Tratamento medicamentoso de ulceração corneana e abscesso estromal em equinos / Medicament Treatment of Corneal Ulcer and Stromal Abscess in Horses

Background: The equine eyelids and cilia protect the eye and promote normal ocular physiological function. Disorders in these structures may result in corneal alterations such as ulcers and stromal abscess. An abscess is a focal mixture of cellular debris, necrotic tissue, leucocytes and possibly infectious agents that initially create a lesion surrounded by a zone of reactive infl ammation. Ulcers and corneal stromal abscess cause severe ocular pain and loss of vision quality in horses. Medical and surgical treatments for stromal abscess have been developed and have evolved over many years. The aim of this work is to report a case of stromal abscess in a horse, after a corneal ulcer related to eyelid deficiency, focusing on therapeutic methods. Case: A 10-year-old crossbreed mare was referred to the Veterinary Clinics Hospital (HCV) of UFPel with an ophthalmic disorder. The mare had an eyelid lesion 2 years before, and since this event she had had recurrent episodes of ophthalmologic disorders. On attendance at the HCV, the mare had photophobia, blepharospasm, conjunctival hyperemia, neovascularization, myosis, uveitis, intense ocular pain, eyelid deficiency and a corneal ulcer about 2 cm long x 2 cm wide in the right eye. Surgical correction of eyelid and corneal disorder was recommended, but not authorized by the owner. Treatment was based on cleaning with physiological solution, gentamicin eyewash, autologus serum every 4 h, atropine 1% every 12 h topically, flunixin meglumin every 12 h intravenously. After 7 days, the corneal ulcer shrank, although there was no improvement in blepharospasm and ocular pain. A corneal abscess 3 cm x 2 cm was noticed. Gentamicin eyewash and autologus serum were administered topically every 4 h for 10 more days. After 14 days of treatment, there was neither blepharospasm nor corneal ulcer and the abscess was shrinking. Gentamicin eyewash was maintained every 6h for 3 more days. After 65 days there was minimal scar tissue in the eye. Discussion: The mare had an ocular traumatic injury 2 years ago and since this event she had presented uveitis and corneal ulcer recurrently, due to loss of eyelid and cilia functional integrity. Equine cornea is avascularized and vascularization of the affected lesion is necessary for resolution and abscess healing. Medical treatment of superfi cial stromal abscess is more economical than surgery and can result in good visual outcomes with mild scarring. Medical treatment consists of a combination of antimicrobial, mydriatic/cycloplegic and anti-inflammatory medications. Flunixin meglumin seems to be the most effective intravenous anti-inflammatory for controlling uveitis in horses. The anti-inflammatory dose may be reduced when there is a decrease in the anterior segment signs of infl ammation and ocular pain. Besides systemic colateral effects, anti-inflammatory therapy also reduces corneal vascularization, and therefore should be used carefully. Antibiotic topical therapy is highly recommended, due to ocular microflora and microorganism encapsulation, and it was used in the present report until there was full epithelial healing. A mydriatic/cycloplegic (atropine 1%) drug was administered aiming to dilate the pupil in order to prevent adherences and to reduce ocular discomfort. Antiproteases agents (autologus serum) are recommended when there is a corneal epithelial loss of integrity. This agent reduces collagen degradation and helps corneal healing. Stromal abscess in horses is usually associated with previous corneal ulceration, and in the present report it also involved eyelid functional deficiency. Medical treatment was effective, ensuring quality of future vision for the animal.

Histopatologia das lâminas do casco de equinos com laminite aguda induzida e tratados com ketoprofeno, fenilbutazona e flunixin meglumine / Histopathology of the digital laminae from horses with acute induced laminitis treated with ketoprophen, phenylbutazone, and flunixin meglumin

Avaliaram-se as alterações histológicas do tecido laminar, obtido por biopsia, em 20 equinos portadores de laminite induzida por sobrecarga de carboidratos e tratados com ketoprofeno, fenilbutazona ou flunixin meglumine. A biopsia foi colhida dos dígitos torácicos 72 horas após a indução. Os achados histológicos foram comparados com os achados de amostras de equinos isentos de laminite. Infiltrado inflamatório neutrofílico foi observado em 80 por cento, congestão em 50 por cento, hemorragia em 35 por cento e hiperplasia na túnica íntima das arteríolas das lâminas dérmicas primárias em 15 por cento das amostras. As taxas de microtrombos e coágulos foram 15 por cento e 20 por cento, respectivamente. Estes achados parecem decorrer dos distúrbios circulatórios que ocasionaram edema, congestão e hiperemia, seguidos de degeneração. Em 70 por cento das análises realizadas nos animais tratados, as lesões histológicas foram inferiores aos graus de claudicação observados. Conclui-se que a biopsia de tecido laminar digital de equinos é viável, os artefatos decorrentes da técnica de biopsia não prejudicam a análise histológica das amostras e os anti-inflamatórios não esteroidais não são capazes de evitar as lesões laminares quando administrados após o início da sintomatologia clínica de laminite.(AU)

