SAEVA Congress 2018 Proceedings | 12-15 February 2018 | ATKV Goudini Spa
ulcers generally are very painful for horses and the iridocyclitis can be suppressed
by the application of 1% atropine drops. Atropine not only causes cycloplegia but
also stabilises the blood-aqueous barrier and the mydriasis maintains a visual axis
and prevents posterior synechiae. Oral or systemic non steroidal anti inflammatory
drugs should also be used. The melting component can be reduced by using serum
which contains growth factors, fibronectin and vitamins which assist in supporting
corneal epithelial cells. Ten percent acetylcysteine or 0.17% dipotassium EDTA can
also be administered.
The following treatment options have been described for stromal abscess [note the
differentiation between ulcerated and non-ulcerated abscesses]. In spite of these
medications, infected ulcers usually progress into deep corneal ulcers where
Descemet’s membrane is reached and perforation of this 3-12µm membrane can
occur. In these cases a surgical option is usually the best, not only to provide a blood
supply with nutrients to the affected site but also give strength and stability to the
defective area of the cornea. Placing a conjunctival pedical flap, corneal
transposition grafts, intestinal mucosa grafts and amnion membrane transplantation
are all viable treatment options. The goal of any ocular surface reconstruction
[tectonic grafts] is to preserve the integrity of the globe, provide support, optimise the
visual outcome and minimize the scar.
1] Topical medical management alone. This is a very conservative option and
should initially be used but if there is no further improvement noted in a short time
ideally a decision should be made for a more aggressive approach if possible.
2] Superficial keratectomy [SK]:
This procedure is performed using a straight and beveled-up corneal knife or corneal
elevator. An alternative to simply removing the epithelial layer, is an Algerbrush. SK
alone may rid very superficial material and can aid penetration of drugs.
3] Superficial keratectomy with Conjunctival Pedical Graft [CPG]:
A SK is performed over the site of the lesion and then the CPG is crafted from the
bulbar conjunctiva and translocated onto the cornea so that this tissue can provide
extra strength to the weakened cornea over the SK site. These grafts contain blood
vessels and lymphatics, thus offering significant antibacterial, antifungal, antiviral,
antiprotease, and anticollagenase effects. This is mediated via PMNs, antibodies,
plasma, and α-2- macroglobulins which are brought directly into the corneal ulcer
bed.
4] Superficial keratectomy and Amnion graft.
Cryopreserved or freeze dried amnion, which is one of the layers from the fetal placenta has
been shown as an excellent source of basement membrane or support structure for
supporting the proliferation, migration and adhesion of new corneal epithelial cells This can
be used to enhance healing by acting as a biologic bandage. Basically the amniotic
membrane stroma gets repopulated with keratocyte derived cells and builds new tissue.
This source of tissue will assist in suppressing inflammation and promoting corneal
surface healing. The benefits of amnion grafting for contributing to corneal healing
include:
•
•
It is avascular [no blood vessels]
Anti-inflammatory effects - IL-1ra, IL-10, Apoptosis
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