horse

  • 文章类型: Journal Article
    死后胎儿挤压,也被称为“棺材出生”,是指胎儿由于腹腔中气体分解的压力而被推出已故女性的现象。虽然在几个考古现场已经记录了人类的死后胎儿挤压,很少有报道说它发生在非人类动物身上。在这项研究中,我们介绍了一例在中国西北部耀和源西周时期的战马坑(CMK2)中观察到的死后胎儿挤压的病例,可追溯到公元前一千年初。这个特定的坑,在现场挖掘的四个人之一,至少有29匹马和3辆木制战车。这些马大多数是年龄在4至12岁之间的年轻人。在有性别估计的22匹马中,21是男性。在这些人中,一匹成年母马(马6)和一匹幼马(马10)特别重要。根据死亡年龄,性别,和两个人的头部取向,除了它们的空间关系,马6很可能是马10的胎儿,并在坑中被挤压。根据马10的分娩阶段,马6很可能在春末或夏初被安葬在CMK2中,在此期间,相对较高的温度可能会产生导致胎儿挤压的气体。虽然在姚河源的战马坑中列入怀孕母马的具体原因仍是未来研究的课题,该病例标志着考古马中死后胎儿挤压的第一份报告。这些发现为中国青铜时代定居精英中作为仪式实践的一部分进行马葬的时机提供了见解,并为当代马兽医学提供了有价值的参考数据。
    Post-mortem fetal extrusion, also known as \"coffin birth\", refers to the phenomenon where a fetus is pushed out of a deceased female due to pressure from decomposing gas in the abdominal cavity. While post-mortem fetal extrusion has been documented in humans at several archaeological sites, there are few reports of it occurring in non-human animals. In this study, we present a case of post-mortem fetal extrusion in equids observed in a chariot-horse pit (CMK2) at the Western Zhou period site of Yaoheyuan in northwestern China, dating to the early first millennium BC. This specific pit, one of four excavated at the site, contained at least 29 horses and 3 wooden chariots. Most of these horses were young adults aged between 4 and 12 years. Out of the 22 horses with sex estimates, 21 were males. Among these individuals, one adult female horse (Horse 6) and one infantile horse (Horse 10) were of particular importance. Based on the age-at-death, sex, and head orientation of the two individuals, alongside their spatial relationships, it is highly likely that Horse 6 was the fetus of Horse 10 and was extruded in the pit. According to the parturition stage of Horse 10, Horse 6 was likely interred in CMK2 in late spring or early summer of the year, during which the relatively high temperature may have generated gas that led to the extrusion of the fetus. Although the specific reason for the inclusion of a pregnant mare in a chariot-horse pit at Yaoheyuan remains a topic for future research, this case marks the first report of post-mortem fetal extrusion in archaeological horses. The findings offer insights into the timing of horse interment as part of ritual practices among the settled elites during the Bronze Age in China and provide valuable reference data for contemporary equine veterinary science.
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  • 文章类型: Case Reports
    在这个案例报告中,我们在10个月大的阿拉伯雌马的肠系膜根部周围出现了不寻常的左结肠顺时针扭转,突出临床表现,诊断方法和成功的手术干预。一只10个月大的阿拉伯雌马,体重约250公斤,有急性腹痛的迹象。历史揭示了厌食症,前一天开始的躁动和严重的腹痛。当地医生以前曾服用氟尼辛葡甲胺,镇痛药,但事实证明它在缓解疼痛方面无效。在体检时,雌马流汗,体温为38.5°C,心动过速(每分钟65次)和呼吸急促(每分钟25次呼吸)。由于绞痛的严重程度和对保守治疗缺乏反应,手术干预被认为是必要的。进行了探索性中线切开术以评估腹部器官。在考试期间,在评估的器官中未发现明显的原发性病变。然而,观察到左结肠长度外切的限制。进一步检查发现,左结肠有一个不寻常的顺时针扭转,在肠系膜根部周围从左向右移位;因此,骨盆屈曲位于正常解剖位置,长度短。据我们所知,这是马的第一个顺时针扭转和左半结肠不典型移位的病例。成功进行了移位的手术矫正。雌马在手术后显示出改善,并且在恢复期未出现任何并发症。
    In this case report, we present an unusual clockwise torsion of left colon around mesenteric root in a 10-month-old Arab filly, highlighting the clinical presentation, diagnostic approach and successful surgical intervention. A 10-month-old Arab filly weighing approximately 250 kg was referred with signs of acute abdominal pain. The history revealed anorexia, restlessness and severe abdominal pain that had begun the previous day. The local practitioner had previously administered flunixin meglumine, an analgesic, but it proved ineffective in relieving the pain. Upon physical examination, the filly exhibited sweating, a body temperature of 38.5°C, tachycardia (65 beats per minute) and tachypnea (25 breaths per minute). Due to the severity of the colic and the lack of response to the conservative treatments, surgical intervention was deemed necessary. An exploratory midline celiotomy was performed to evaluate the abdominal organs. During the examination, no obvious primary lesions were identified in the evaluated organs. However, a restriction in exteriorizing the left colon\'s length was observed. Further examination revealed an unusual clockwise torsion of the left colon that displaced in left to the right side around the mesenteric root; thereby, pelvic flexure was located in the normal anatomical position with a short length. To the best of our knowledge, this is the first reported case of clockwise torsion and an atypical displacement of the left colon in horses. The surgical correction of the displacement was successfully performed. The filly showed improvement post-surgery and did not exhibit any complications during the recovery period.
