted to the Ophthalmology Service of the Federal University of Bahia with a corneal abnormality. During ophthalmic evaluation the right cornea was stained positively with fluorescein; a blurred bullous lesion, with irregular surface, compatible with the diagnosis of bullous keratopathy was found. This is a rare condition in a bird which was treated successfully with a modified third eyelid flap associated with antibiotic and hyaluronic acid eye drops. The adopted therapeutic proved to be simple to implement and viable for repair of the bullous keratopathy in the Yellow-headed caracara.
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Tabibian D, Mazzotta C, Hafezi F. PACK-CXL: Corneal cross-linking in infectious keratitis. EYE AND VISION 2016; 3:11. [PMID: 27096139 PMCID: PMC4836155 DOI: 10.1186/s40662-016-0042-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 03/24/2016] [Indexed: 11/24/2022]
Abstract
Background Corneal cross-linking (CXL) using ultraviolet light-A (UV-A) and riboflavin is a technique developed in the 1990’s to treat corneal ectatic disorders such as keratoconus. It soon became the new gold standard in multiple countries around the world to halt the progression of this disorder, with good long-term outcomes in keratometry reading and visual acuity. The original Dresden treatment protocol was also later on used to stabilize iatrogenic corneal ectasia appearing after laser-assisted in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). CXL efficiently strengthened the cornea but was also shown to kill most of the keratocytes within the corneal stroma, later on repopulated by those cells. Review Ultraviolet-light has long been known for its microbicidal effect, and thus CXL postulated to be able to sterilize the cornea from infectious pathogens. This cytotoxic effect led to the first clinical trials using CXL to treat advanced infectious melting corneal keratitis. Patients treated with this technique showed, in the majority of cases, a stabilization of the melting process and were able to avoid emergent à chaud keratoplasty. Following those primary favorable results, CXL was used to treat beginning bacterial keratitis as a first-line treatment without any adjunctive antibiotics with positive results for most patients. In order to distinguish the use of CXL for infectious keratitis treatment from its use for corneal ectatic disorders, a new term was proposed at the 9th CXL congress in Dublin to rename its use in infections as photoactivated chromophore for infectious keratitis -corneal collagen cross-linking (PACK-CXL). Conclusion PACK-CXL is now more frequently used to treat infections from various infectious origins. The original Dresden protocol is still used for this purpose. Careful modifications of this protocol could improve the efficiency of this technique in specific clinical situations regarding certain types of pathogens.
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Affiliation(s)
- David Tabibian
- Laboratory for Ocular Cell Biology, University of Geneva, Geneva, Switzerland ; Department of Ophthalmology, Northampton General Hospital, Northampton, United Kingdom
| | - Cosimo Mazzotta
- Siena Crosslinking Center, Siena University Hospital, Siena, Italy
| | - Farhad Hafezi
- Laboratory for Ocular Cell Biology, University of Geneva, Geneva, Switzerland ; Department of Ophthalmology, University of Southern California, Los Angeles, CA USA ; EyeCare Laboratory Research Zurich Associates (ELZA) Institute, Webereistrasse 2, 8953 Dietikon, Switzerland
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Sanchez RF, Dawson C, Matas Riera M, Escanilla N. Preliminary results of a prospective study of inter- and intra-user variability of the Royal Veterinary College corneal clarity score (RVC-CCS) for use in veterinary practice. Vet Ophthalmol 2015; 19:313-8. [PMID: 26315115 DOI: 10.1111/vop.12307] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To introduce a new corneal clarity score for use in small animals and describe its inter- and intra-user variability. ANIMALS STUDIED Twelve dogs and two cats with corneal abnormalities and five dogs with healthy corneas. MATERIALS AND METHODS Four examiners scored every patient twice and never consecutively, focusing on the central cornea. The peripheral cornea was scored separately. The following scoring system was used to describe corneal clarity: G0: no fundus reflection is visible on retroillumination (RI) using a head-mounted indirect ophthalmoscope. G1: a fundus reflection is visible with RI. G2: a 0.1-mm diameter light beam is visible on the anterior surface of the iris and/or lens. G3: gross fundic features are visible when viewed with indirect ophthalmoscopy (IO) using a head-mounted indirect ophthalmoscope and a hand-held 30D lens, although fine details are not clear. G4: fine details of the fundic features are clearly visible with IO. The minimum grades given were analyzed for inter- and intra-user variability with kappa analysis. RESULTS Intra- and interuser variability of the central corneal clarity ranged from 0.78 to 0.96, showing substantial to almost perfect reproducibility, and from 0.66 to 0.91, showing substantial to almost perfect reliability, respectively. Intra- and interuser variability of the peripheral cornea ranged from 0.83 to 0.95, showing almost perfect agreement, and from 0.53 to 0.91, showing moderate to almost perfect agreement. CONCLUSIONS The RVC-CCS is well suited to assess and monitor central corneal clarity in small animals and to compare outcomes between studies and different surgeons.
