Uveitis and a Detached Retina: Surgery to Save Horse's Vision

Professor Hartmut Gerhards with the Clinic for Horses of Ludwig-Maximilians University of Munich, Germany, travelled half-way around the world to perform a vitrectomy on a horse at the Louisiana State University School of Veterinary Medicine. Gerhards was assisted by Dr. Bettina Wollanke of Munich, and Eric S. Storey, DVM, MVSc, Dipl. ACVO, assistant professor of ophthalmology at the LSU School of Veterinary Medicine. While vitrectomies are performed regularly in Germany, they are rarely performed in the United States. This is the first time this procedure has been performed on a horse at LSU.

The horse, Lexius (Lexi), a 13-year-old Dutch Warmblood mare, had an infection in the vitreous that caused chronic inflammation and uveitis in both eyes. The most likely cause of the infection is the bacteria leptospirosis. Uveitis is the most common inflammatory change to the uvea of the horse and can affect up to 12% of the population. It is the main cause for the blinding of horses. Lexi also has a detached retina in her left eye, and plans are being made to reattach her retina soon in a separate surgery.

When Lexi was first presented at the LSU School of Veterinary Medicine, Bob Gardes of Lafayette, La., was trying her out as a competition horse when a pre-purchase exam uncovered a recent problem with her eyes. Bob called his friend Julie Calzone who had known the horse for many years, and the two of them set up a consultation and exam with Storey.


Dr. Bettina Wollanke (left) assists Professor Hartmut Gerhards as he performs a vitrectomy on an equine patient at the LSU School of Veterinary Medicine's veterinary teaching hospital.

At that time, Storey diagnosed Lexi with uveitis in both eyes and a detached retina in the left eye. "It took Bob and I less than a minute to shake hands and agree to take joint ownership of Lexi," said Calzone. "Someone has to help the horse," said Gardes. "She can't speak for herself." The two new owners were given three treatment options by Storey. "First, we could treat the symptoms," said Storey. "The horse would still go blind, but it would be delayed. Second, we could give the horse cyclosporine A implants, which are placed between the sclera and the uveal tissue. The implants slowly release cyclosporine to eliminate the inflammation and fight the infection. Third, we could perform a vitrectomy, where the gel behind the lens and in front of the retina is removed and replaced with intravenous fluid."

Bob and Julie opted for the third treatment, along with a grant to pay for the procedure and whoever needed to be there for the surgery.

"We have long suspected that leptospirosis caused uveitis in most cases," continued Storey. "Gerhards is the first person to effectively prove that in clinical cases. He removes the vitreous, cultures it, and conducts a polymerase chain reaction (PCR) test to look for DNA of the bacteria. He has shown that the bacteria are present in a high number of cases." Cyclosporine implants are successful because they suppress the inflammation and possibly the growth of the bacteria, but the results are not permanent; removing the vitreous gel entirely potentially offers a life-long cure. "Removal of the vitreous and antibiotics in the IV fluid help prevent recurrence in many horses," said Storey.

According to Storey, vitrectomies have been frequently performed in Germany since the 1990s and seem to offer a life-long cure. The LSU School of Veterinary Medicine is equipped to perform the procedure, but no one at the School had performed the procedure in horses. "The only person in the world who has performed this procedure many, many times is Dr. Hartmut Gerhards in Germany," said Storey. "We called and asked him to come perform the surgery."

Gerhards performed the surgery Sept. 22 with his assistant, Wollanke, and Storey. Gerhards brought some specialized equipment with him, specifically a handpiece and a vitrectomy base unit that runs it. The surgery took approximately 1.5 hours, and Lexi is doing well one month after surgery. Storey plans to travel to Germany to assist Gerhards with other vitrectomies so that he will be able to offer the procedure at LSU in the future.

"Both Bob and I feel very strongly that Lexi called all the shots including picking Storey and LSU," said Calzone. "We knew we were chosen to stand by her while she led the way for a new life and new eye sight, not only for herself but for other horses in North America. She is a very special horse, and we all are fortunate that she chose us. Needless to say, if it weren't for Storey and LSU none of this would have been possible."

Lexi's recovery is excellent. Gardes and Calzone had first intended to breed Lexi in the spring, but that plan has changed. She's returning to work and will be shown by Gardes. Calzone has agreed to be the groom.

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