Roundtable Notes from 2013 IEOC/Acrivet Symposium

Transcription

1 Roundtable Notes from 2013 IEOC/Acrivet Symposium Cornea Various discussions on linear keratopathy, IMMK, and other cornea topics Keypoint: 1. We hypothesize that linear keratopathy (Haab s striae) is always a consequence of elevated IOP, most likely transient when no other signs are evident. (How the heck can we prove this?) 2. If the eye is otherwise normal and 1 striae is present, we tell owners not to be concerned. 3. it is not justifiable to call all non-ulcerative keratitis cases (other than abscesses) IMMK, but we don t know what else to call them yet. IMMK allergy testing? IDEXX System immune response, intensifies with age sublingual therapy Treatment for IMMK Diclofenac and DMSO What should vaccine/de-worming schedule be with IMMK No change, continue Pre-treat with Banamine or Steroids Topical Adequan/HA products IMMK is an umbrella term we don t know its triggers Linear keratopathy does not concern us Linear Keratopathy Have seen pigment on band although not common Seen in young Have seen bilateral but majority unilateral If found at pre-purchase recheck at 6 months IMMK Some painful / some non painful Cytology PCR bacteriology always STT, Fluorescein, Rose bengal breed influences presentation of IMMK Page 1 of 7

2 we do not like the nomenclature linear keratopathy? Fluorescein (flu) - depends upon appearance of area of uptake - faint retention with abrasions? - use blue light and look for autofluorescence before applying flu - hyper-fluorescing cells react to flu stronger than others - this is a real phenomenon, don t know what it means Not all non-ulcerative lesions are IMMK e.g. superficial / supepithelial / stromal abscess; fungal; neoplasia IMMK - Swedish cases after keratectomy look better (better coat, brighter, eat better,perform better) even if they are not overtly painful before sx - some scar more than others, but always more comfy 1. Linear keratopathy Difference between Haab s striae being due to glaucoma and linear keratopathy being incidental Likely different processes 2. IMMK Likely multiple dozen processes 3. Additional discussion of: how we like BioSist; amnion likely doesn t have same structural support as provided by conjunctiva; utilizing tenons under grafts after it is trimmed to provide additional support in deep ulcers. Page 2 of 7

3 Intraocular I intraocular melanoma glaucoma risk 15% A Matthews time frame - 6 wks 9 yr range M. Neaderland doesn t see melanomas until late in course - may present for glaucoma to find melanoma AM usually referred for corneal opacity in grey horse finds melanoma CH not seen glaucoma but many lost to follow-up Pauline present late in course in glaucoma not for tumors per se AM case presented with ciliary melanoma 7-8 mm 0 presented with glaucoma MN seen diffuse melanomas (eg. ring melanoma) AM not seen diffuse and not sure why 2 glaucoma as actual mass rel. small (not sufficient ICA obstruction) BPatterson seen any PIFM s -? in architecture in ICA AM John Mould looked at HP of these globes no inflammation BP seen 1 glaucoma (became bilateral) AM seen 1 - older horses MN intravitreal gentamicin CH likes TSCP AM TSCP invites uveitis. He s cured 1 case with latanoprost severe uveitis MN TSCP only in visual eye AM after enucleation of controlled IOP case more comfortable and a different horse - seen 3 cases pigmentary uveitis/endothelialitis Susan how much gentamicin? MN use 100 mg gentamicin (intra ing) also some dexameth, a topical ab 1 week and banamine 1-2 wk BP what to expect after MN usually not phthisical (most buphthalmic when treated) Congenital glaucoma no luck to resolve - gentamicin plus ½ ml dexameth (1mg) injection Dan spoke to vitreoretinal surgeon if fails the gentamicin is leaking out How long for lens to become cataractous? Depends on disease, weeks years Complications of cataract Sx: Foals vs. Adult Rechecks on animals that had sx. as foals 3-4 yeas post-op training ok, visual Page 3 of 7

4 FOALS smaller eye, pupils that do not respond well to light Recommend planned posterior capsulotomy due to fact that they all develop severe capsular opacification HORSES WITH ERU - cataract sx and implant. Look good for a few months then have glaucoma as complication. Conclusion despite advancements cataract sx and CsA implant cataract sx still not recommended Melanoma: glaucoma this group experience has not see them progress to Intraocular 1. see butterfly lesions form overnight with panuveitis 2. how to prove that Muller cells are what is migrating in OCT of chorioretinal bullet hole lesions? (lots of histopath) 3. how to handle bullet hole lesions in pre-purchase exam? 4. how many people refract horses coming in for vision eval? (very few) 5. standardizing vision testing and combining with orth/neuro exam Page 4 of 7

5 Research Ideas competition horses getting topical drugs look at systemic levels - not performance enhancing drugs CSA implants tacrolimus topical steroids grants for this? samples from multiple clinicians infusions with SPLs, tear film concentrations to see if MIC is achieved drug mixtures efficacy thermo gels and drug delivery IMMK need all samples to go to one place for analysis multicentric study herpetic kerotoconjunctivitis - what drugs are effective - which individual viruses - are these virus induced or an immune mediated rxn serum for melting ulcer antiprotease activity difference between serum and plasma? (b/c plasma easier to get) Anesthesia - evaluate a few outcome parameters among different anesthetic protocols, procedures, etc. - positioning of horse for lungs, etc. - positioning of horse with retrobulbar block - distribute a form to all IEOC members for anesthetic survey (didn t get further than this) Stem cell companies/uses in clinical cases apply topical to melting ulcer add stem cells (Limbal origin) other benefits? growing field of regenerative medicine Drug levels USEE/FEI on certain drugs Page 5 of 7

6 What drugs are available Communication Blood levels What is the level that effects performance How does intraocular inflam. Influence absorption What effects on performance Where do we access this information Retrobulbar lidocaine where does it go? EPM does it cause ocular disease How do you confirm/diagnose this condition? Anti-fungals drug resistance, new drugs on the horizon epidemiology of stromal abscesses allergy testing established protocol for vision testing in horses Page 6 of 7

7 Examination Techniques Most people use sedation Sedation - University setting always - case dependent Dilating - for pre-purchase yes IEOC should have CERF like form for pre-purchase Digital pictures with pre-purchase - Nikon 7000 Fluorescein stain - most spray Mixing Fluorescein and rose bengal No; how do you interpret? Page 7 of 7