scholarly journals Severe Corneal Edema in a Dog Naturally Infected by Leishmania spp.

2020 ◽  
Vol 48 ◽  
Author(s):  
Nathalie Moro Bassil Dower ◽  
Tássia Moara Amorim ◽  
Alexandre Pinto Ribeiro ◽  
Álvaro Felipe De Lima Ruy Dias ◽  
Valéria Régia Franco Sousa
Keyword(s):  
Anterior Uveitis ◽  
Surgical Procedure ◽  
Corneal Stroma ◽  
Corneal Edema ◽  
Clinical Treatment ◽  
Domestic Dog ◽  
Bullous Keratopathy ◽  
Eye Drops ◽  
Laboratory Examination ◽  
Ophthalmic Changes

Background: Visceral leishmaniasis (VL) is an infectious disease caused by the protozoan Leishmania infantum that is transmitted to dogs and humans by sandflies. The incidence of eye injuries in VL is high. They occur in 20 to 81% of infected dogs and include blepharitis, granulomatous conjunctivitis, scleritis, keratitis, anterior uveitis, keratoconjunctivitis sicca, and secondary glaucoma. However, some dogs present only the clinical signs of eye damage. The main objective of this manuscript is to report a case of anterior uveitis with severe corneal edema in a dog with VL that underwent clinical and surgical ophthalmic treatments after miltefosine therapy.Case: An 8-month-old, intact male Labrador Retriever with brown fur presented with pruritus, diffuse desquamation, and conjunctival hyperemia on physical evaluation. On the basis of an ophthalmic examination, nodular conjunctivitis and uveitis were diagnosed in both eyes. Moreover, laboratory examination results showed hyperproteinemia, increased serum alkaline phosphatase activity, and positive reactions to immunochromatographic tests for VL. Clinical treatment was instituted from the moment of diagnosis, when miltefosine and allopurinol were prescribed. At the end of treatment, based on laboratory examination results, only allopurinol was prescribed at a lower dose than initially prescribed for treatment continuation. Topical medications (prednisolone eye drops and sodium hyaluronate) were recommended for the ophthalmic changes. One week after the start of topical treatment, the dog showed an improvement in eye inflammation but still had bilateral corneal edema. A hyperosmotic agent was prescribed to improve edema, and a surgical procedure was recommended if there was no improvement. The physician opted for the surgical procedure in one of the eyes that had not shown significant improvement after the clinical treatment.Discussion: VL is a zoonosis, and the domestic dog is the main reservoir. These animals often have dermatological conditions, and the ophthalmic changes observed can be unilateral or bilateral, with more than one change in the same eye. Lymphoplasmacytic or granulomatous anterior uveitis is the most prevalent change, as the uvea and conjunctiva are important lymphoid areas of the eye; this also explains the high incidence of uveitis and conjunctivitis in dogs with VL. In uveitis, corneal edema is driven by endothelial cell damage induced by prostaglandins, which interfere with the function of the endothelial pump and interrupt the normal dehydrated state of the cornea. Severe corneal edema can result in the formation of fluid-filled multifocal bubbles in the corneal stroma—a condition called bullous keratopathy. These bubbles accumulate under or inside the corneal epithelium, and they can burst spontaneously, leading to corneal erosions or ulcerations. Drug therapy with hyperosmotic agents could, in principle, reduce the formation of bubbles. Surgical options to decrease edema and blistering include a permanent conjunctival graft or thermokeratoplasty. Thermokeratoplasty induces the formation of superficial scars in the corneal stroma, applying multiple cauterization foci to the stroma exposed in the areas of bullous keratopathy and epithelial ulceration. In conclusion, the surgical therapeutic choice results in better visual quality in patients who do not respond well to clinical treatment.

Descemet’s Membrane Detachment

2013 ◽  
Author(s):  
Malik Y. Kahook
Keyword(s):  
Surgical Intervention ◽  
Corneal Stroma ◽  
Corneal Edema ◽  
Glaucoma Surgery ◽  
Bullous Keratopathy ◽  
Descemet’S Membrane Detachment ◽  
Descemet's Membrane ◽  
Central Regions ◽  
Descemet’S Membrane ◽  
Mechanical Manipulation

