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  Discussion on Had the Cyclosporine implant done...
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Member:
Lmsenus

Posted on Monday, Jun 21, 2004 - 2:19 pm:

Some of you may have seen my last post regarding Paladin, my QHxTB gelding with ERU. He has had episodes (most recently) every 8-12 weeks since September, non-stop. We reluctantly had come to the conclusion that there was no way to control the condition short of removing the affected eye.

Our vet recommended that before we went that route we have an exam by an equine ophthalmologist. We did -- Dr. Andras Komaromy of the Univ. of Pennsylvania was kind enough to give Pal a thorough exam. The good news was that the damage to his eye was minimal - very minor pigmentation of the retina - and that he was a good candidate for entry into the trial for the cyclosporine implant. We decided that we had nothing to lose by doing the implant, but potentially a lot to gain.

We had the surgery performed on 6/16. Prior to the surgery, we treated Pal as if he was having an episode (Banamine and dexamethasone ointment). He came thru the surgery just fine. The method of doing the implant is now less invasive than it used to be. Now a flap is made in the sclera, and the implant placed under the flap -- I don't know if "subcutaneous" is the right description for this method in the sclera, but it would be appropriate if the implant were put under the skin elsewhere on the body (Norplants, anybody?)

We are now in our fifth day post-op. Pal came home from the clinic on Saturday 6/19 (thanks, Dr. Milne, for your hospitality and after-care!). There is some swelling of the eyelid and the eye was a little cloudy on Saturday when Dr. Komaromy examined him again (not unexpected). We're continuing to treat him with banamine/dex ointment/atropine on a decreasing schedule until he will be med-free in about three weeks.

I'll keep everyone posted on his progress. We know this isn't a cure, and even if we can get him down to mild episodes every once in a while, we'll be delighted. Of course, we're hoping for the best....
Member:
Gafarm

Posted on Monday, Jun 21, 2004 - 2:33 pm:

Can I have permission to cross post this message to the BlindHorses group?
Thanks
Member:
Lmsenus

Posted on Monday, Jun 21, 2004 - 2:58 pm:

Donald, please feel free. One of our considerations was that we might be able to give some hope to other horses and their people, and maybe in some small way contribute to finding a way to cure or prevent this disease.
Moderator:
DrO

Posted on Tuesday, Jun 22, 2004 - 6:40 am:

Thanks for the continued update Lisa. For those interested in Lisa's original posts they can be found at: Equine Diseases » Eye Diseases » Anterior Uveitis, Recurrent Uveitis, Periodic Opthalmia, and Moonblindness » Discussion on Recurrent Uveitis from Lepto - long term treatmenta.
DrO
Member:
Lmsenus

Posted on Friday, Oct 1, 2004 - 1:48 pm:

Greetings, all. I haven't posted in quite a while, so I thought I'd give you an update.

Pal is now 15 weeks post-op. He is doing extremely well. By about 6 weeks post-op, the degree of aqueous flare in his eye was down to 2 on a scale of 1-10. For the first time, our vet was *really* able to assess the damage to the posterior portion of the eye. Pal has two very small blind spots on his retina, floaters (mostly settled to the bottom of the eye), and a very minor cataract. None of these were unexpected.

At about 10 weeks post-op, he had a very minor episode. This came at the point where we had just decreased his neo/poly/dex ointment to once daily. His lower eyelid became puffy, and his eye was teary. However, there was no real photosensitivity, pupil response remained normal, and there was no noticable flare. We were able to treat the episode by going back to 2x daily with the ointment for a week, and banamine 2x daily for 2 days. Because the atropine was not necessary, he remained in full work except for the day the episode began. Dr. Kamoromy told us that this is pretty typical as the cyclosporine comes to full strength in the eye.

Pal has been in full work, and we've observed that within a month after the surgery, he was less spooky and more relaxed generally. We're interpreting this to mean that he's seeing better.

The best news of all, tho, is that Pal returned to the show ring on 9/26 after a 3-year hiatus. He jumped around without the least hesitation over some very dressed jumps and brought home excellent ribbons, including a blue.

Pal's next exam is 10/5. His eye hasn't looked this clear in ages... So far, so good...
Moderator:
DrO

Posted on Friday, Oct 1, 2004 - 4:06 pm:

A toast to Pal!
DrO
Member:
Lmsenus

Posted on Monday, Jun 6, 2005 - 12:37 pm:

It's been a long time, but I thought I'd update all of you on Pal's condition. Over the fall and winter, Pal's eye began to flare up again, particularly as we backed down the steroid levels (he was on neo/poly/dex ointment, then DrOps). Unfortunately, we were never able to wean him off the steroids 2x daily.

And as the winter progressed, I noticed changes in Pal's behaviour under saddle. It was especially noticeable on the approach to jumps -- I could feel him weaving underneath me. He started to duck out on the jumps, even familiar ones -- not normal for a horse that used to really take me to the jumps. He also started to spook from random things every once in a while, like from his own shadow. We came to the conclusion that he was just not seeing well from his left eye. His eye also stopped dilating properly. A year ago, one dose of atropine would have him fully dilated for two weeks. Now, it hardly makes a difference. We started doing atropine twice a week just to exercise the eye.

We came to the painful conclusion that perhaps Pal shouldn't be jumping at this point. It was so disappointing after such a hopeful start.

