The combined use of surgical debulking and diode laser photocoagulation for limbal melanoma treatment: a retrospective study of 21 dogs.

OBJECTIVE: To evaluate effectiveness and safety of debulking and diode laser photocoagulation (DPC) for the treatment of limbal melanoma (LM). PROCEDURE: Retrospective multi-institutional case series. Medical records of animals diagnosed with LM at the Centro Veterinario Specialistico (CVS) and at the Long Island Veterinary Specialists from 1994 to 2014 were retrieved. Signalment, location, extent of tumors, recurrence rate, and early and late complications were reported. Patient follow-up information was obtained from veterinary ophthalmologists, primary care veterinarians, and where appropriate, owners. RESULTS: Twenty-one eyes of 21 dogs (13 females and 8 males) were included in this study. The dogs' average age was 6 years (range: 7 months-11 years). The follow-up period ranged from 1-108 months (median 48 months) after the last DPC procedure. Long-term follow-up was obtained by telephone interviews in 6 of 20 cases and by clinical re-evaluations in 14 of 20 cases. The most common early complications were a moderate anterior uveitis and peripheral corneal edema (21/21 eyes). Late complications included corneal fibrosis and/or pigmentation (20/21). In one case, a severe bullous keratopathy associated with extensive corneal fibrosis was observed (1/21). One case was blind due to concurrent Sudden Acquired Retinal Degeneration (SARD). However, after surgery 2 of 20 eyes lost vision and one of these was enucleated. CONCLUSIONS: Debulking, in addition to diode laser photocoagulation, was technically straightforward to perform, minimally invasive, well tolerated, and highly successful in this case series.

Carbon dioxide laser photoablation adjunctive therapy following superficial lamellar keratectomy and bulbar conjunctivectomy for the treatment of corneolimbal squamous cell carcinoma in horses: a review of 24 cases.

OBJECTIVE: To determine the complications and nonrecurrence rates following superficial lamellar keratectomy, bulbar conjunctivectomy, and adjunctive carbon dioxide (CO(2)) photoablation for corneolimbal squamous cell carcinoma (SCC) in the horse. STUDY DESIGN: Retrospective study. Sample population Twenty-four horses with corneolimbal SCC. PROCEDURE: Medical records of horses diagnosed with corneolimbal SCC that was surgically excised and where CO(2) photoablation was used as an adjunctive therapy from 2000 to 2007 were reviewed. Signalment, prior therapy, tumor location and size, complications, and recurrence of SCC were recorded. RESULTS: The Thoroughbred was the most commonly (25%) represented breed. Lesions were >10 mm in diameter in 70.8% of cases. Eight horses (33.3%) had neoplastic cells extending to the deep margin of the keratectomy. All horses were available for follow-up for an average ± standard deviation of 40.7 ± 25 months. Four horses (16.7%) developed a recurrence of SCC. Three of these four horses underwent repeat keratectomy and CO(2) photoablation, one each, at 4 months, 1, and 2 years following the initial procedure. One horse underwent enucleation 8 months following the initial procedure. CONCLUSIONS AND CLINICAL RELEVANCE: As an adjunctive therapy, CO(2) photoablation was successful in 87.5% of the horses following a single procedure and in a total of 91.7% following a second therapeutic application. CO(2) photoablation appears to be effective as an adjunctive therapy following removal of large corneolimbal SCC in the horse and in cases in which all tumor cells were not excised.

Light and electron microscopic evaluation of canine corneal endothelium following CO2 photokeratotomy.

