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Phillla (Phillla)
| | Posted on Wednesday, Jan 31, 2001 - 2:52 pm: |   |
My horse with ERU and secondary glaucoma is currently having a bad flare-up. We were very concerned at first that we were heading down the path of enucleation this trip, but seem to have been able to control it. However, I'm more interested than ever at surgical options for both the ERU and the glaucoma. While I believe at this point he's lost all sight in this eye, I'd like to be able keep him pain free so we can at least keep the eye intact (and do ANYTHING, surgical or otherwise, to keep the sight that he does have in the other eye).
Does anyone have any more recent experience or knowledge about surgical options for ERU, namely vitrectomy or the insertion of cyclosporine implants? Any idea of which one is more effective at preventing subsequent episodes? Any ideas of which types of horses/situations are better suited to one procedure over another?
Is anyone other than Dennis Brooks performing vitrectomies? What happened with the study that was being done on the cyclosporine implants? I believe the study ended some time ago...is anyone doing this procedure right now?
The laser surgery for glaucoma--I've heard of at least one horse that has had both this surgery and the surgery to implant the cyclosporine implants. Is it common for a horse to tolerate both surgeries well? Could they be done at the same time, or would they have to be done separately?
I know...I'm just full of questions  Any current information or experience that anyone has on any of these procedures would be much appreciated.
Laura |
Robert N. Oglesby DVM (Dro)
| | Posted on Thursday, Feb 1, 2001 - 8:17 am: | |
Hello Philla,
Vitrectomy and the result of 400 case studies was discussed last month at the AAEP meeting and I have included a summary and discussion of that meeting in the article on ERU that you will find at, Equine Diseases: Eye Diseases: Anterior Uveitis, Recurrent Uveitis, Periodic Opthalmia, and Moonblindness.
DrO |
debbie gregory-wehn (Chanda)
| | Posted on Wednesday, Jan 31, 2001 - 7:21 pm: | |
Laura,
I have a 21 year old appy mare with ERU. I joined the ERU network off of the web. You pay a one time membership. There are newsletters and info from other owners with horses who have this terrible disease. It is headed up by Mary Nelson. The web site is www.igs.net/~vkirkwoodhp/eru.htm. The last I heard the implants were being done at North Carolina U. Good luck. Debbie |
Phillla (Phillla)
| | Posted on Thursday, Feb 1, 2001 - 9:25 am: | |
Thanks for such a quick response guys.
Dr. O--I read the article (very thorough!) you put together, but I didn't see any information about vitrectomies in the US, only the German research. I guess when I asked if you knew of anyone other than Dennis Brooks doing vitrectomies, I meant in the U.S. Was I hasty in my read of the article and just missed it?
At the AAEP meeting, was there any discussion about the lepto in Germany being different than the lepto in the US, and that possibly vitrectomies were more successful in German horses than American horses because of that?
Assuming my horse is a candidate, I'm pretty aggressively pursuing a surgical treatment in addition to what we've been doing. I'm really trying to understand whether the vitrectomy or the cyclsporine implants would be a better option for him...but I'm having trouble finding enough information about either.
I understood the German research (particularly as summarized in your article) to imply that postoperative cataracts were a real concern with vitrectomies. Does that mean that only eyes affected by ERU where most or all sight has been lost are good candidates for vitrectomy? Whereas if the ERU-affected eye still had sight, you'd rather not do a vitrectomy (and that would tilt the scales toward the cyclosporine implants)?
Debbie--Thanks for the info on the network. I sent the form and fee to Mary several days ago; I imagine she's already sent me back materials, I just haven't gotten them yet. I'm hopeful there's more recent info in there. The most recent info I was given was that the cyclosporine implants were being studied at North Carolina, the research was extended to Ohio State, but was completed sometime this past summer (i.e., no more studies active, so no way to get my horse the cyclosporine implants in a study environment). I'm unclear whether the cyclosporine implants are being done anywhere right now, either inside or outside a study.
