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Michael Zigler BSc, DVM (Guelph), CertVOphthal (RCVS-UK), MSc (Edinburgh). Pigmentary Uveitis

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Page 1: Pigmentary Uveitis - vetemergency.cavetemergency.ca/wp-content/uploads/2015/11/Pigmentary-Uveitis.pdfiridociliary cysts, pigmentary uveitis, ... Neighbour-joining trees of domestic

Michael Zigler BSc DVM (Guelph)

CertVOphthal (RCVS-UK) MSc (Edinburgh)

Pigmentary Uveitis

2285 Bristol Circle Oakville Ontario L6H 6P8

phone 905-829-9444 fax 905-829-9646

httpwwwvetemergencyca

e-mail mziglervetemergencyca

Pigmentary Uveitis - Clinical Signs Breed Predisposition

Golden Retriever Labrador Retriever Flat Coat Retriever Great Dane

No sex predisposition Age Ciliary Body Cysts 3 ndash 4 years Clinical Signs

In early cases it is hard to document overt inflammatory disease

Ciliary Body Cysts Iris cysts uveal cysts ciliary body cysts

Persistent or re-occurring conjunctivitis Progressive hyperpigmentation of the iris Pigment migration onto the anterior lens capsule Posterior synechia Focal cataracts - progressive Angle Closure Secondary Glaucoma

Iris Cysts

Dogs Cats

copy Dr Dennis Brooks copy Dr Maria Joao Vieira

Iris cysts seen in numerous breeds

Husky Boston Terrier

copy Dr Carla Kolta copy Dr Brian Watson

Always Measure IOP Normal Intraocular Pressure normal range varies depending

upon how the IOP is measured

Indentation tonometry

Schioumltz tonometer

15 to 25 mmHg Applanation tonometry

Tonopen (XL or Vet) 15 to 20 mmHg

Rebound Tonometry

Tonovet

12 to 18 mmHg

Pigmentary Uveitis ndash early signs

copy Dr David Whitney copy Dr Sara Patton

Pigmentary Uveitis

copy Dr John Sapienza

Pigmentary Uveitis with Iris Cysts

copy Dr Michael Zigler

copy Dr John Sapienza

Pigmentary Uveitis

copy Dr John Sapienza copy Dr Doug Esson

Pigmentary Uveitis ndash later signs

copy Dr April Hahn copy Dr Alison Litchfield

Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and

pigmentarycystic glaucoma over a decade in western Canada

Holly V Sandmeyer LS Bauer BS etal (2015) Golden retriever cystic uveal disease a longitudinal study of

iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada

Veterinary Ophthalmology DOI 101111vop12293

Some cysts remain hidden behind the iris

displacing the iris root forward resulting in

a shallow anterior chamber and possible

compromise of the drainage angle

Use of high-resolution ultrasound as a diagnostic tool in

veterinary ophthalmology

Bentley E Miller PE Diehl KA (2003) JAVMA 223

1617-1622

Ultrasound biomicroscopy (UBM) for

detection of canine uveal cysts

UBM 50 MHz probe

Regular ocular ultrasound

probe is 75 or 12 MHz

Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts

Type of probe detected

Ocular us probe 0

UBM probe sensitivity 47

specificity 92

Pathogenesis of Uveitis

The pathogenesis of uveitis An imbalance between the regulatory mechanisms and

inflammatory mechanisms contribute to uveitis Only some examples of contributing role

players such as regulatory T cells versus Th17 cells are shown A combination of

environmental risk factors and genetic risk factors tip the balance towards the development

or chronicity of uveitis RPE retinal pigment epithelium PMNs polymorphonuclear cells

Pathogenesis of Pigmentary Uveitis

What comes first

Uveal Cysts

Uveal Cysts Uveitis

Uveitis Genetic

predisposition

Genetic

predisposition

Golden Retriever Foundation Health Survey of 1444 Goldens (1998-1999)

0 ndash 3 yrs 3 ndash 8 yrs 8 ndash 13 yrs 13+ yrs Total

Uveitis 0 2 11 3 16

Iris Cysts 0 5 7 0 12

Eye dx all 381 1444

COPLOW

Cases

numerator denominator percentage

Glaucoma 530 2176 24

Golden

Retreivers

25 530 5

Iridociliary

Cysts

13 25 52

COPLOW ndash Comparative Ophthalmic Pathology Laboratory of Wisconsin

survey of 2176 enucleated or eviscerated dog eye submissions

COPLOWrsquos Cases of Glaucoma with Iris

Cysts in Golden Retrievers

large thin-walled cysts lined with attenuated cuboidal epithelium filling most of the posterior chamber (1313 100)

thick walled cysts containing hyaluronic acid (813 62)

a solid cellular proliferation (213 15)

a retro-corneal membrane associated with a defect in Descemets membrane (713 54)

iris bombe (513 38)

a pre-iridal fibrovascular membranes (413 31)

hemorrhage (413 31)

a cellular membrane on the anterior lens surface (613 46)

retinal detachment (513 38)

peripheral anterior synechia (513 38)

posterior synechia (613 46)