OBJECTIVE: To determine using light and scanning electron microscopy if treatment with CO2 photokeratotomy alters the corneal endothelium in healthy dogs. PROCEDURE: Eight surgery laboratory dogs were determined to be free of ocular abnormalities. Under general anesthesia, the left eye of each dog was treated in a quadrant from 12 to 3 o'clock with the CO(2) laser in a defocused mode. The right eye served as a control. There were four treatment groups, each with 2 dogs: group 1 (2 W, 0.1 J/s, 0.8 mm tip), group 2 (3 W, 0.3 J/s, 0.8 mm tip), group 3 (2 W, 0.04 J/s NovaScan), group 4 (3 W, 0.06 J/s, NovaScan). The 0.8 mm tip delivered a power density of 382 W/cm(2) or 573 W/cm(2), at 2 or 3 watts respectively. The NovaScan handpiece delivered a power density of 30 W/cm(2) or 40 W/cm(2), at 2 or 3 Watts respectively. Following euthanasia, right and left corneas including a 2-mm scleral rim were harvested and fixed in commercial grade Karnovsky's fixative. One piece of cornea was processed routinely, embedded in Embed 812 resin, sectioned at 1 um, stained with toluidine blue and evaluated with the light microscope. A separate piece of each cornea was routinely processed and examined with a JEOL 6400 scanning electron microscope (SEM) at 20 KV. RESULTS: No changes in endothelial cell morphology were detected by light microscopy in the sections examined. SEM indicated normal endothelial cell morphology in control eyes with presumed artifactual changes at the corneal free margin (4/8 eyes). Multiple punctate to linear regions of endothelial cell destruction were observed in 6/8 laser-treated corneas. A significant increase in corneal thickness ranging from 1.90 to 37.28% was observed in all laser treated corneas. This increase in thickness correlated linearly with the degree of endothelial damage. Ultrastructural findings also correlated with postoperative clinical findings. CONCLUSION: CO2 laser photokeratotomy alters corneal endothelial cell morphology and thickness.

A case of multiple unilateral corneal epithelial inclusion cysts in a dog.

A three-year-old neutered female Labrador cross was presented for investigation of two corneal epithelial inclusion cysts affecting the left eye. The aetiopathogenesis of the cyst formation was suspected to be traumatic. The cysts were removed successfully by superficial keratectomy, followed by a third eyelid flap. Histologically, both lesions were represented by cystic formations lined with multi-layered squamous epithelium, consistent with stromal inclusion of surface corneal epithelium. Complete recovery was achieved, and there was no recurrence at six month follow-up.

Corneal stromal invasive squamous cell carcinoma: a retrospective morphological description in 10 horses.

OBJECTIVE: To describe the pathomorphological features of corneal stromal invasive squamous cell carcinoma (CSI-SCC) in horses. MATERIAL AND METHODS: A total of 87 equine SCC in the Comparative Ocular Pathology Laboratory of Wisconsin database were retrieved. The signalment and anatomical distribution were summarized. Ten CSI-SCC out of 87 SCCs were further investigated focusing on pathomorphological description. All 10 cases were stained with H&E, periodic acid-Schiff stain and Verhoeff's elastic stain. RESULTS: Four Appaloosas, two Quarter horses, two American Paint, one Pinto and one Thoroughbred horse were affected. The mean age at the time of enucleation/keratectomy was 16.7 +/- 5.2 years. Out of 10, five horses were clinically diagnosed as chronic stromal keratitis, 3 of 10 had a previous biopsy diagnosed as SCC, 1 of 10 was described as stromal mass, and 1 of 10 as invasive SCC. Previous keratectomies before enucleation were performed in 3 of 10 horses, of which 2 also had additional lasertherapy/cryotherapy. Seven of 10 cases showed tumor infiltration in the anterior-mid stroma, 3/10 in the mid-deep stroma. The anterior epithelium had no contact with the CSI-SCC in 8 of 10 cases, 7 of 10 had intact and normal epithelium, and 3 of 10 showed intact, dysplastic corneal and conjunctival epithelium. The limbus was not pigmented in 8 of 10 specimens. There was a mild-moderate lymphoplasmacytic inflammation between the neoplastic islands. Solar elastosis was present in 2 of 10 samples. CONCLUSION: The CSI-SCC shows a distinctive intrastromal tumor growth pattern with a smooth, intact corneal epithelium. The tumor can be underestimated and misdiagnosed as chronic active stromal keratitis. A deep biopsy is necessary for the definitive diagnosis.

The effects of moxifloxacin ophthalmic solution 0.5% or gatifloxacin ophthalmic solution 0.3% treatment on corneal wound healing in pigmented rabbits following anterior keratectomy.