Corneal injury resulting from glaucoma surgery has been well described. Causes of injury can range from direct mechanical manipulation to the often more subtle pharmacologically induced injuries that occur with use of antifibrotic medications. Descemet’s membrane detachment (DMD) occurs uncommonly during or after intraocular surgery and has been linked with a variety of procedures ranging from simple clear cornea cataract extraction to deep lamellar keratoplasty. The corneal endothelium, which rests upon Descemet’s membrane, functions as a pump to keep the stroma from becoming swollen. Therefore, DMD results in focal corneal edema and possibly bullous keratopathy. If detachment of Descemet’s membrane extends far enough centrally, visual acuity may become sufficiently compromised to necessitate corneal transplantation surgery (either full-thickness penetrating keratoplasty [PKP] or Descemet’s stripping with automated endothelial keratoplasty [DSAEK]). In glaucoma surgery, DMD often results from the mechanical manipulation that occurs with creation of the cornealtrabecular meshwork opening. Knowing how to accurately diagnose and treat DMD can prevent disastrous consequences and preserve vision. Mackool and Holtz proposed separating DMD into 2 categories, planar and nonplanar, depending on the distance of separation between Descemet’s membrane and the posterior corneal stroma. Planar DMD involves less than 1 mm separation of Descemet’s membrane from the corneal stroma and may be limited to the periphery or extend from the periphery to central regions. Nonplanar DMD involves greater than 1 mm separation of Descemet’s membrane from the corneal stroma and may also be categorized as limited to the periphery or extending to central regions. The significance of this classification was the belief that planar DMD was more likely to spontaneously resolve while nonplanar DMD required surgical intervention. Assia and colleagues also split DMD into 2 categories: DMD with scrolling of tissue and DMD without scrolling of tissue. They believed this classification more accurately described potential for spontaneous resolution in that nonscrolled DMD was more likely to resolve without surgical intervention, even if its location was >1mm from the posterior corneal stroma. While useful as a general guide, these classification systems are not foolproof, and each case of DMD should be viewed independently.

A pilot study of genipin cross-linking effects on bullous keratopathy in rabbits

2020 ◽  
Vol 1 (1) ◽  
pp. 1-6
Author(s):  
Jing Qiao
Keyword(s):  
Body Weight ◽  
Cell Apoptosis ◽  
Corneal Stroma ◽  
Corneal Edema ◽  
Collagen Fibers ◽  
Terminal Deoxynucleotidyl Transferase ◽  
Cross Linking ◽  
Control Group ◽  
Bullous Keratopathy ◽  
Group A

AIM: To evaluate the effects of genipin cross-linking on bullous keratopathy in rabbits. METHODS: Nine female New Zealand white rabbits with bullous keratopathy were used as an experimental model. They were randomized into three groups. Corneas in Group A (treatment group, n=3) were immersed in 0.25% genipin at 24℃ for 40min; those in Group B (control group, n=3) were immersed in 0.9% sodium chloride solution at 24℃ for 40min; and those in Group C (blank control group, n=3) received no treatment. Follow-up examinations were performed within 2wk after treatment, including slit-lamp microscopy, central corneal thickness (CCT), evaluations of body weight and stress responses, histopathological analyses, and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) for detecting stromal cell apoptosis. RESULTS: Compared to Groups B and C, remission of corneal edema, corneal healing, disappearance of epithelial bullae, a significant decrease in CCT (P<0.05), and a significant increase in body weight (P<0.05) were found in Group A. Animals in Group A became more active and showed less aggression and violent resistance behavior. More regular and dense arrangement of collagen fibers in the corneal stroma and formation of blue strips of cross-linking products were observed in Group A. Cell apoptosis occasionally occurred in the corneal stroma of Group A, while no cell apoptosis was observed in Groups B and C. CONCLUSION: Genipin cross-linking treatment for bullous keratopathy in rabbits results in remission of corneal edema and relief of pain. We hypothesize that genipin cross-linking strengthens collagen fibers in corneal stroma to avoid the formation of corneal edema and bullae.

scholarly journals Amnwiotic Membrane Transplantation as a Treatment for Sterile Infiltration and Corneal Melting after Corneal Crosslinking for Keratoconus

2018 ◽  
Vol 9 (1) ◽  
pp. 185-189 ◽  
Author(s):  
Takanori Sasaki ◽  
Takeshi Ide ◽  
Ikuko Toda ◽  
Naoko Kato
Keyword(s):  
Visual Acuity ◽  
Diclofenac Sodium ◽  
Corneal Stroma ◽  
Amniotic Membrane Transplantation ◽  
Eye Drops ◽  
Epithelial Defect ◽  
Persistent Epithelial Defect ◽  
Corneal Crosslinking ◽  
Corneal Epithelial Defect ◽  
Corneal Melting

We report a case of corneal melting through sterile infiltration presumably due to excessive use of nonsteroidal anti-inflammatory eye drops after corneal crosslinking (CXL). It was treated using steroids combined with amniotic membrane transplantation (AMT). A 33-year-old man with progressing keratoconus underwent left eye CXL. We prescribed betamethasone and levofloxacin eye drops 5 times daily and diclofenac sodium eye drops 3 times daily for 3 days. Three days after CXL, there was a persistent epithelial defect and the left corneal stroma was clouded. His visual acuity remained unchanged. We prescribed betamethasone hourly and 20 mg prednisolone daily. At 1 week after CXL, the corneal epithelial defect and infiltration were unchanged. He had not stopped using diclofenac at the prescribed time. On day 17, we performed AMT and his cornea and visual acuity improved. AMT may be effective against persistent epithelial defects and corneal melting after CXL.

