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  Discussion on Recurrent Uveitis from Lepto - long term treatment
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New Member:
Lmsenus

Posted on Wednesday, Jan 21, 2004 - 12:07 pm:

My horse began having RU episodes two years ago. Since the initial episode, he has had seven. This most recent is very frustrating, occurring about two weeks after his last subconjuctival injection for a previous episode. So far, there has been very minimal damage to the eye. The vets attribute this to catching the episodes in the first couple of hours of onset and treating aggressively. On the other hand, the episodes are coming more frequently.

My horse titers for lepto (1:1600 two years ago, just took a sample to check again). Also, his dam lost an eye to the same condition -- and his battle with RU is now following the same pattern.

We are treating with topical steroids initially, then with subconjuctival injections. We used pred. acetate the first time we did the injections (a year and a half ago) and got 11 months of quiescence. Then when he flared again we treated topically. 10 weeks later he flared again and we treated with injections, this time using triamcinolone. Now here we are, two weeks from the last triamcinolone injection, with yet another episode. This time we've gone back to pred. for the injections.

We're starting to examine more long-term treatments, surgical and otherwise. What have been your experiences with the cyclosporin implant and with vitrectomy? Has anybody here simply removed the eye and replaced it with a prosthesis? I have a wonderful show hunter here and would love to keep him going. On the other hand, regardless of my ambitions, I want to do the most humane thing for the horse.
Moderator:
DrO

Posted on Thursday, Jan 22, 2004 - 8:20 am:

Hello Lisa,
The article associated with this forum presents the results of 16 cases treated with cyclosporin implants. I myself have not sent a case, though our local university does them. The article also discusses other possibilities to prevent recurrent episodes to be explored.

I don't remove the eye until it is blind.
DrO
Member:
Lmsenus

Posted on Friday, Jan 30, 2004 - 2:07 pm:

Hi DrO.
We got Pal's lepto titer back yesterday, he's at 1:800 now for L. pomona. On Dr. Gilger's recommendation we started him on high doses of doxycycline for a month and plan to retiter after treatment. They eye looks good right now (12 days post-subconjunctival injection), but we're going to treat topically if it flares while he's on the doxy.

I guess we're just not sure whether we're going to get any better remission by doing the implants, versus other treatments. I'll let you know how he does on the doxy. Have you (or anybody else here) gotten remission from lepto-induced ERU by doing the antibiotics? I know it hasn't really been studied, but I was wondering if there was any anecdotal evidence that it might work?
Moderator:
DrO

Posted on Saturday, Jan 31, 2004 - 5:40 pm:

Treating the Lepto is one of the suggestions in the article I referenced earleir Lisa. I believe there are some case studies in the article.
DrO
Member:
Lmsenus

Posted on Thursday, Mar 11, 2004 - 8:02 pm:

Dr. O,
Just an update on Pal. We completed the first 30 days on doxy and decided to continue for another 30 prior to re-titering. He's getting 4500 mg a.m. & p.m. (9000 mg total/day). So far the eye looks the best it has in a long time - very clear. Pal is back to regular work and seems no worse for wear, visually speaking.

My local vet and Dr. Gilger seem to think that if we see a DrOp in titer from 800 to 400-600, we'll be doing well. Of course I'd like to see it lower than that....

We're fast approaching the danger zone, tho. He'd been on an 8-10 week flare-up interval, and we're coming up on the 8-week mark this weekend. I'm keeping my fingers crossed.

-- Lisa
Moderator:
DrO

Posted on Friday, Mar 12, 2004 - 8:16 am:

Excellent Lisa,
DrO
Member:
Lmsenus

Posted on Sunday, Apr 18, 2004 - 4:12 pm:

DrO,
I'm sorry to report that Pal experienced another episode starting today. I caught it in the first couple of hours, thankfully. We were 12 weeks to the day from the last episode. I guess we have the answer regarding the use of doxy for Pal -- not effective. We're still having him re-titered for lepto tomorrow, as the vet is coming for his spring shots anyway. I'm curious to see if two months on doxy did anything. But in any case, it still hasn't arrested the condition.

Oh well, back to square one.... I'm amazed at how persistent we owners are with our ERU horses... We know there's no cure, but we're still looking for the best possible treatment for our four-legged children, and hoping that a cure will come...
Moderator:
DrO

Posted on Monday, Apr 19, 2004 - 7:01 am:

I am sorry to hear this Lisa. It seems to be the one straw to grasp before contemplating the more costly surgical options in cases that cannot be managed with steroids alone.
DrO
Member:
Lmsenus

Posted on Wednesday, May 19, 2004 - 1:33 pm:

Well, we're finally conceding the battle with ERU. Pal began yet another episode about a week and a half ago, just a week after finishing his course of meds from the previous episode. This is his fifth episode in nine months. As his vision is already somewhat impaired in the affected eye, there's really no point in the heroics of the implant surgery. We've made the painful decision to have the eye removed.

The doxy treatment was not without some effect tho: we got his lepto titer down from 1:800 to 1:200, but that was like closing the barn door after the horse had run out (pardon the expression).

Any advice for helping Pal recover from the surgery? He's spent so much time with a blackout patch over the eye already that he's pretty well adjusted to being one-eyed.
Member:
Canter

Posted on Wednesday, May 19, 2004 - 2:23 pm:

Lisa,
I can't help you much with the recovery after surgery, but I can offer a another suggestion. If Pal is stalled in the type where he can hang his head over the door, I would suggest padding the edge of the open frame with blankets or something soft so that after the surgery, he will be less likely to bang his head into the frame. A horse at my previous barn had an eye removed and the owner padded the frame. The mare adjusted quite well and suffered no further injury due to the blindness on one side.

Best wishes....
Moderator:
DrO

Posted on Thursday, May 20, 2004 - 6:55 am:

The only problem I have ever seen is with the artificial implants used to give the eye a more normal appearance. Complications (irritation and infection) from the implant are common. I had one horse that had an implant for 7 years without trouble only to have it become infected and have to be removed. The horse recovered without complications.
DrO
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