Intravitreal injection of low-dose gentamicin for the treatment of recurrent or persistent uveitis in horses: Preliminary results.
Authors: Fischer Britta M, McMullen Richard J, Reese Sven, Brehm Walter
Journal: BMC veterinary research
Summary
# Editorial Summary Recurrent uveitis remains a significant clinical challenge in equine practice, with many cases failing to respond adequately to conventional topical and systemic anti-inflammatory therapy, leaving owners with limited options when surgical interventions such as pars plana vitrectomy or cyclosporine implants are contraindicated, unavailable, or declined. Fischer and colleagues conducted a prospective case series of 86 horses receiving low-dose intravitreal gentamicin injections (4 mg in either diluted or preservative-free formulations) as an adjunctive treatment, meticulously documenting the injection technique, complications occurring within 24 hours and up to 780 days post-injection, and clinical response to therapy, whilst also investigating whether systemic or ocular Leptospira seropositivity influenced outcomes. Of the 59 horses with documented follow-up data, the treatment demonstrated therapeutic benefit in controlling uveitic inflammation, though the authors documented both immediate peri-injection complications and delayed post-injection adverse events requiring careful monitoring and owner counselling. This preliminary data—the first published objective assessment of intravitreal gentamicin in horses—provides a potential adjunctive option for cases refractory to conventional management, though practitioners should consider the complication profile and undertake appropriate diagnostic investigation for Leptospira before proceeding, particularly given the limited sample size and follow-up heterogeneity. The findings warrant further investigation with larger cohorts and standardised follow-up protocols to establish efficacy benchmarks and safety profiles relative to alternative surgical or medical interventions.
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Practical Takeaways
- •Intravitreal gentamicin injection offers a potential adjunctive treatment option for horses with recurrent/persistent uveitis when surgical options are contraindicated, unavailable, or declined by owners
- •The procedure can be performed under sedation and local anesthesia as an office-based treatment, making it more accessible than surgical alternatives
- •Leptospira status should be evaluated as it may influence treatment outcomes in equine recurrent uveitis cases
Key Findings
- •Intravitreal gentamicin injection (4 mg) was performed in 86 horses with recurrent or persistent uveitis under sedation and local anesthesia
- •Follow-up data was available for 59 of 86 horses over 30-780 days post-injection
- •Study evaluated both peri-injection complications (within 24 hours) and post-injection complications (30-780 days)
- •Leptospira status (systemic and ocular) was assessed and evaluated for effect on treatment outcome