In the last week or two, Pal developed ulceration of the cornea, probably due to the long-term use of the steroids. He is now off the steroids, but as soon as they were discontinued, his eye flared up. At least the use of Ocufen DrOps (an NSAID) has provided some relief.

After all our best efforts, we have decided that there is no way to control Pal's ERU and that removal of the eye is the kindest thing to do for him. It looks like we'll have the procedure sometime in the next week or so.

Do I think the implant was worth the effort? Yes. I think we needed to do everything possible before coming to the radical conclusion of removing the eye.

Why do I think it was ineffective? Just a guess, but I think Pal may have an active lepto infection within the orb itself. We won't know for sure until the vitreous is cultured.

Once we know more about the pathology of the eye itself, I'll post that information.

-- Lisa
Moderator:
DrO

Posted on Tuesday, Jun 7, 2005 - 6:24 am:

Thank you so much for keeping us updated Kim and I am sorry to hear about the recent downturn but it sounds like you have a good handle on it and it is truly amazing what these horses can adjust to in time.
DrO
Member:
Rpotter

Posted on Thursday, Jun 9, 2005 - 9:37 pm:

Is Paladin only affected in one eye? I have the 13 year old mare w/ Uveitis that has progressed to a cataract in one side. She is completely blind in that eye. Last week we ran a 15.9 in the barrels and placed in all of our events. I think it has a lot to do with the horses attitude, time to adjust, and trust in the rider. I won't let anyone else ride my mare, b/c I don't want her to lose trust in her rider and of course for other peoples safety (liability)... but she has seem to adjust amazingly well to her handicap.
Member:
Lmsenus

Posted on Thursday, Jun 30, 2005 - 1:25 pm:

Rachel,
Paladin is only affected in his left eye. He's always been one of those horses who doesn't have a good concept of his own size or the amount of space he takes up, so he's been bumping into stuff on the left side and surprising himself. The blindness is a new occurrence, so we're hoping that as time goes by he'll adjust.

Years ago, I had a mare who was blind in one eye, and I didn't know it. She was an awesome jumper and you'd never know from her way of going that she couldn't see on one side. I hope Pal adjusts that well.
Member:
3rsatsmf

Posted on Friday, Jun 30, 2006 - 12:19 pm:

Hi Lisa,

Thank you for sharing your CsA experiences. Remy the Friesian and I are scheduled for bilateral implants by Dr. Komaromy next Wednesday. Remy was diagnosed as a good candidate as his flares are controllable with one dose of Banamine, although he does show alot of pupil constriction. (atropine doesn't work on the first dose) Despite a 3-year history of uveitis flares, Remy has very few changes to his eyes. Perhaps it is because Reno, my first horse (Remy is my second) and I battled uveitis for nearly a year before he was humanely euthanized at 5 yo due to blindness, both his retinas detached. I posted that saga in 2001, and learned alot with Reno which I applied to Remy. Anyway, thank you for your posts, I was especially glad to hear that you felt it was worth it. I'll keep you posted on our progress.
New Member:
famous

Posted on Sunday, Oct 19, 2008 - 8:09 pm:

I am wondering how any of your horses are doing at this point with the uveitis. I am scheduled to take my sweet horse at the end of the month for the implant in his left eye. Am worried sick about outcome. Thanks for your updates.
Lora
Member:
gramsey1

Posted on Sunday, Oct 19, 2008 - 8:25 pm:

Lora,
What were the indications?
I posted this under cloudy eyes.
The camera "sees" the condition worse that I. It is easy to see his iris. And little white filaments in the fluid behind the cornea.
We bought him a year ago. He has never had a weepy eye or exhibited pain.
application/pdf6 yr old TB
onyxeyes_Layout 1.pdf (52.2 k)
New Member:
famous

Posted on Sunday, Oct 19, 2008 - 8:42 pm:

Hi Guy,
He had recurrent bouts of painful eye inflammation and tearing over the past year. I just happen to switch vets b/c our old vet moved and the new vet suggested we go to the university of Missouri as he did not like how the eye looked. He did not have the equipment to do the proper eye exam. The opthalmologist diagnosed him and we began a regimen of dex injections which we have completed now and am giving him oral prednisilone. I have to put atropin in the eye two times per day and pred ointment four times per day. The eye looks calm now and the pain is gone. The opth vet said we caught it very early and feels confident about the outcome of the implant.
Member:
3rsatsmf

Posted on Monday, Oct 20, 2008 - 7:24 am:

When Dr. Komaromy did Remy's implants, he also injected a small amount (micro-liters) of gentocin in each vitreous. There have been very good results with that as well. I'm not sure if it was posted on this board, but if not try www.chronicleforums.com. I remember seeing it somewhere and these are the only two horse boards which I read.
New Member:
famous

Posted on Tuesday, Oct 28, 2008 - 11:45 pm:

Just back from University Vet Hospital and my horse's eye brought us less than desirable news. His retina has detached and the surgery would do nothing to help vision - it would however keep episodes further apart. The surgeon suggested that I take a little time to see how things progress - that we could get the surgery later if desired. His vision is probably only shadows. He does seem to have some vision still. Needless to say, it has been a day and then some. I will continue with eye ointments and the Guardian Mask for now.
Moderator:
DrO

Posted on Wednesday, Oct 29, 2008 - 8:23 am:

Sorry to hear the news Lora. Keep us updated on your progress.
DrO
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