Just made an appointment to take my horse to Ohio State next week, so hopefully will get lots of information then.
Will let you guys know anything noteworthy I find out. |
Robert N. Oglesby DVM (Dro)
| | Posted on Friday, Feb 2, 2001 - 8:21 am: | |
There is no reason at this time to think that the Lepto in Germany is different.
Concerning case selection, I think it was clear they believe that the earlier in the disease process this procedure is done the better the prognosis.
I did note that your horse has glaucoma. In severe cases of glaucoma (> 50 mm Hg) the long term prognosis is poor to guarded in their opinion: vitrectomy may not correct the abnormality.
DrO |
Sue Lander (Slander)
| | Posted on Friday, Apr 20, 2001 - 9:16 am: | |
Laura,
I just found out my horse has ERU, have you found out about any more treatment options since your last note in February?
Sue |
Phillla (Phillla)
| | Posted on Friday, May 11, 2001 - 10:26 pm: | |
Sue,
Sorry for the delay in my response. Here's what additional info I know now (not much):
Vitrectomy or cyclosporine implants are, to the best of my knowledge, the only surgical options addressing ERU right now. However, the cyclosporine implants are now available in a slightly different procedure that's less invasive than the original procedure (though still only being done at North Carolina and Ohio State, as far as I know).
During our trip to Ohio State, we decided not to pursue any surgical treatment at that time for my horse. We confirmed (after much examination) that he has indeed lost all sight in his affected eye. In addition to ERU, secondary glaucoma, and cataracts, that eye is also affected by phthisis bulbi (which is a shrinking of the eye itself from chronic inflammation). We're taking a sort of "wait and see" approach to his care, but basically we'll end up going down one of two paths: Recurrences are manageable in terms of duration, frequency and intensity and the eye continues to shrink because of the phthisis bulbi and eventually the eye will shrink so much that both the ERU and the glaucoma will resolve themselves and his eye, other than being smaller and sightless, won't cause him any more trouble. Alternatively, the duration, frequency and intensity of subsequent flare ups is such that we just do the enucleation (basically weighing the risks of general anesthesia vs. the discomfort that flare ups are causing him...as soon as the discomfort outweighs the surgical risk, go for the enucleation).
At this point, he's been recurrence-free for over 2 months, the eye is clear and bright, and has definitely shrunken some more. Keeping our fingers crossed
A couple of other thoughts in terms of surgical options: Horses with moderate-to-severe cataracts are not candidates for the original cyclosporine implant surgery because the cataracts obscure too much of the surgical field. Not sure about what that means in terms of candidacy for the newer procedure.
Also, vitrectomy is a permanent solution (i.e., that surgery would only need to be done once). The cyclosporine implants only last a limited amount of time (no one knows for sure how long, but approximately 3 years), and then your horse would need to have another surgery to implant new cyclosporine implants. As far as I know, Dennis Brooks continues to be the only veterinary opth. in the US performing vitrectomies, so you'd probably have to go to him (in Florida) to get that done.
This past February (after our trip to OSU), my horse had a flare up (nowhere near as bad as the January flare) that was controlled, at least in part, with electro acupuncture. So you might want to consider electro acupuncture (some other people in the ERU network have also reported treatment success with this). If my horse has another flare-up, one of the first things I'll do is call my vet that's also IVAS certified in acupuncture and do that treatment again. Also, I just put this horse on VitaFlex Accel. I was looking for a multi-mineral supplement and chose this one. Since starting Accel, he hasn't had another flare and his eyes have been sparkling bright and clear. Could be total coincidence, who knows (that's part of my personal theory that keeping immune function strong is a good thing in terms of reducing ERU flare ups).
I think that's about all I know that's new. Will be going back to Ohio State for a "well baby" check-up in August (to monitor the affected eye and to closely monitor the unaffected eye to make sure it's really unaffected). Whatever news I get then I'll share.
Laura |
Phillla (Phillla)
| | Posted on Friday, May 11, 2001 - 10:44 pm: | |
I just thought of one other thing that I learned...