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  • 文章类型: Case Reports
    在电化学疗法(ECT)期间,将化疗药物注射到肿瘤中,然后提供电穿孔。在马,操纵耳朵可能会非常痛苦,将局部区域技术与镇静相结合可能是避免麻醉相关风险的好选择。在马尸体中描述了内部和外部耳廓和耳道的两个注射点阻滞,它允许耳大神经(GAN)的所有三个分支完全染色,耳内神经支(IAB),耳外支(LAB),和尾耳神经(CAN),提示IAB和LAB阻滞期间腮腺内注射的风险较低。
    一名8岁的意大利跳跃者接受ECT治疗,以治疗左内侧耳廓的成纤维细胞结节病。用乙酰丙嗪静脉镇静后,罗米菲丁,和布托啡诺,如前所述,提供了两个注入点的块。GAN的街区是盲人,而电神经定位器用于IAB,实验室,和可以。总共注射12ml的0.5%罗哌卡因。安全地进行了ECT,没有任何困难。马很好地耐受该程序并且在镇静后75分钟完全恢复。未发现并发症。
    所描述的方法似乎是可行的,并且适用于在ECT的情况下阻断马耳的感觉神经支配。
    UNASSIGNED: During electrochemotherapy (ECT), a chemotherapeutic drug is injected into the tumor and then an electroporation is provided. In horses, ear manipulation may be very painful, and combining a loco-regional technique with sedation might be a good option to avoid anesthesia-related risks. A two-injection-point block of the internal and external pinna and acoustic meatus was described in horse cadavers, and it permitted complete stain of all three branches of the great auricular nerve (GAN), internal auricular nerve branch (IAB), lateral auricular branch (LAB), and caudal auricular nerve (CAN), suggesting a lower risk of intra-parotid injection during the IAB and LAB block.
    UNASSIGNED: An 8-year-old Italian jumping gelding presented for ECT to treat a fibroblastic sarcoid in the left medial pinna. After intravenous sedation with acepromazine, romifidine, and butorphanol, a two-injection-point block was provided as previously described. The block of the GAN was blind, whereas an electrical nerve locator was used for the IAB, LAB, and CAN. A total of 12 ml of 0.5% ropivacaine was injected. The ECT was safely performed without any difficulties. The horse well tolerated the procedure and completely recovered 75 minutes after sedation. No complications were detected.
    UNASSIGNED: The described approach seems feasible and suitable for the blockade of the sensory innervation of the equine ear in the case of ECT.
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  • 文章类型: Case Reports
    虽然比较少见,淋巴瘤是马最常见的造血肿瘤,多中心淋巴瘤仍然是该疾病最常见的表现。马淋巴瘤的发病机制仍然知之甚少,诊断通常在疾病的晚期得到证实,影响预后。这项研究调查了临床,病态,1例马多中心淋巴瘤的分子特征。
    在Vairão动物繁殖中心住院的5岁杂交母马,葡萄牙,突然出现眶上水肿和下颌淋巴结肿大的临床症状,发展中的发烧,面部水肿,和全身淋巴结病。由于多系统器官衰竭,在第一个临床症状出现24天后,母马最终死亡。血液和生化分析,尸检,并对受影响的组织进行显微镜和分子评估。尸检时,主要发现是多发性多结节性病变,沿口咽浆液表面分布,气管,心包,胃肠道,和肠系膜.微观上,这些包括对CD3(T细胞)表现出免疫阳性的肿瘤圆形细胞的实体增殖.基于这些发现,诊断为中度多中心T细胞淋巴瘤.