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Affiliation(s)
- Rick F Sanchez
- The Royal Veterinary College, Ophthalmology Service, Department of Clinical Science and Services, University of London, Hawkshead lane, North Mymms, Herts, AL9 7TA, UK
| | - Charlotte Dawson
- The Royal Veterinary College, Ophthalmology Service, Department of Clinical Science and Services, University of London, Hawkshead lane, North Mymms, Herts, AL9 7TA, UK
| | - Màrian Matas Riera
- The Royal Veterinary College, Ophthalmology Service, Department of Clinical Science and Services, University of London, Hawkshead lane, North Mymms, Herts, AL9 7TA, UK
| | - Natàlia Escanilla
- The Royal Veterinary College, Ophthalmology Service, Department of Clinical Science and Services, University of London, Hawkshead lane, North Mymms, Herts, AL9 7TA, UK
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Gallhoefer NS, Spiess BM, Guscetti F, Hilbe M, Hartnack S, Hafezi F, Pot SA. Penetration depth of corneal cross‐linking with riboflavin and
UV
‐A (
CXL
) in horses and rabbits. Vet Ophthalmol 2015. [DOI: 10.1111/vop.12301] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Nicolin S. Gallhoefer
- Augen Vet Lindenthalguertel 83 50935 Cologne Germany
- Division of Ophthalmology Equine Department Vetsuisse Faculty University of Zurich Winterthurerstrasse 260, 8057 Zurich Switzerland
- Center for Clinical Studies Vetsuisse Faculty University of Zurich Winterthurerstrasse 260, 8057 Zurich Switzerland
| | - Bernhard M. Spiess
- Division of Ophthalmology Equine Department Vetsuisse Faculty University of Zurich Winterthurerstrasse 260, 8057 Zurich Switzerland
| | - Franco Guscetti
- Institute of Veterinary Pathology Vetsuisse Faculty University of Zurich Winterthurerstrasse 268, 8057 Zurich Switzerland
| | - Monika Hilbe
- Institute of Veterinary Pathology Vetsuisse Faculty University of Zurich Winterthurerstrasse 268, 8057 Zurich Switzerland
| | - Sonja Hartnack
- Division of Veterinary Epidemiology Vetsuisse Faculty University of Zurich Winterthurerstrasse 260, 8057 Zurich Switzerland
| | - Farhad Hafezi
- Laboratory for Ocular Cell Biology University of Geneva Rue Alcide‐Jentzer 22 CH‐1211 Geneva 14 Switzerland
- Department of Ophthalmology University of Southern California 1450 San Pablo St. Los Angeles CA 90033 USA
- The ELZA Institute AG Webereistrasse 2 8953 Dietikon Zurich Switzerland
| | - Simon A. Pot
- Division of Ophthalmology Equine Department Vetsuisse Faculty University of Zurich Winterthurerstrasse 260, 8057 Zurich Switzerland
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Tabibian D, Richoz O, Hafezi F. PACK-CXL: Corneal Cross-linking for Treatment of Infectious Keratitis. J Ophthalmic Vis Res 2015; 10:77-80. [PMID: 26005557 PMCID: PMC4424723 DOI: 10.4103/2008-322x.156122] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 11/04/2014] [Indexed: 11/04/2022] Open
Abstract
This article discusses corneal cross-linking (CXL) and how it transitioned from a modality for treating corneal ectatic disorders to an inventive means of treating infectious keratitis. Initially, CXL was successfully developed to halt the progression of ectatic diseases such as keratoconus, using the standard Dresden protocol. Later, indications were extended to treat iatrogenic ectasia developing after laser-assisted in situ keratomileusis (LASIK) and photo-refractive keratectomy (PRK). At the time, it had been postulated that the combination of ultraviolet light with riboflavin could not only biomechanically strengthen the cornea but also was capable of destroying living cells and organisms including keratocytes and pathogens. Thus a new and innovative concept of treatment for infectious keratitis emerged through the use of CXL technology. Initially only advanced infectious melting ulcers resisting standard microbicidal therapy were treated with CXL in addition to standard therapy. In subsequent studies CXL was also used to treat bacterial keratitis as first line therapy without the use of concomitant antibiotic therapy. With the increasing interest in CXL technology to treat infectious keratitis and to clearly separate its use from the treatment of ectatic disorders, a new term was adopted at the 9(th) CXL congress in Dublin for this specific indication: PACK-CXL (photoactivated chromophore for infectious keratitis). PACK-CXL has the potential to eventually become an interesting alternative to standard antibiotic therapy in treating infectious corneal disorders, and may help reduce the global burden of microbial resistance to antibiotics and other therapeutic agents.
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Affiliation(s)
- David Tabibian
- Laboratory for Ocular Cell Biology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Olivier Richoz
- Laboratory for Ocular Cell Biology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Farhad Hafezi
- Laboratory for Ocular Cell Biology, Faculty of Medicine, University of Geneva, Geneva, Switzerland ; Department of Ophthalmology, University of Southern California, Los Angeles, California, USA ; The ELZA Institute, Dietikon/Zurich, Switzerland
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Ultraviolet A/Riboflavin Collagen Cross-Linking for Treatment of Moderate Bacterial Corneal Ulcers. Cornea 2015; 34:402-6. [DOI: 10.1097/ico.0000000000000375] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Richoz O, Gatzioufas Z, Francois P, Schrenzel J, Hafezi F. Impact of Fluorescein on the Antimicrobial Efficacy of Photoactivated Riboflavin in Corneal Collagen Cross-linking. J Refract Surg 2013; 29:842-5. [DOI: 10.3928/1081597x-20131115-01] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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