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equine Ophtho junior > Equine Recurrent Uveitis > Flashcards

Equine Recurrent Uveitis Flashcards

1
Q

Leading cause of Blindness in horses

A

ERU

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2
Q

Uveitis starts as

A

blood-ocular barrier compromise

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3
Q

Chemical and cellular mediators that leak from vessels

A
  1. PMNs
  2. then Lymphocytes
  3. Inflammatory cytokines
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4
Q

Consequences of vascular permeability (5)

A
  1. Formation of exudates that adhere to post iris, CB, and choroid
  2. Inclusion bodies in non-pigmented ciliary epithelium
  3. Exudates interfere with uveal function
  4. Exudates accumulate around ciliary processes and iris
  5. Iris and ciliary body become swollen, edematous and infiltrated with inflammatory cells
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5
Q

ERU Lymphocyte infiltration (6)

A
  1. Heavy influx into uveal/other eye tissues
  2. Clusters resembling follicles in ciliary body
  3. T-cells predominate, MHC Class II reactive
  4. inflammation of choroid
  5. Tissue damage from cytokines, immune interaction
  6. Altered function=loss blood supply to retina
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6
Q

Retinal Pathology (5)

A
  1. Lympocyte infiltration at the Retinal pigmented epithelium
  2. Thickened inner limiting membrane
  3. Degeneration of photoreceptors
  4. Subretinal exudate from choroidal vasculature
  5. Retinal folds and detachment at retinal pigmented epithelium
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7
Q

Signs of acute Uveitis (5)

A
  1. Hypopion
  2. Hyphema
  3. Aqueous flare
  4. Fibrin
  5. Keratic Precipitates
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8
Q

Signs of chronic Uveitis (12)

A
  1. Synechiae
  2. Cataract
  3. Iris color change
  4. Corneal vacularization
  5. Permanent corneal edema
  6. Corneal bullae and ulcers
  7. Corpora nigra atrophy
  8. Band keratopathy
  9. butterfly lesions (chorioretinal scars)
  10. Glaucoma
  11. Lens lux
  12. Phthisis bulbi
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9
Q

Glaucoma CS (5)

A
  1. Corneal edema
  2. Mydriasis
  3. Haab’s striae-breaks in descemet’s mem
  4. Buphthalmia
  5. Accompanying uveitis
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10
Q

Phthisis bulbi (2)

A
  1. Shrunken globe

2. End-stage something….

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11
Q

Classic Uveitis

A
  1. CS of acute uveitis
  2. Episodic recurrence, variable intervals
  3. Gets chronic signs over time
  4. Unilateral I think
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12
Q

Likely pathogenesis of ERU (3)

A
  1. Immune cells enter eye and recognize self antigen
  2. Recurrent episodes likely from ‘epitope spreading’
  3. Persistence of organism doesn’t commonly play a role
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13
Q

Appies more likely to suffer uveitis than other breeds by

A
  1. 3 times
    - sparse main/tail, light pigment
    - fewer spots less ERU (Leopards)
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14
Q

Risk factors for Lepto (5)

A
  1. Pasture access to cows, pigs, deer
  2. Close proximity to ponds/rivers
  3. Use of pond water for drinking
  4. Rat infestation
  5. Heavy rainy season
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15
Q

Theories of lepto link

A
  1. Due to direct toxicity - initially yes
  2. Autoimmune disorder triggered by molecular mimicry-probably
  3. Leptospira modulating immune response-possibly
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16
Q

Percentage of eyes with uveitis losing sight if Lepto + (11 yrs): (4)

A
  1. lepto positive and appy: 100%
  2. lepto neg and appy: 71%
  3. lepto pos and non appy: 52%
  4. lepto neg non appy: 34%
17
Q

Steroids and uveitis

A

> 25% of horses with uveitis suffer corneal ulcers over time (Steroid treatment can be dangerous)

18
Q

Outcome of Uveitis (3)

A
  1. NO MATTER WHAT, many uveitic horses go blind
  2. Some horses have to be euthanized
  3. Some horses can live on as family pets
19
Q

Sequelae of uveitis (7)

A
  1. > 25% horses suffer corneal ulcers
  2. 25% have corneal scars
  3. 6% develop calcium plaques on cornea (difficult to treat)
  4. Posterior synechia
  5. lens lux
  6. cataracts
  7. glaucoma
20
Q

Pars Plana Vitrectomy (4)

A
  1. Sucks out vitreous
  2. Obtain sample for PCR, culture
  3. Decrease vitreal opacities
  4. Reduces severity and number of uveitis episodes in humans
21
Q

Vitrectomy case selection (4)

A
  1. Recurrent uveitis despite treatment
  2. Minor intraocular changes
  3. ERU causes by persistent intraocular lepto
  4. Vitreal opacities
22
Q

Vitrectomy contraindicated if

A

extensive posterior synechiae

23
Q

Complications of vitrectomy (7)

A
  1. Recurrence of uveitis
  2. Post surgical uveitis-expected
  3. Cataract
  4. vitreal hemorrhage
  5. Hyphema
  6. Anterior segment fibrin
  7. Retinal detachment
24
Q

Cyclosporine implant (7)

A
  1. Biodegradeable, implanted w/in suprachoroidal space
  2. Blocks IL-2 production
  3. Minimizes T lymphocyte production
  4. Induces immunosuppression
  5. Delivers 4 micrograms/day for up to 5 years
  6. 81% have less inflammation and attacks
  7. 87% are visual at 14 moths postop
25
Q

CsA implant candidate selection (5)

A
  1. Good response to traditional medical therapy
  2. Lack concurrent ocular dz (glaucoma, cataract)
  3. Little to no active inflammation (PRETREAT)
  4. Frequent relapse uveitis or early relapse ERU after d/c meds
  5. Educated owner
26
Q

Vaccine recommendations for Lepto

A
  1. If normal eyes and seronegative for lepto
  2. High risk farms
  3. No other drugs or vaccines on same day
27
Q

Salvage proc

A
  1. Enucleation
  2. Intrascleral prosthesis (ISP)
  3. Ciliary body ablation (for glaucoma) 25-100 mg gentamycin

equine Ophtho junior (14 decks)

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