    关于马淋巴瘤的分子表征的研究仍然很少。作为一个实体本身是相当异构的,重要的是要描述物种间的特殊性,以了解其发展和行为。
    UNASSIGNED: Although relatively uncommon, lymphoma is the most prevalent haematopoietic neoplasia in horses, and multicentric lymphoma remains the most common presentation of the disease. The pathogenesis of equine lymphoma is still poorly understood and the diagnosis is usually confirmed at an advanced stage of the disease, compromising the prognosis. This study investigated the clinical, pathological, and molecular features of a case of equine multicentric lymphoma.
    UNASSIGNED: An apparently healthy 5-year-old crossbreed mare hospitalized at the Centre of Animal Reproduction of Vairão, Portugal, suddenly presented clinical signs of supraorbital oedema and mandibular lymph node enlargement, developing fever, facial oedema, and generalized lymphadenopathy. The mare ended up dying twenty-four days after the first clinical signs due to multisystem organ failure. Haematological and biochemical analyses, necropsy, and microscopic and molecular evaluation of affected tissues were performed. At necropsy, the main findings were multiple multinodular lesions, distributed along the serous surface of oropharynx, trachea, pericardium, gastrointestinal tract, and mesentery. Microscopically, these consisted of solid proliferations of neoplastic round cells that exhibited immunopositivity for CD3 (T cells). Based on these findings, a medium-grade multicentric T-cell lymphoma was diagnosed.
    UNASSIGNED: There is still very little research regarding the molecular characterization of lymphoma in horses. As an entity itself is quite heterogeneous, it is important to describe the interspecies particularities to understand its development and behaviour.
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  • 文章类型: Case Reports
    一只17岁的母马出现急性发热,肌无力和膀胱功能障碍被诊断为马疱疹病毒性脊髓脑病(EHM)。母马暂时躺着,接受了肠胃外液体治疗,血浆输注,类固醇/非甾体抗炎药(SAID/NSAIDs)和膀胱导管插入术。10天后,母马住院。神经系统评估显示共济失调和本体感觉障碍主要发生在后肢。母马能够站立,但无法从卧位或走路中站起来。继发并发症包括大肠杆菌膀胱炎,角膜溃疡和压疮。使用全身支撑吊带21天。药物治疗包括全身抗菌药物,NSAIDs,逐渐停止SAIDs,胃肠外液体治疗和膀胱灌洗。在发烧后第13天,母马在鼻拭子和血液样本中以及在第13天和第25天的尿液样本中检测到水痘病毒等同α1(EHV-1)DNA呈阳性。神经系统体征在34天内得到改善,母马因轻度后肢无力/共济失调而出院。继发性并发症在2周内解决。在八个月的随访中,运动功能得到了显著改善。
    A 17-year-old mare presenting with acute fever, weakness and bladder dysfunction was diagnosed with equine herpesvirus myeloencephalopathy (EHM). The mare become transiently recumbent, underwent parenteral fluid therapy, plasma infusion, steroidal/nonsteroidal anti-inflammatory drugs (SAID/NSAIDs) and bladder catheterization. After 10 days the mare was hospitalized. Neurological evaluation revealed ataxia and proprioceptive deficits mainly in the hind limbs. The mare was able to stand but unable to rise from recumbency or walk. Secondary complications included Escherichia coli cystitis, corneal ulcers and pressure sores. A full-body support sling was used for 21 days. Medical treatment included systemic antimicrobials, NSAIDs, gradual discontinuation of SAIDs, parenteral fluid therapy and bladder lavage. The mare tested positive for Varicellovirus equidalpha 1 (EHV-1) DNA in nasal swab and blood samples on day 13 and in urine samples on days 13 and 25 after the onset of fever. Neurological signs improved over a period of 34 days and the mare was discharged with mild hind limb weakness/ataxia. Secondary complications resolved within 2 weeks. At the eight-month follow-up, marked improvement in locomotory function had been achieved.
