Abstract：
OBJECTIVE: To describe a combined treatment approach for heterochromic iridocyclitis and secondary keratitis (HIK) in horses.
METHODS: A total of 15 horses (16 eyes).
METHODS: Sixteen eyes from 15 horses (mean age 14.1 years, range 6-26 years) received low-dose (4 mg) intravitreal preservative-free gentamicin injection (IVGI) and modified Gundersen grafts with standing sedation and local anesthesia following a clinical diagnosis of HIK. Additional therapies of suprachoroidal triamcinolone (8 mg) injection, episcleral bromfenac implants, and suprachoroidal cyclosporine implants were performed in individual cases. Leptospira titers were also reported when available.
RESULTS: The most frequent ophthalmic findings were pigmented keratic precipitates (n = 15/16 eyes, 94%), corneal edema (n = 14/16 eyes, 88%), and pigmented cells suspended in the anterior chamber (n = 7/16 eyes, 44%). Postoperative treatment generally consisted of topical and systemic NSAIDs, topical antibiotics, and a topical mydriatic agent. Complications included persistent corneal edema (7/16, 44%), corneal ulceration (6/16, 38%), graft failure requiring revision (2/16, 13%), stromal abscess (1/16, 6%), surgery site infection (1/16, 6%), and suspected retinal degeneration following IVGI (1/16, 6%). One case was enucleated 6 months after treatment (1/16, 6%). Of the 12 eyes with at least 3 months of post-treatment follow-up, 10 were comfortable and visual with static or improved symptoms of HIK.
CONCLUSIONS: This multimodal treatment approach aims to address both the anterior uveitis and endothelial decompensation frequently seen in horses with HIK. The surgery can be performed under standing sedation. Continued evaluation and long-term follow-up is necessary in all horses with HIK.
METHODS: A total of 15 horses (16 eyes).
METHODS: Sixteen eyes from 15 horses (mean age 14.1 years, range 6-26 years) received low-dose (4 mg) intravitreal preservative-free gentamicin injection (IVGI) and modified Gundersen grafts with standing sedation and local anesthesia following a clinical diagnosis of HIK. Additional therapies of suprachoroidal triamcinolone (8 mg) injection, episcleral bromfenac implants, and suprachoroidal cyclosporine implants were performed in individual cases. Leptospira titers were also reported when available.
RESULTS: The most frequent ophthalmic findings were pigmented keratic precipitates (n = 15/16 eyes, 94%), corneal edema (n = 14/16 eyes, 88%), and pigmented cells suspended in the anterior chamber (n = 7/16 eyes, 44%). Postoperative treatment generally consisted of topical and systemic NSAIDs, topical antibiotics, and a topical mydriatic agent. Complications included persistent corneal edema (7/16, 44%), corneal ulceration (6/16, 38%), graft failure requiring revision (2/16, 13%), stromal abscess (1/16, 6%), surgery site infection (1/16, 6%), and suspected retinal degeneration following IVGI (1/16, 6%). One case was enucleated 6 months after treatment (1/16, 6%). Of the 12 eyes with at least 3 months of post-treatment follow-up, 10 were comfortable and visual with static or improved symptoms of HIK.
CONCLUSIONS: This multimodal treatment approach aims to address both the anterior uveitis and endothelial decompensation frequently seen in horses with HIK. The surgery can be performed under standing sedation. Continued evaluation and long-term follow-up is necessary in all horses with HIK.
摘要：
目的：描述马异色虹膜睫状体炎和继发性角膜炎（HIK）的联合治疗方法。
方法：共15匹马（16眼）。
方法：来自15匹马的16只眼（平均年龄14.1岁，范围6-26年）在临床诊断为HIK后，接受了低剂量（4mg）玻璃体内无防腐剂庆大霉素注射液（IVGI）和改良的Gundersen移植物，并进行了镇静和局部麻醉。额外的治疗脉络膜上曲安西龙（8毫克）注射，巩膜上植入溴芬酸，在个别病例中进行了脉络膜上环孢素植入。当可用时,也报告钩端螺旋体滴度。
结果：最常见的眼科发现是色素沉着的角膜沉淀（n=15/16眼，94%），角膜水肿（n=14/16眼，88%），和悬浮在前房中的色素细胞（n=7/16眼，44%）。术后治疗通常包括局部和全身NSAIDs，局部抗生素，和局部散瞳剂。并发症包括持续性角膜水肿（7/16，44%），角膜溃疡（6/16，38%），移植物失败需要翻修(2/16，13%)，基质脓肿（1/16，6%），手术部位感染（1/16，6%），怀疑IVGI后视网膜变性（1/16，6%）。1例患者治疗后6个月摘除（1/16，6%）。治疗后随访至少3个月的12只眼，10例舒适且视觉上有静态或改良的HIK症状。
结论：这种多模式治疗方法旨在解决HIK马中常见的前葡萄膜炎和内皮代偿失调。手术可以在站立镇静下进行。所有HIK马匹都需要继续评估和长期随访。
方法：共15匹马（16眼）。
方法：来自15匹马的16只眼（平均年龄14.1岁，范围6-26年）在临床诊断为HIK后，接受了低剂量（4mg）玻璃体内无防腐剂庆大霉素注射液（IVGI）和改良的Gundersen移植物，并进行了镇静和局部麻醉。额外的治疗脉络膜上曲安西龙（8毫克）注射，巩膜上植入溴芬酸，在个别病例中进行了脉络膜上环孢素植入。当可用时,也报告钩端螺旋体滴度。
结果：最常见的眼科发现是色素沉着的角膜沉淀（n=15/16眼，94%），角膜水肿（n=14/16眼，88%），和悬浮在前房中的色素细胞（n=7/16眼，44%）。术后治疗通常包括局部和全身NSAIDs，局部抗生素，和局部散瞳剂。并发症包括持续性角膜水肿（7/16，44%），角膜溃疡（6/16，38%），移植物失败需要翻修(2/16，13%)，基质脓肿（1/16，6%），手术部位感染（1/16，6%），怀疑IVGI后视网膜变性（1/16，6%）。1例患者治疗后6个月摘除（1/16，6%）。治疗后随访至少3个月的12只眼，10例舒适且视觉上有静态或改良的HIK症状。
结论：这种多模式治疗方法旨在解决HIK马中常见的前葡萄膜炎和内皮代偿失调。手术可以在站立镇静下进行。所有HIK马匹都需要继续评估和长期随访。
