This is an archived Horseadvice.com Discussion. The parent article and menus are available on the navigation menu below:
HorseAdvice.com » Diseases of Horses » Eye Diseases » Anterior Uveitis, Recurrent Uveitis, Periodic Opthalmia, and Moonblindness »
  Discussion on Latest advancements in ERU
Author Message
Member:
Rpotter

Posted on Tuesday, Mar 15, 2005 - 10:04 pm:

I have a 13yr old QH mare with bilateral ERU. It was initiated by a case of Leptospirosis over a year ago. She has at this time suffered little permanent damage to the internal structures of the eye,and typically responds quickly to Banamine, and topical Pred acetate and atropine.
Has anyone had any personal experience with either of the two types of cyclosporin implants being done at NC State, UFL or Ohio? I am particularly interested in the latest procedure in which a cyclosporin implant is placed underneath the sclera instead of into the vitreal chamber. Let me know if you have any comments...
Moderator:
DrO

Posted on Wednesday, Mar 16, 2005 - 6:28 pm:

Rachel I checked the veterinary and scientific literature and cannot find anything published on the intrascleral implant. However it seems logical and easy to see why there may be fewer complications (cataract formation for instance). What have you heard about this? I presume you have been through a prolonged antimicrobial therapy as outlined in the article for Lepto induced ERU?
DrO
Member:
Rpotter

Posted on Thursday, Mar 17, 2005 - 7:36 am:

Dr. Brooks at NC State I think has done the majority of the research on it. I attended the ERU lecture at the Western Veterinary COnference this past Feb, and it was mentioned in Dr. Dwyers lecture. She had little personal experience with it though. The exact placement is suprachoriodal, and is supposed to be a real easy and quick procedure. They also show a picture of the "button" implant in the recently published Equine Opthalmology book. I got an email from Dr. Dwyer last night. She had just returned from some opthalmology sessions, and the latest is that the supplier of the button implants has stopped production. U of FL has one left that is not spoken for, but she was sure Dr. Brooks at NC State would have more. I'm going to contact them in the next day or so and get the latest from him. I'll keep you posted. I was just hoping maybe someone here might have had one done and could give me some additional input.

As for the Lepto treatment, yes, we went through that last summer when she was diagnosed w/ positive titers at the initial uveitis episode. I think she actually contracted it about 7 months before that, but I had just missed it. She was only febrile and lethargic for a day and responded well with Banamine. Her titers were checked this fall and were in the negative range.
I'll keep everyone up to date on the latest info I find out.
Moderator:
DrO

Posted on Thursday, Mar 17, 2005 - 11:19 am:

Are you talking about the new edition (2004) of Equine Opthamology by Barnett. I have a copy and cannot find mention of the new procedure. I would be interested in any new information and thanks for keeping us appraised.
DrO
Member:
Lmsenus

Posted on Monday, Jun 6, 2005 - 12:22 pm:

Rachel, my horse Paladin had the intrascleral implant done in June 2004. Pal's ERU was also caused by leptospirosis, but in his case the ERU had been dormant for a number of years before becoming active again three years ago.

My opthalmologist, AnDrOs Kamoromy, was trained at NC State and U of FL before moving to Penn (New Bolton Center) last year. Pal was apparently only the 20th horse done by the intrascleral method. The biggest advantage of the intrascleral approach is less invasive = less chance of complications such as infections post-op.

Unfortunately for Pal, the implant was not effective. He is going to lose his eye in the next week or two.

I also know another horse that had the intrascleral implants, in his case bilaterally. He had the procedure this past fall. He has already lost his sight in one eye, and the other is failing. I don't believe this particular horse is a case of lepto-induced ERU (he's an App).

As far as the procedure itself, it was done under general anaesthesia and took approximately one hour from putting the horse under to bringing him out. The incision healed quickly and with no complications. Prior to the procedure, we had Pal on banamine and prednisolone DrOps as a prophylactic. We were told to expect a flare as a result of the procedure itself, but what we experienced was extremely minor. Pal was at the clinic for three or four days total. Within 24 hours, Pal was no worse for wear.

