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D.E. Brooks, M.E. Lassaline, M.E. Kallberg, A.M. Komaromy, K.N. Gelatt, F.J. Ollivier; Deep Lamellar Endothelial Keratoplasty in Horses with Deep Stromal Abscessation . Invest. Ophthalmol. Vis. Sci. 2004;45(13):4804.
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Purpose:Corneal epithelial micropunctures inoculate microbes and/or foreign bodies into the posterior stroma to cause deep stromal abscesses (DSA) at the level of Descemet's membrane and endothelium in horses. These DSA are often medically nonresponsive and associated with blinding iridocyclitis. A modification of the Melles/Terry deep lamellar endothelial keratoplasty (DLEK) surgical technique was utilized in eight horses with focal DSA. Methods:Retrospective medical records study. The DLEK procedure involves an 18–25 mm limbal incision to a depth just anterior to Descemet's membrane, lamellar dissection to expose and remove the DSA, sutureless placement of a split–thickness, frozen, stromal/endothelial graft, and closure of the limbal incision with 7–0 vicryl. An 8 yr old Quarterhorse gelding, 1 yr old Thoroughbred colt, 17 yr old Paint mare, 5 yr old Tennessee Walking Horse mare, 8 yr old Thoroughbred mare, 4 yr old Quarterhorse stallion, 9yr old Thoroughbred mare, and a 3 yr old Thoroughbred filly received the DLEK procedure. Results:The abscesses ranged from 3–8 mm in diameter. Healing was achieved in 14–30 days in six horses, although only one graft remained transparent. Intralesional hyphae (n=4) and hyphae/eosinophils were present (n=1) in histologic specimens of the SA. Complications included wound dehiscence (n=1), suture line infection with beta hemolytic Streptococcus (n=1), and sandwich keratitis (n=1). One horse died of intestinal problems and a second from septic pneumonia and colitis. Conclusions:This procedure has a high rate of tectonic success and a high level of graft rejection in the therapy of DSA of horses. There appears to be more to the etiology and pathogenesis of DSA than microtrauma.
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