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  • 文章类型: Case Reports
    目的:描述MicroPulse™经巩膜睫状体光凝(MP-TSPC)治疗马青光眼的临床应用和结果。
    方法:四匹主养马患有原发性(n=2)或继发性(n=2)青光眼。
    方法:马在站立镇静下接受MP-TSCPC治疗,至少随访30天(范围30-1241天)。受影响的眼睛用31.3%的占空比和3000mW的激光功率治疗180s。收集的数据包括信号,术前和术后眼压(IOP),激光设置,药物,并发症,和重复治疗。
    结果:四匹马(5只眼)接受了至少一次MP-TSCPC治疗。术前平均IOP为44mmHg(范围33-49mmHg)。术后即刻平均IOP为34mmHg(4眼;范围19-55mmHg)。在1周,IOP为38mmHg(5眼,范围21-80mmHg),2周时为40mmHg(3眼,范围17-80mmHg),1个月时为35mmHg(5只眼;范围20-50mmHg),3个月时为18mmHg(2眼;范围14-21mmHg),6个月时为35mmHg(2只眼;范围30-39mmHg),在>300天时为24mmHg(3眼;范围18-29mmHg)。并发症包括角膜溃疡(n=1眼),IOP失控(n=3只眼睛),需要重复治疗(n=2只眼)。
    结论:与上述设置一起使用的MP-TSCPC无法成功治疗大多数病例。未来的研究应针对原发性青光眼病例,并使用替代激光设置。
    OBJECTIVE: To describe the clinical application and outcome of MicroPulse™ transscleral cyclophotocoagulation (MP-TSCPC) treatment in horses with glaucoma.
    METHODS: Four client-owned horses with primary (n = 2) or secondary (n = 2) glaucoma.
    METHODS: Horses were treated with MP-TSCPC under standing sedation with a minimum of 30 days of follow-up (range 30-1241 days). Affected eyes were treated with a 31.3% duty cycle and 3000 mW laser power for a total of 180 s. Data collected included signalment, pre- and post-procedure intraocular pressures (IOPs), laser settings, medications, complications, and repeat therapy.
    RESULTS: Four horses (5 eyes) received at least one treatment with MP-TSCPC. Mean preoperative IOP was 44 mmHg (range 33-49 mmHg). The immediate mean postoperative IOP was 34 mmHg (4 eyes; range 19-55 mmHg). At 1 week, IOP was 38 mmHg (5 eyes; range 21-80 mmHg), at 2 weeks was 40 mmHg (3 eyes, range 17-80 mmHg), at 1 month was 35 mmHg (5 eyes; range 20-50 mmHg), at 3 months was 18 mmHg (2 eyes; range 14-21 mmHg), at 6 months was 35 mmHg (2 eyes; range 30-39 mmHg), and at >300 days was 24 mmHg (3 eyes; range 18-29 mmHg). Complications included corneal ulceration (n = 1 eye), uncontrolled IOP (n = 3 eyes), and need for repeat treatment (n = 2 eyes).
    CONCLUSIONS: MP-TSCPC used with the above-described settings was unsuccessful in treating the majority of cases. Future studies should be targeted at primary glaucoma cases and with use of alternative laser settings.
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  • 文章类型: Journal Article
    马的软骨下骨囊肿是可能发生在不同解剖位置的跛行的主要原因之一。该研究描述了包含在富含血小板的血浆(PRP)中的脂肪组织间充质基质细胞(AMSC)的囊内植入的再生疗法。在体外和体内测试了AMSCs在成骨细胞中的分化能力。鉴于旨在研究AMSCs在马骨缺损和骨科病理中的应用,一匹从未参加过比赛的四岁雄性纯种赛马因股骨内侧髁囊肿导致左后腿跛行而接受治疗。这匹马接受了用关节镜入路进行的新手术,其中囊腔充满了PRP中所含的AMSC。手术后3、5和10个月进行放射学检查,以评估囊肿留下的间隙中新再生的骨组织的发育。术后12个月和经过6个月的常规日常训练,这匹马没有表现出任何跛行症状,开始了赛车生涯。根据研究,AMSCs和PRP的使用提示对于治疗软骨下骨囊肿有希望的益处.