PURPOSE: These studies examined corneal healing rates, Type-IV collagen and zonula occludens membrane-associated protein (ZO-1) expression, as well as aqueous PGE(2) and IL-1 beta concentrations in pigmented rabbits treated with either moxifloxacin 0.5%, gatifloxacin 0.3% or BSS following anterior keratectomy. METHODS: Anterior keratectomy surgery was followed by topical administration with commercial ophthalmic formulations of either moxifloxacin or gatifloxacin or BSS (TID for 96 h). Images of the fluorescein-stained healing corneas were analyzed for wound area. At 48 or 96 h following surgery, aqueous humor samples were collected and analyzed for the inflammatory mediators PGE(2) and IL-1 beta using an ELISA. The corneas were subsequently evaluated using both scanning and transmission electron microscopy. In a second parallel study, corneas were evaluated at both 48 and 96 h for Type-IV collagen and ZO-1 expression using immunohistochemistry. RESULTS: Fluorescein-stained corneal images at 96 h postsurgery demonstrated that 90% +/- 8% re-epithelialization for moxifloxacin, 81% +/- 14% for gatifloxacin, and 88 +/- 6% for BSS((R)) (P > 0.05). PGE(2 )levels in the aqueous humor of fluoroquinolone treated eyes were reduced at 48 h compared to BSS treated eyes. IL-1 beta was undetectable in all samples. No differences in Type-IV collagen or ZO-1 expression were observed between any treatment groups. There were no differences between groups in histological appearance or in ultrastructural healing processes. CONCLUSIONS: These studies demonstrated that the commercial ophthalmic formulations of moxifloxacin and gatifloxacin were similar to each other in their effects on the levels of aqueous humor PGE(2) and rates of corneal wound re-epithelialization.

Superficial keratectomy and topical mitomycin C as therapy for a corneal squamous cell carcinoma in a dog.

A 10-year-old female West Highland white terrier was presented with refractory hyperplastic keratitis of the left cornea of one month's duration. At this time, a vascularised and rough lesion 5 mm in diameter was observed on the left cornea. No other abnormality was recognised on the affected eye. The corneal neoplasm was surgically removed and histologically diagnosed as a squamous cell carcinoma. For two months after the surgery, 0.04 percent mitomycin C (MMC) eye drops were applied as adjuvant chemotherapy. Primary corneal squamous cell carcinoma with no history of keratoconjunctivitis sicca is rare in dogs. In the present report, surgical removal of the neoplasm was combined with the topical administration of the anticancer drug mitomycin C and a good prognosis was obtained. The result indicates that the combination treatment used in this case may be an appropriate therapeutic choice for corneal squamous cell carcinoma in dogs.

Shope fibroma virus keratitis and spontaneous cataracts in a domestic rabbit.

A 7-year-old domestic rabbit presented for an enlarging ventral perilimbal mass OS. Keratectomy was performed to remove the mass. A diagnosis of Shope fibroma virus keratitis was confirmed based on signalment, clinical signs, histologic evaluation and virus isolation. Progression of bilateral cataracts leading to visual deficits was addressed with phacoemulsification. The rabbit remained visual and comfortable 5 months postoperatively and free of recurrence of the limbal mass 9 months after initial presentation.

Combined keratectomy, strontium-90 irradiation and permanent bulbar conjunctival grafts for corneolimbal squamous cell carcinomas in horses (1990-2002): 38 horses.