scholarly journals Benzalkonium chloride corneal toxicity post-cataract surgery

2020 ◽  
Vol 17 (1) ◽  
pp. 56-60
Author(s):  
Keith Ong ◽  
Leonard Ong
Keyword(s):  
Cataract Surgery ◽  
Benzalkonium Chloride ◽  
Corneal Stroma ◽  
Eye Drops ◽  
Descemet's Membrane ◽  
Corneal Toxicity ◽  
Descemet’S Membrane ◽  
Free Steroid

Two patients with presumed benzalkonium chloride (BAK) corneal toxicity after routine cataract surgery are presented. Patient 1 had corneal stroma and Descemet’s membrane folds. Patient 2 had moderate superficial punctate epithelial erosions (SPEE). They were on Chlorsig, Maxidex, and Acular eye drops tds postoperatively. The corneas of these two patients improved when BAK was removed or minimized from the postoperative eye drop regimen. Two vials of 1 ml dexamethasone 4mg/ml for injection were added to Chlorsig 10 ml bottle to substitute for Maxidex eye drops. BAK toxicity should be suspected when the cornea is not as clear as expected postoperatively. A practical way to eliminate BAK from postoperative eye drops is described, and would be useful until pharmaceuticals mass-produce BAK-free steroid eye drops economically.

Lens and Anterior Uvea

2022 ◽  
pp. 359-392
Keyword(s):  
Macular Edema ◽  
Anterior Uveitis ◽  
Clinical Signs ◽  
Inflammatory Cells ◽  
Clinical Findings ◽  
Eye Drops ◽  
Systemic Diseases ◽  
Intravitreal Triamcinolone ◽  
Keratic Precipitates ◽  
Intravitreal Triamcinolone Injection

This chapter illustrates photos of clinical signs seen in uveitis and interesting cases of lens pathologies. Anterior uveitis is the inflammation of the iris and the ciliary body. Anterior uveitis can be idiopathic, isolated, or associated with systemic diseases. The clinical findings observed in anterior uveitis include keratic precipitates, inflammatory cells and flare in anterior chamber, hypopyon, rarely hyphema, miosis, iris nodules and atrophy, synechiae, and band keratopathy in chronic cases (shown in corneal degenerations chapter). The inflammation in anterior uveitis is almost always immune. Treatment includes steroid eye drops, cycloplegic drops, sub-Tenon steroid injections when cystoid macular edema is present. Chronic macular edema can be treated with intravitreal Triamcinolone injection and Dexamethasone implants. In cases of refractory anterior uveitis or associated immune systemic diseases, immunomodulatory treatment or biologic agents are prescribed.

scholarly journals Case Reports for Topical Treatment of Corneal Ulcers with a New Matrix Therapy Agent or RGTA® in Dogs

2019 ◽  
Vol 6 (4) ◽  
pp. 103
Author(s):  
Jessica A. Martinez ◽  
Franck Chiappini ◽  
Denis Barritault
Keyword(s):  
Case Reports ◽  
Primary Treatment ◽  
Bullous Keratopathy ◽  
Eye Drops ◽  
Corneal Ulcers ◽  
New Therapeutic Approaches ◽  
Time Period ◽  
New Treatment ◽  
Ophthalmic Treatment ◽  
Ulcerative Keratitis

Superficial corneal ulcers that fail to heal within a normal time period and are refractory to conventional therapy in dogs are common in veterinary practice. Different etiologies can lead to this result, including spontaneous chronic corneal epithelial defects (SCCEDs) and ulcerative keratitis associated with bullous keratopathy. Thus, there is an urgent need to find new therapeutic approaches such as matrix therapy replacement. To determine the efficacy of a new ophthalmic treatment (Clerapliq®) for SCCEDs and ulcerative keratitis associated with bullous keratopathy, a total of 11 dogs referred to the clinic because of nonhealing erosive ulcers after a classic primary treatment were enrolled to get this new treatment. Dogs underwent ophthalmic exams and 7 dogs (10 eyes) were diagnosed with superficial ulceration and 4 dogs (5 eyes) with bullous keratopathy due to endothelial dystrophy/degeneration. They received eye drops of Clerapliq® every 3 days until recovery. The results showed that the corneas with recurrences of the ulcers were resolved predominantly by using Clerapliq® every 3 days in 83.3% of the cases during a period of treatment ranging between 6 to 35 days. Therefore, this new approach using matrix therapy regenerating technology in treating superficial ulcers and bullous keratopathy in dogs can be successfully considered as an adjunctive therapy.

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