Equine ulcerative keratitis in the Netherlands (2012-2021): Bacterial and fungal isolates and antibiotic susceptibility.

BACKGROUND: Ulcerative keratitis is a common ophthalmic disease in horses which can be complicated by microbial infection and requires immediate, accurate treatment to prevent loss of visual function or the eye. OBJECTIVES: To report the results of microbial cultures, antibiotic susceptibility tests and corneal cytology in horses with ulcerative keratitis presented to a referral clinic, to assess agreement between cytology and culture results, to investigate whether previous topical treatment affected microbial culture results and whether the incidence of antimicrobial resistance changed during the study period. STUDY DESIGN: Retrospective analysis. METHODS: Case characteristics and results of cytology and microbial cultures were retrieved. Statistical analyses included descriptive statistics, χ2 or Fisher's exact test and McNemar test. RESULTS: Samples for bacterial culturing (n = 187), fungal culturing (n = 153) and cytology (n = 153) were collected from 178 horses. Bacterial and fungal cultures were positive in 36% (n = 67) and 20% (n = 30), respectively. Staphylococcus (n = 35/67; 48%), Streptococcus (n = 12/67; 16%) and Aspergillus species (n = 22/30; 81%) were most frequently found. Microorganisms were observed in 14% of cytology samples (n = 22/153). Acquired antibiotic resistance was commonly observed amongst Streptococcus and Staphylococcus species. Acquired antibiotic resistance to gentamicin was more common in cases previously treated with gentamicin (p < 0.001). The incidence of acquired antibiotic resistance did not increase significantly between Cohort 2012-2017 and Cohort 2018-2021. Neither bacterial nor fungal culturing results were in agreement with cytology findings (p < 0.001 and p = 0.02, respectively). In 6 of 104 samples that were negative on fungal culturing, cytology revealed fungal elements. MAIN LIMITATIONS: Due to the retrospective nature of this study, some case characteristics and test results were unavailable. CONCLUSIONS: Acquired resistance was commonly observed amongst Streptococcus and Staphylococcus species, and in bacteria previously exposed to topical gentamicin. The incidence of acquired antibiotic resistance did not increase over time. When fungal cultures prove negative, cytology may have some added benefit in identifying keratomycosis.

Noninvasive diode laser-an effective and safe treatment of iris cysts in 46 eyes of 35 horses.

BACKGROUND: Iris cysts in horses are often asymptomatic and noticed incidentally. However, cysts can cause local corneal oedema and erratic behaviour like shying, decreased performance and head-shaking. OBJECTIVES: To describe the use of diode laser as a noninvasive treatment option for iris cysts in the horse and to document factors influencing its efficacy, associated complications, long-term outcome and rate of recurrence. STUDY DESIGN: Retrospective case series. METHODS: Case records of horses treated for iris cysts by diode laser at the Utrecht University Equine Clinic were reviewed between 2008 and 2020. Diagnosis was based on ophthalmic and ultrasonographic evaluation. Long-term follow-up was obtained in two phases, a telephone survey with the owner and a photographic re-evaluation of the treated eyes. RESULTS: Thirty-five horses were included, with a total of 46 eyes treated. One day after diode laser treatment (short-term), 35/46 treated eyes had a good decrease in cyst size, 7/46 had a moderate effect, 1/46 had a minimal effect, 1/46 had no effect, and in two cases the effect was unspecified. The decrease in size after diode laser treatment in polycystic eyes (odds ratio [OR] 0.381, 95% CI 0.1530-0.724), p = 0.001), thick-walled cysts (OR = 0.139; CI = 0.023-0.726, p = 0.02) and hyperplastic corpora nigra (OR = 0.081; CI = 0.004-0.528, p = 0.03) was significantly less satisfactory, with ORs of 0.381, 0.139 and 0.081, respectively. Minor complications, such as mild reactive uveitis, were reported in 8/46 (17%) eyes. On long-term follow-up (median 19 months; IQR 25.5), clinical signs had diminished or disappeared in most cases (93%) and 83% of the owners would recommend the treatment. Based on long-term photographic re-evaluation (median 32.5 months; IQR 49.75), 2/16 cases of recurrence were seen. MAIN LIMITATIONS: Retrospective design, follow-up by telephone questionnaire and photographic re-evaluation. Loss to follow-up in the photographic re-evaluation. CONCLUSIONS: Both short- and long-term results indicate diode laser treatment is a useful and safe option for iris cyst size reduction, with a low risk of recurrence. Presurgical ultrasonography is recommended to assess the feasibility of treatment and to allow for better surgical planning.