Post-op, we gave him two weeks off, then put him back into light work for a couple of weeks, then back to full work. The time off and light work was to prevent elevation of blood pressure which could cause bleeding. We didn't have any problems in that regard. He was initially on steroid ointment six times a day, on a tapering dose schedule. You can e-mail me and I'll send you the whole post-op regimen, if you're curious.
Member:
Rpotter

Posted on Thursday, Jun 9, 2005 - 9:17 pm:

Since my post, Goldie has developed a cataract in her Right eye. The Left eye at this time is still ok. She has not had any flare ups in several months (knock on wood) At this time I keep her on Pred DrOps once a day as a prophylactic. She is also on Asprin daily (for whatever good it does. I would be very interested in any info you have on the implants. When I checked on then in Feb, the manufacturer had stopped supplying them. I don't know if that has changed. Would you still go through with the surgery given the info you know now? I know our time is limited... but I'd like to keep riding as long as we can. She just enjoys it so much. I also have a fellow barrel racer that had his horse diagnosed with Uveitis (lepto- induced) last month. He had bought her for $45,000 a year before... He is VERY interested in the surgery. Let me know what you can
Moderator:
DrO

Posted on Friday, Jun 10, 2005 - 9:38 am:

Rachel,
I would talk to your vet about switching from aspirin to 1 gram bute / 1000 lbs daily. I found this in a recent summary and notice Dr. Gilger's name (NC State Vet School) on it. Perhaps your vet could contact his to see if this product is available for horses:

Invest Ophthalmol Vis Sci. 2005 Feb;46(2):655-62.

Preclinical evaluation of a novel episcleral cyclosporine implant for ocular graft-versus-host disease.

Kim H, Csaky KG, Gilger BC, Dunn JP, Lee SS, Tremblay M, de Monasterio F, Tansey G, Yuan P, Bungay PM, Lutz RJ, Robinson MR.

National Eye Institute, National Institutes of Health, Bethesda, Maryland 20892-1863, USA.

PURPOSE: To develop a local drug delivery system that provides therapeutic cyclosporine levels to treat lacrimal gland graft-versus-host disease after allogeneic hematopoietic stem cell transplantation. METHODS: Episcleral cyclosporine implants were manufactured with a silicone-based matrix design, and in vitro release rates were determined. Preclinical evaluation included toxicology (clinical examination, serial electroretinography, and histopathology) in normal rabbits and dogs, pharmacokinetics in normal rabbits, and pharmacodynamics in a canine model of aqueous tear deficiency and keratoconjunctivitis sicca. RESULTS: The cyclosporine implants showed sustained release of drug over time with in vitro assays. Histopathology showed normal ocular tissues in both dogs and rabbits 6 months after implantation. The cyclosporine implant produced lacrimal gland drug levels 1 to 2 log units higher than those reported with a variety of topical cyclosporine formulations and oral administration. The cyclosporine implant was effective in a canine model of keratoconjunctivitis sicca, with all animals able to discontinue topical cyclosporine and maintain normal Schirmer scores over a 6-month follow-up. CONCLUSIONS: This preclinical evaluation showed that the episcleral cyclosporine implant was safe, delivered potentially therapeutic cyclosporine levels to the lacrimal gland, and showed efficacy in a clinically relevant model of keratoconjunctivitis sicca. The episcleral cyclosporine implant shows promise in reducing the morbidity associated with lacrimal gland graft-versus-host disease after allogeneic hematopoietic stem cell transplantation. In addition, continuous release of cyclosporine in the subconjunctival space with the episcleral implant was an effective means of delivering drug to the ocular surface and may have potential in treating other ocular inflammatory diseases.
DrO
Home Page | Top of Page | Join Us!
Horseadvice.com is a BBB Accredited Business. Click for the BBB Business Review of this Horse Training in Stokesdale NC