    Subchondral bone cysts in horses represent one of the main causes of lameness that can occur in different anatomical locations. The study describes the treatment in regenerative therapy of the intracystic implantation of adipose tissue mesenchymal stromal cells (AMSCs) included in platelet-rich plasma (PRP). The ability of AMSCs to differentiate in osteogenic cells was tested in vitro and in vivo. Given the aim to investigate the application of AMSCs in bone defects and orthopedic pathologies in horses, a four-year-old male thoroughbred racing horse that had never raced before was treated for lameness of the left hind leg caused by a cyst of the medial femoral condyle. The horse underwent a new surgery performed with an arthroscopic approach in which the cystic cavity was filled with AMSCs contained in the PRP. Radiographs were taken 3, 5, and 10 months after the surgery to assess the development of newly regenerated bone tissue in the gap left by the cyst. Twelve months after the operation and after six months of regular daily training, the horse did not show any symptoms of lameness and started a racing career. According to the study, the use of AMSCs and PRP suggests promising benefits for treating subchondral bone cysts.
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  • 文章类型: Case Reports
    背景:牙龈Halicephalobusgingivalis是一种具有人畜共患潜力的线虫,可在各种哺乳动物中引起致命的机会性感染。这种寄生虫在瑞典从未被诊断出,在任何物种中,在提交案件之前。
    方法:进口的21岁冰岛母马出现严重的神经系统症状。马最终被安乐死,并提交验尸检查,其中发现肾脏严重病变。组织病理学显示,肾脏和大脑中都存在牙龈卟啉单胞菌。寄生虫的系统发育分析确定它属于谱系1。
    结论:随着瑞典牙龈卟啉单胞菌的发生,在马和包括人类在内的其他哺乳动物中,这种疾病应被添加到神经系统疾病急性发作病例的鉴别诊断清单中。
    BACKGROUND: Halicephalobus gingivalis is a nematode with zoonotic potential which can cause fatal opportunistic infections in various mammals. The parasite has never been diagnosed in Sweden, in any species, prior to the presented case.
    METHODS: An imported 21-year-old Icelandic mare developed severe neurological signs. The horse was eventually euthanized and submitted for post-mortem examination where severe lesions in the kidneys were noted. Histopathology revealed the presence of H. gingivalis in both kidneys and the brain. Phylogenetic analysis of the parasite determined it to belong to Lineage 1.
    CONCLUSIONS: With the occurrence of H. gingivalis in Sweden, the disease should be added to the list of differential diagnoses in cases with acute onset of neurological disease in both horses and other mammals including humans.
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  • 文章类型: Journal Article
    背景:手指深屈肌腱(ALDDFT)的副韧带脱位是一种常见的损伤。尽管这种伤害很普遍,文献仅限于小案例系列,治疗后报告的成功率从18%到75%不等。
    目的:确定ALDDFT损伤后恢复工作的预后和相关因素。
    方法:回顾性病例系列。
    方法:回顾了来自四家马医院(2000年1月和2018年12月)诊断为ALDDFTdesmitis的马的病历。检索到的数据包括案例详细信息,使用,历史,跛行治疗和随访。成功被定义为重返工作岗位。反向逐步逻辑回归用于识别与返回工作显着相关的变量。
    结果:包括91匹马。平均年龄为13.5岁(标准差为4.9岁)。在最初的演讲中,有34%(28/91)的马是健全的。百分之六十八(62/91)的马匹仅通过控制运动进行管理,28%(29/91)采用皮损内注射治疗,治疗性超声,对ALDDFT进行体外冲击波治疗或行行经管切除术,3%(3/91)的患者在未治疗的情况下实施安乐死.64%(54/85)的马匹重返工作岗位。与那些恢复健康的马相比,在随访中跛脚的马不太可能重返工作岗位(比值比[OR]107.93,95%置信区间[CI]20.06-580.61,p<0.001)。与没有粘连的马相比,超声检查粘连的鉴定也与重返工作岗位的几率降低相关(OR0.10,95%CI0.01-0.76,p=0.03)。
    结论:研究的回顾性性质,关于随访的选择偏差的可能性。
    结论:64%(54/85)的马在ALDDFT受伤后重返工作岗位。跛行和粘连形成的持久性与不良预后显着相关。
    BACKGROUND: Desmitis of the accessory ligament of the deep digital flexor tendon (ALDDFT) is a commonly reported injury. Despite the commonality of this injury, the literature is limited to small case series, with the reported success following treatment varying from 18% to 75%.