Comparing Blind and Ultrasound-Guided Retrobulbar Nerve Blocks in Equine Cadavers: The Training Effect.

In standing ophthalmic surgery in horses, a retrobulbar nerve block (RNB) is often placed blindly for anesthesia and akinesia. The ultrasound (US)-guided RNB may have fewer complications, but the two techniques have only been compared once in equine cadavers. This study compares the techniques for success and complication rates and analyzes the effect of training on US guidance. Twenty-two equine cadavers were divided into three groups: blind RNBs were performed bilaterally in eight cadavers, US-guided RNBs were performed bilaterally in seven cadavers, and after US-guided training, blind RNBs were performed bilaterally in seven cadavers. All RNBs were performed by the same two inexperienced operators, and a combination of contrast medium (CM; 1.25 mL) and methylene blue dye (1.25 mL) were injected (2.5 mL total volume). Needle positioning in the periorbita and the distance of the CM to the optic foramen were assessed using computerized tomography (CT). Dye spreading was evaluated by dissection. In group 1, 37.5% of the injections were in the optimal central position in the periorbita; in group 2, 75% and in group 3, 71.4%. There was no significant difference between the groups regarding needle position (groups 1 and 2 p = 0.056; groups 1 and 3 p = 0.069, groups 2 and 3 p = 0.8). The mean CM distribution distance was not significantly different between all groups. Group 1 had 18.75% intraocular injections versus 0% in group 2 and 7.1% in group 3 (not significant). US guidance showed no significant increases in accuracy nor decreases in complications. However, the effects on accuracy showed a trend towards significant improvement, and larger scale follow-up studies might show significant training effects on US guidance.

Penetration of topically administered dexamethasone disodium phosphate and prednisolone acetate into the normal equine ocular fluids.

BACKGROUND: Topical dexamethasone and prednisolone are currently the mainstay treatment for equine ophthalmic inflammatory diseases, such as equine recurrent uveitis. Comparative pharmacokinetic studies in horses are lacking and current guidelines are mainly based on empirical data and extrapolation from other species. OBJECTIVES: To investigate the penetration and local concentrations of topically applied dexamethasone and prednisolone in normal equine ocular fluids and serum. STUDY DESIGN: Prospective randomised experimental pharmacokinetic study. METHODS: Twenty-one Shetland ponies without ophthalmic disease were treated bilaterally topically every 2 hours during 24 hours to obtain steady state drug concentrations. One eye was treated with 0.15 mg of dexamethasone disodium phosphate (0.1%), and the other eye was simultaneously treated with 1.5 mg of prednisolone acetate (1%). Serum samples were taken prior to the induction of general anaesthesia. Aqueous and vitreous humour samples were taken during euthanasia at time points after administration of the last dose (t = 5 min, t = 15 min, t = 30 min, t = 60 min, t = 90 min, t = 120 min, t = 180 min). Each pony was randomly assigned to one time point, and three ponies were sampled per time point. Dexamethasone and prednisolone concentrations were measured by liquid chromatography-mass spectrometry. RESULTS: The mean dexamethasone concentration in aqueous humour was 32.4 ng/mL (standard deviation [SD] 10.9) and the mean prednisolone concentration was 321.6 ng/mL (SD 96.0). In the vitreous and in serum samples concentrations of both corticosteroids were below the limit of detection (LOD 2.5 ng/mL). MAIN LIMITATIONS: The study group was limited to subjects without evidence of current ophthalmic disease. A limited number of time points were measured. CONCLUSIONS: Potentially effective dexamethasone and prednisolone concentrations were measured in the anterior chamber, but vitreal concentrations were negligible. Systemic uptake was low. Therefore, treatment with only topically administered corticosteroids is deemed insufficient in horses in cases of posterior uveitis. Further studies evaluating other routes of administration are warranted.

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.

Morphological variations of the infraorbital canal during CT has limited association with headshaking in horses.

