Cutting Edge Treatments In International Veterinary Ophthalmology

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Significant medical and surgical advances have occurred in veterinary ophthalmology in the last fifty years. While the administration of topical ophthalmic preparations in small animals is usually simple, the use of the subpalpebral system for medication of the horse eye is of considerable benefit. New antibiotics have been introduced to combat bacterial resistance, which continues to be a problem. Topical antifungal agents remain for the most part, fungostatic, and additional drugs are needed. Drugs to control or eliminate endogenous proteinases and collaganase in corneal ulceration are urgently needed.

Medical therapy of the glaucomas has experienced continuous change with the introduction of topical beta antagonists, carbonic anhydrase inhibitors, alpha agonists, and most recently, prostaglandins. Of these agents, the prostaglandins (PGs) produce the greatest declines in intraocular pressure (IOP) in the normal and glaucomatous dogs. Preliminary reports of prostaglandins in normal cats indicate no or limited changes in IOP. New drugs that provide glaucomatous eye neuroprotection and/or neuroregeneration by the reduction of the damage associated with the release of the neurotransmittor, glutamate, and the influx of intraneuronal calcium, are forthcoming.

Cyclosporine A has markedly improved the therapy of keratoconjunctivitis sicca in dogs, causing the majority of these patients to secrete sufficient levels of tears to resolve the signs of this disease. Other immune-me-diated external eyes diseases, such as chronic superficial keratitis, and plasma cell infiltration of the nictitans, may also be controlled with topical cyclosporine A. Intracameral plasminogen tissue activator (tPA) has proven highly successful in producing fibrinolysis of blood clot and clotted fibrin of less than two weeks duration in all animal species. Medical and surgical attempts to control angiogenesis, inflammation, postoperative fibrosis, and lens capsular fibrosis are still early, but advances are forthcoming.

Opportunities for improved surgical procedures are considerable and will advance patient care with eyelid, corneal, lens and vitreoretinal disorders. Corneal grafts, improved glaucoma anterior chamber by-pass devices, improved IOLs, and higher success rates for vitreoretinal surgeries are predicted. Based on the past one-half century, significant and profound improvements in both pharmacological and surgical treatments of animal eye patients will be possible.