    OBJECTIVE: To identify the prognosis and factors associated with a return to work following ALDDFT injury.
    METHODS: Retrospective case series.
    METHODS: Medical records of horses from four equine hospitals (January 2000 and December 2018) with a diagnosis of desmitis of ALDDFT were reviewed. Data retrieved included case detail, use, history, lameness treatment and follow-up. Success was defined as returning to work. Backward stepwise logistic regression was used to identify variables significantly associated with return to work.
    RESULTS: Ninety-one horses were included. The mean age was 13.5 years (standard deviation 4.9 years). Thirty-four percent (28/91) of horses were sound at the initial presentation. Sixty-eight percent (62/91) of horses were managed using controlled exercise alone, 28% (29/91) were treated with intra-lesional injection, therapeutic ultrasound, extracorporeal shockwave therapy or desmectomy of the ALDDFT and 3% (3/91) were euthanased without treatment. Sixty-four percent (54/85) of horses returned to work. Horses that were lame at follow-up were less likely to return to work (odds ratio [OR] 107.93, 95% confidence interval [CI] 20.06-580.61, p < 0.001) than those that returned to soundness. Identification of adhesions on ultrasonography was also associated with having reduced odds for return to work when compared to horses without adhesions (OR 0.10, 95% CI 0.01-0.76, p = 0.03).
    CONCLUSIONS: Retrospective nature of the study, the potential of selection bias with regards to follow-up.
    CONCLUSIONS: Sixty-four percent (54/85) of horses returned to work following injury of the ALDDFT. Persistence of lameness and adhesion formation were significantly associated with a poor outcome.
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  • 文章类型: Case Reports
    核黄素/UV-A角膜交联(CXL)已用于治疗成年马的角膜溃疡,但其在危重新生儿马驹中的应用尚未被描述。5例住院,患有角膜溃疡的重症监护新生儿小马驹,描述了眼科治疗及其长达一年的结果。在3/5马驹(5只眼)中进行CXL光疗的单一治疗。在施用核黄素眼用溶液20分钟之后,以30mW/cm2照射UV-A光3分钟。CXL后停止局部抗生素给药。另外两只小马驹接受了标准治疗。眼部病变的描述,记录荧光素染色和照相文件。视觉结果,角膜透明度和美学,在随访中评估愈合时间。在使用CXL治疗的病例中,局部用药的频率大大降低。CXL后3天内角膜混浊和疼痛减轻。在用CXL处理的小马驹中,在临床体征发作后24、28、35天和CXL后10、15、21天,溃疡愈合(荧光素染色阴性)。在用CXL治疗的病例中未发现纤维化或角膜疤痕。两个标准治疗病例分别在26天和36天后愈合。角膜交联可能是危重新生儿马驹角膜溃疡的额外或替代治疗,并可能减少抗生素的使用。
    Riboflavin/UV-A corneal cross-linking (CXL) has been applied to treat corneal ulcers in adult horses, but its use in critically ill neonatal foals has not been described. Five cases of hospitalized, critically ill neonatal foals that were in intensive care with corneal ulcers, the ophthalmic treatment, and their outcome up to 1 year are described. A single treatment of CXL phototherapy was performed in three of five foals (five eyes). The application of a riboflavin ophthalmic solution for 20 minutes was followed by the UV-A light irradiation at 30 mW/cm2 for 3 minutes. Topical antibiotic administration was withdrawn after CXL. Two other foals received standard treatment. Descriptions of ocular lesions, fluorescein staining, and photographic documentation were recorded. The visual outcome, corneal transparency, and aesthetics, as well as healing time were evaluated in the follow-up. The frequency of topical medication considerably decreased in cases treated with CXL. Corneal opacity and pain decreased within 3 days following CXL. In the foals treated with CXL, the ulcers healed (fluorescein stain negative) in 24, 28, and 35 days after the onset of clinical signs and 10, 15, and 21, after CXL. No fibrosis or corneal scars were found in the cases treated with CXL. The two standard treatment cases healed after 26 and 36 days respectively. Corneal cross-linking may be an additional or alternative treatment of corneal ulcers in critically ill neonatal foals and may reduce the use of antibiotics.
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