Headshaking is a common problem in horses. The etiology is unknown but thought to involve sensory input from branches of the trigeminal nerve, some of which are within the infraorbital canal. The objective of this retrospective cross-sectional study was to describe the CT anatomy and variations of the infraorbital canal in horses with local disease processes and normal horses, and to examine associations between those findings and headshaking. Computed tomography scans were reviewed and morphological changes of the infraorbital canal were described. Presence of changes was then tested for association with headshaking prevalence, presence of disease processes in the region of the infraorbital canal, age, and sex. Nonparametric tests were used and a P-value of .05 was considered significant. A total of 218 horses were included, 9% of which had headshaking and 45% had CT lesions in the region of the infraorbital canal. Morphological changes to the bone of the infraorbital canal were found in 121 horses (56%) and included the following: increased mineralization 39 (18%), decreased mineralization 89 (41%), deformed shape 51 (23%), displaced position 43 (20%), and disruption 11 (5%). All changes of the infraorbital canal significantly increased in frequency with the presence of adjacent disease. Increased mineralization and disruption of the infraorbital canal were significantly associated with headshaking in horses with adjacent disease; the latter only reached significance after exclusion of dentally immature horses. No other changes were significantly associated with the presence of headshaking. No association was found between headshaking and the age or sex of the horse.

Case series: periocular habronemiasis in five horses in the Netherlands.

In tropical and subtropical climates, infection of periocular tissue by Habronema larvae is a recognised cause of conjunctivitis or blepharitis. To the authors' knowledge, only a few cases of habronemiasis have been described in Western Europe, and it has not been documented previously in the Netherlands. The objective of this report is to describe the occurrence of five cases of (peri)ocular habronemiasis in the Netherlands, of which four date from the past few years. The diagnosis was based on the history, clinical signs and histopathologic examination of biopsy specimens. A granulomatous conjunctivitis/dermatitis and sulphur-like granules were present in all cases. Histopathology showed an eosinophilic granulomatous inflammation, and three out of five (60 per cent) samples revealed one or more nematodes on section. Treatment combinations with surgical excision, local corticosteroid and/or anthelmintic drugs were used. Furthermore, all horses received ivermectin or moxidectin. Treatment resulted in healing of the lesions in four horses. One case, which was refractory to treatment, resolved spontaneously after the onset of colder weather. This case series suggests an increased prevalence of (peri)ocular habronemiasis in the Netherlands. This diagnosis should therefore be considered when being presented with a horse with granulomatous conjunctivitis/dermatitis in Western Europe, especially during the summer months.

A retrospective analysis of the risk factors for surgical site infections and long-term follow-up after transpalpebral enucleation in horses.

BACKGROUND: Implants are often used to improve the cosmetic appearance of horses after enucleation of the eye. When surgical site infection (SSI) occurs, the implant will almost always be lost. The aim of this study is to collect data on the risk factors for SSIs and report long-term follow-up (cosmetic results and return to work) after transpalpebral enucleations. In this retrospective study, records of horses undergoing transpalpebral enucleation were reviewed (2007-2014) and telephone interviews were used to obtain long term follow-up. The potential risk factors for SSIs (indication for enucleation, use of an implant, standing procedures, duration of surgery, opening of the conjunctival sac and prolonged use of antimicrobials) were analysed for their association with the outcome measure 'SSI' vs 'no SSI' by multivariable binary logistic regression testing. Indications for enucleation were grouped as follows: Group 1 (clean) included equine recurrent uveitis, too small or too large globes, and intraocular tumours, Group 2 (non-clean) included corneal perforation/rupture and infected ulcers and Group 3 (tumour) included extraocular tumours. RESULTS: One hundred and seven cases of enucleation were evaluated. An implant was used in 49 horses. The overall number of SSIs was 8 (7.5%). Multivariable logistic regression testing showed implants (OR 7.5, P = 0.04) and standing procedures (OR 12.1; P = 0.03) were significantly associated with the percentage of SSIs and increased the risk of SSI. The eyes of horses in Groups 2 and 3 trended towards a larger risk for developing SSIs (OR 4.9; P = 0.09 and OR 5.9; P = 0.1, respectively). Prolonged use of antimicrobials, long surgery times and the opening of the conjunctival sac during dissection did not show significant associations with SSI risk. CONCLUSIONS: The risk of SSI after enucleation is low in clean eyes and when no implant is used. Placing an implant or performing a standing enucleation significantly increases the risk of SSIs. Although implants can be used for eyes that fall into Groups 2 and 3, 17% of the horses in these two groups developed an SSI leading to loss of the implant.