Experimental laminitis caused by carbohydrate overload was induced in 20 healthy horses. Seventy two hours after induction, samples of the laminar tissue were obtained by biopsy from the thoracic limbs digits for histopathology. The histological findings were compared to samples from horses without laminitis. Neutrophilic infiltrate was observed in 80 percent of the samples, congestion in 50 percent, hemorrhage in 35 percent, and hyperplasia of the arteriolar intima layer of the primary dermal lamina in 15 percent. Thrombi and intravascular blood clots were observed in 15 percent and 20 percent of the samples, respectively. Apparently, these findings were due to circulatory changes that resulted in edema, congestion, and hyperemia, followed by degeneration. In 70 percent of analyses performed on treated horses, the histological lesions were less severe than the clinical signs of lameness. It is concluded that: (i) the biopsy technique of laminar digital tissue from horses is viable; (ii) the artifacts generated by the biopsy technique do not compromise the histological analyses; and (iii) non-steroidal anti-inflammatory drugs do not avoid laminar lesions when administered after the beginning of clinical signs of laminitis.(AU)

Inibição e reversão da agregação plaquetária de eqüinos in vitro com o uso de ketoprofeno, fenilbutazona e flunixim meglumine / In vitro inibition and reversion of equine platelet aggregation using ketoprophen, phenylbutazone and flunixin meglumin

Como são várias as enfermidades e os distúrbios que induzem à hipercoagulabilidade e à pré-ativação de plaquetas em eqüinos. A atividade de medicamentos utilizados para controle dessas enfermidades sobre a agregação de plaquetas pode, não apenas servir para avaliar sua evolução, como também a resposta terapêutica. Com o objetivo de avaliar a prevenção e a reversão da agregação plaquetária de eqüinos in vitro foram utilizados os antiinflamatórios não esteroidais (AINES): ketoprofeno, fenilbutazona e flunixim meglumine. A comparação demonstrou que a fenilbutazona e o ketoprofeno previnem a agregação de plaquetas de eqüinos induzida pelo ADP, de forma mais eficaz do que o flunixim-meglumine e, superior ao fragmento monoclonal de anticorpo Reopro, sendo semelhante a dos bloqueadores de receptores de membrana Ro-438857 e RGDS. Quanto a reverão da agregação plaquetária tanto a fenilbutazona quanto o ketoprofeno demonstraram efeitos dose-dependente.(AU)

Several diseases may lead to platelet pre-activation and hypercoagulability states in horses. The activity of many drugs against platelet aggregation may, not only contribute to the evaluation of a disease but also its response to the therapy. With the aim to study in vitro prevention and reversion of platelet aggregation, the non steroidal anti-inflammatory drug (NSAID): ketoprophen, phenylbutazone and flunixin-meglumin were evaluated. The comparison demonstrated that phenylbutazone and ketoprophen prevented platelet aggregation induced by ADP better than flunixin-meglumin, in a superior manner to the monoclonal antibody Reopro, and in a better way than the membrane receptor blockers Ro-438857 and RGDS. The reversion of platelet aggregation demonstrated that even phenylbutazone or ketoprophen have a dose-dependent effect.(AU)

Ativação de plaquetas de eqüinos com laminite induzida e tratados com ketoprofeno, fenilbutazona e flunixin meglumina / Platelets activation in equine with induced laminitis and treated with ketoprophen, phenylbutazone and flunixin meglumin

Avaliou-se a ativação de plaquetas em 20 eqüinos com laminite induzida, tratados com ketoprofeno, fenilbutazona e flunixin meglumina. As alterações de plaquetas incluíram mudança de forma, alteração da relação entre os eixos maior e menor, aumento de perímetro, emissão de pseudópodes, aumento no número de alfa-grânulos e de grânulos de glicogênio e redução no número de gama-grânulos. As plaquetas de eqüinos, quando ativadas, apresentaram perfil de organela diferente de plaquetas normais, e as drogas antiinflamatórias, não-esteroidais, demonstraram atividade na ativação plaquetária de eqüinos in vivo. O flunixin meglumina apresentou melhor atividade em modular a ativação plaquetária de eqüinos in vivo do que a fenilbutazona e o ketoprofeno.(AU)

The platelets activation from 20 equines submitted to laminitis induction and treated with ketoprophen, phenylbutazone and flunixin meglumin, was evaluated. The platelets changes included shape change, altered relations between axis, increased perimeter, pseudopodia, increased alpha-granules and glycogen-granules, and decreased in gamma-granules. Platelets when activated present a different organelle profile than normal ones. Equine activated platelets had different organelles profile than normal ones, and anti-inflammatory drugs can modulate the platelet activation, being the flunixin meglumin better than phenylbutazone and ketoprophen.(AU)

Uso da flunixina meglumina tópica no tratamento de uveítes em cães / Topical flunixin meglumine in the treatment of canine uveitis

Este trabalho teve por objetivo comparar o efeito (uso tópico) da flunixina meglumina e da dexametasona no controle da uveíte anterior em cães, por meio de avaliação clínica e pela dosagem de proteínas no humor aquoso. Foram utilizados 17 cães portadores de uveíte anterior de diversas etiologias. Os animais, divididos em dois grupos, foram tratados durante 15 dias. Observou-se maior eficácia da flunixina meglumina na cura clínica das uveítes e na redução significativa da concentração de proteínas no humor aquoso em relação à dexametasona. Concluiu-se que a preparação comercial de uso parenteral pode ser utilizada como colírio no tratamento de doenças inflamatórias da úvea.(AU)

The purpose of this study was to compare the effects of flunixin meglumine and dexamethasone topically for control of uveitis in dogs. Clinical evaluation and assessment of aqueous protein concentration were performed. Seventeen dogs with anterior uveitis secondary to variable ethiologies were studied. The animals were allotted in two groups and treated during 15 days. The flunixin meglumine was more efficient for induction of decrease in aqueous protein concentration, and control of uveitis when compared to dexamethasone. Thus, a parenteral solution of flunixin meglumine can be employed for the treatment of inflamatory uveal diseases.(AU)