Unlike dogs or other animals used in competitions where cosmetic appearance is important, horses are not good candidates for prosthetic eyes (in the case that you ended up removing the eye). The risk of infection and other complications is high...odds are high that after much grief, you will end up removing the prosthetic eye. Ohio State strongly advised against trying to do this. |
Robert N. Oglesby DVM (Dro)
| | Posted on Saturday, May 12, 2001 - 9:05 am: | |
That has been my experience also with prosthetics. Great job sumerizing your experiences Philla.
DrO |
Cynthia Strech
Member
Username: 4merri
Post Number: 10
Registered: 8-2004
| | Posted on Friday, May 13, 2005 - 8:59 am: | |
Hi:
I have been battling this ERU with severe corneal ulcers resulting in very advanced secondary Glaucoma for almost a year now, with 4 different vets; two Opthalmologists. Originally there was a mis-diagnosis of Linear Kertopathy; but the initial flair ups were so bad that no ocular internal structures were able to be seen. My mare was in such excrutiating pain she was in a debilitated state for days, even under heavy pain medication. The flair ups were consistantly about every month and just about that long to get them under control. Result: I took her to MSU consulted with another opthalmologist who recommended enucleation. But the other thing that was highly and consistantly recommended, was: NO VACCINATIONS!! until the eye comes out. This was the recommendation by 4 different vets. Another recommendation: no stress, change in diet or heavy training, putting to much stress on the system/eye. Enucleation was the consensus, hands down, as prognosis was poor and she was already totally blind in the eye. She is currently taking Bute daily to help with the long term aggrevation of the eye pain. I have opted for the enucleation this week and will let you know how that goes. I think in the consideration for the horse you need to mull over the long term effects of flair-ups, infection and pain management with whatever drugs you are using to manage it. For me the clear cut answer was having a horse pain free. It breaks my heart, but it would break my heart more to see her suffer and possibly come down with some disease that I couldn't vaccinate her for. Just the thought that I will not have to live, literally from }day to day wondering if something is going to trigger these debilitating flair-ups will be a tremendous burden removed from both of us. She'll still be beautiful to me and SHE is not that vain. Cynthia |
Nancy S. Kaplan
Member
Username: Redalert
Post Number: 98
Registered: 10-2004
| | Posted on Friday, May 13, 2005 - 9:56 am: | |
Cynthia,
Thank goodness you are doing the right thing for your horse... I(my horse and I)battled with a different kind of eye problem for quite awhile, when enucleation was available to me the whole time. He ended up with dehabilitating gastric ulcers from all the stress, pain, and medications. Once I FINALLY had the eye enucleated, he never Looked back(no pun intended).He does not miss the eye at all...is the same horse in every way, except that he has to now stay on ulcer meds! I WISH I had done this for him sooner! I don't know what you are considering as a part of your horse's surgery, but, the surgeon put a silicone ball under the lid in the empty socket, so it looks like he just has a closed eye(no hollow socket). It is not bad looking...just wanted to offer you my support !!! Whatever you decide, cudos to you for choosing a better life for your horse in spite of the "cosmetics" of it! She must be very special!
Nancy |
Kim Fotter
Member
Username: Fpony
Post Number: 335
Registered: 9-1999
| | Posted on Saturday, May 14, 2005 - 7:00 am: | |
Hi Cynthia,
My pony also had his eye removed after a long summer of a painful eye that i couldn't get under control. He has the same dx as your horse. I think the ulcer were the most painful. He had this condition for 5 years and it had done very well. The choice is a hard one but I'm glad I stopped trying to fix the eye. He is now pain free. He still is cute as a button and seems to love life. He is getting use to total lose of sight in that eye. They told me he was blind before but he must have had some sort of slight movement or light in that eye as now he acts blind in it and never really did before. So your horse may have a slight adjustment,too. The silicpone ball worked well for us too.No complications.
Good luck.Let us know how the surgery goes and when it is scheduled. Kim and Foxy pony! |