OBJECTIVE: The purpose of this study was to evaluate the effectiveness of postoperative beta-irradiation with strontium-90 as an adjunctive treatment to superficial keratectomy and permanent bulbar conjunctival graft for removal of equine corneolimbal squamous cell carcinoma (SCC), in decreasing recurrence rate. STUDY: The retrospective case study included 38 horses diagnosed and treated for SCC of the eye that involved the limbus and/or cornea. The patients were treated between 1990 and 2002, with strontium-90 irradiation immediately after corneal and conjunctival graft surgery. Recurrence was defined as the postoperative and postirradiation regrowth of SCC in the same site and globe that was previously treated. RESULTS: The Appaloosa was the most commonly represented breed and horses that had more than one base coat color represented the majority of the cases (53%). The coat colors of white, chestnut/sorrel and gray were the most commonly represented colors of the horses treated. Eight horses (21%) could not be assessed for tumor recurrence due to lack of two or more post-treatment examinations, and another horse was enucleated 6 days postoperatively due to progressive corneal ulceration. Twenty-four horses (63% of the entire study population; 83% of the followed cases) had a mean +/- SD of 1754 +/- 1319 days without tumor recurrence, ranging from 14 days to 5110 days. Five horses (13% of the entire study population; 17% of the assessed horses) had tumor recurrence at a mean +/- SD of 449 +/- 339 days with a range of 29 days to 900 days. For the five recurrences, treatment included local excision (n = 1), enucleation (n = 2), and additional strontium-90 therapy (n = 3). CONCLUSIONS: The combination of superficial keratectomy, beta-irradiation and permanent bulbar conjunctival grafts for limbal, corneal or corneolimbal SCC in horses is effective in at least 83% of the horses. Recurrence occurred in about 17% of the horses. Multiple biannual re-examinations are recommended to observe for tumor recurrence.

Multiple limbal haemangiosarcomas in a border collie dog: management by lamellar keratectomy/sclerectomy and strontium-90 beta plesiotherapy.

An eight-year-old, neutered, male border collie dog was presented with a six-week history of left ocular discomfort and a raised, red mass at the lateral limbus. The right eye had been enucleated approximately 12 months previously following suspected trauma when the eye had become red and painful. The mass was excised using superficial keratectomy/sclerectomy and the surgery site was treated with strontium-90 beta radiation. Histopathological findings were consistent with a diagnosis of haemangiosarcoma. Immunohistochemical staining showed uniform expression of CD31 in neoplastic cells, confirming their endothelial origin. Two further treatments with strontium-90 beta radiation were applied to the surgical site at weekly intervals. Twenty-six weeks after surgery, a second, raised, red limbal mass became apparent at the medial limbus of the left eye. Surgical excision and adjuvant strontium-90 beta plesiotherapy were performed as described for the initial tumour. Routine histopathological analysis confirmed haemangiosarcoma at this site. Eighty-six weeks following the initial presentation, no recurrence of ocular haemangiosarcoma was evident.

Superficial keratectomy and cryosurgery as therapy for limbal neoplasms in 13 horses.

OBJECTIVE: To determine the usefulness and clinical outcome of a combined procedure of superficial keratectomy and cryosurgery as a treatment for limbal neoplasms in horses. STUDY DESIGN: Retrospective study. ANIMALS: Thirteen horses with 14 limbal tumors. METHODS: Medical records of all patients with limbal tumors, referred to the Department of Equine Sciences of Utrecht University between 1995 and 2002, were retrieved. Patient data were analyzed with respect to signalment, tumor surface area and histologic diagnosis. Surgery, performed under general anesthesia, included surgical debulking of the tumor followed by cryosurgery. Long-term follow-up information was obtained by re-evaluation in the clinic, by the referring veterinarian, and/or by telephone enquiry. RESULTS: Therapy was successful in 9 out of 14 eyes after the first attempt (64%); one eye needed retreatment (7%), and four eyes were eventually enucleated (29%). The mean follow-up period was 4.8 years. The initial surface area of the tumor significantly influenced outcome (P < 0.01). Squamous cell carcinoma was the most predominant tumor type (79%). Haflinger horses accounted for 69% of the cases whereas their occurrence in the overall hospital population is approximately 5%. CONCLUSIONS AND CLINICAL RELEVANCE: The described technique of superficial keratectomy and cryosurgery is a simple procedure for the treatment of limbal tumors in equine patients that does not require sophisticated equipment. Nor is it tampered by legal restriction, and appears to be effective in tumors with a small surface area (< 2 cm2). Haflinger horses seem to be predisposed for the development of ocular squamous cell carcinoma.

Treatment of an ocular squamous cell carcinoma in a stallion with atrial fibrillation.

A stallion was presented for surgical treatment of limbal squamous cell carcinoma. Excision with a conjunctival pedicle flap was done to prevent ocular invasion and preserve vision. A complication was the diagnosis of atrial fibrillation, which was not converted to sinus rhythm due to the potential complication of treatment with quinidine sulfate.