SAEVA Congress 2018 Proceedings | 12-15 February 2018 | ATKV Goudini Spa
injections are administered in a similar manner, one across the centre of the lesion and the other
across the ventral aspect of the lesion. All doses are injected in the corneal stroma just anterior to the
lesion, covering as much of the abscess bed as possible. Some form of magnification should be used
[eg: operating loupe]
When the voriconazole is injected into the stroma one may see corneal lamellar
fracturing. This opacity usually improves within a few days. This procedure obviously
carries a risk of anterior stromal laceration, intracameral injection and conjunctival
congestion. One may also find that non sensitive organisms are spread further within
the stroma along the needle tract. This procedure most likely will result in regression
of corneal vascularisation, resolution of cellular infiltrate in the abscess bed, and
frequently a grey coloured scarred area in the stroma may remain. The obvious
advantages of the procedure are the high concentration of the drug directly at the
site of the fungal abscess, less mechanical disruption to the cornea and improved
clearance of material from the stroma.
Reference:
1. Smith K, Pucket J and Gilmour M
Treatment of six cases of equine
corneal stromal abscessation with
intracorneal
injection
of
5%
voriconazole
solution
Veterinary
Ophthalmology
(2014)
17,
Supplement 1, 179–185
2. Tsujita H and Plummer C Corneal
stromal abscessation in two horses
treated
with
Intracorneal
and
subconjunctival injection of 1%
voriconazole
solution
Equine
Veterinary Ophthalmology (2013) 16,
6, 451–458
9] Enucleation and intraorbital prosthesis
It is unfortunately not unusual that a stromal abscess eventually leads to extensive
panophthalmitis and loss of the globe. In cases like this the globe needs to be
removed by enucleation or excenteration.
The decision making regarding the use of an intraocular or intraorbital
prosthetic device depends on the initial pathology in the globe/orbit prior to
the decision making between performing an enucleation or an excenteration:
An enucleation would be chosen when:
•
•
•
There is end stage uveitis or panophthalmitis when the globe is unlikely
to rupture whilst being removed.
Intraocular neoplasia
End stage glaucoma
90