Pathogenesis of Secondary Glaucoma

in Pigmentary Uveitis

Glaucoma

Uveitis

PIFM

Synechia Cataracts

Uveal and Iris Cysts

b

a Cytokines

b Inflammatory

debris blocks

drainage angle

c PIFM blocks

drainage angle

d Synechia blocks

drainage angle

e Lens induced

uveitis

Golden

Retriever

Histopathology ndash ciliary cysts

copy Dr John Sapienza

The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in

the Golden Retriever

Veterinary Ophthalmology

Volume 12 Issue 6 pages 361-368 26 OCT 2009 DOI 101111j1463-5224200900732x

httponlinelibrarywileycomdoi101111j1463-5224200900732xfullf1

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf4

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf5

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf6

Treatment Options - Topical

Treatment Options - Oral

Treatment Options - Injectable

Triamcinolone

Administer 02ml (8mg) by

subconjunctival injection

Intravitreal injection

TPA - Tissue Plasminogen

Activator

Administer 02ml by

intracameral injection

Preparation of Triamcinolone

for intravitreal injection

Method to wash out

preservatives

Diagrams

Triamcinolone can be purchased in 40 mgmL or 10 mgmL

concentrations both of which have significant preservatives

when taken straight from the bottle

For intravitreal injection the preservatives must be washed out

by removing the liquid carrier and re-suspend the triamcinolone

in sterile balanced salt solution

Step 1 Draw 1 cc of triamcinolone (40 mgmL) into a 5 cc

syringe

Step 2 Place a 022 microm filter on the syringe and reattach the

needle

Step 3 Expel the fluid through the filter and discard it thereby

trapping the triamcinolone particles in the filter

Step 4 Draw 4 cc of sterile balanced salt solution into the

syringe thereby re-suspending the triamcinolone particles

Step 5 Expel and discard the fluid again and re-suspend the

triamcinolone particles by drawing up 4 cc of balanced salt

solution again The triamcinolone is now washed

Step 6 Remove the filter and needle and attach a blunt canula

for intraocular use The final concentration of triamcinolone is

10 mgmL

A Retisertreg B I-vationtrade implant

C Suprachoroidal implant D E Intravitreal

implants (eg Ozurdexreg Illuvien) F

microparticles nanoparticles liposomes G

Verisome system H Cortiject emulsion

The Future

Sustained drug delivery Intravitreal Anti-metabolite agents

Anti-VEGF therapy has

been used in the treatment

of glaucoma amp ocular

neovascular diseases

anti-angiogenic properties

anti-fibrotic properties

Bevacizumab amp

Ranibizumab

References Bentley E Miller PE Diehl KA (2003) Use of high-resolution ultrasound as a diagnostic tool in veterinary ophthalmology JAVMA

223 1617-1622

Corcoran KA Koch SA (1993) Uveal cysts in dogs 28 cases (1989-1991) JAVMA 203545-6

Deehr AJ Dubielzig RR (2002) A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers Veterinary Ophthalmology 1153-158

Devgan U (2006) Intraocular use of triamcinolone Removing preservatives from triamcinolone can minimize ocular toxicity and side effects Ocular Surgery News US Edition Dec 15th 20016

Esson D Armour M Mundy P Schobert CS Dubielzig RR (2009) The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in the Golden Retriever Vet Ophthalmol 12361-8

Holly VL Sandmeyer LS Bauer BS Verges L Grahn BH (2015) Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada Vet Ophthalmol doi 101111vop12293

Lin P Suhler EBet al (2014) The Future of Uveitis Treatment Ophthalmology 121 365ndash376

Sapienza JS et al (2000) Golden Retreiver Uveitis 75 cases (1994-1999) Veterinary Ophthalmology vol 3 Pg 241-246

Taylor LN Townsend WM etal (2015) Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts AJVR 76540ndash546

Townsend WM1 Gornik KR (2013) Prevalence of uveal cysts and pigmentary uveitis in Golden Retrievers in three Midwestern states JAVMA 2431298-301

vonHoldt BM et al (2010) Neighbour-joining trees of domestic dogs and grey wolves Nature doi101038nature08837

Page 2: Pigmentary Uveitis - vetemergency.cavetemergency.ca/wp-content/uploads/2015/11/Pigmentary-Uveitis.pdfiridociliary cysts, pigmentary uveitis, ... Neighbour-joining trees of domestic

2285 Bristol Circle Oakville Ontario L6H 6P8

phone 905-829-9444 fax 905-829-9646

httpwwwvetemergencyca

e-mail mziglervetemergencyca

Pigmentary Uveitis - Clinical Signs Breed Predisposition

Golden Retriever Labrador Retriever Flat Coat Retriever Great Dane

No sex predisposition Age Ciliary Body Cysts 3 ndash 4 years Clinical Signs

In early cases it is hard to document overt inflammatory disease

Ciliary Body Cysts Iris cysts uveal cysts ciliary body cysts

Persistent or re-occurring conjunctivitis Progressive hyperpigmentation of the iris Pigment migration onto the anterior lens capsule Posterior synechia Focal cataracts - progressive Angle Closure Secondary Glaucoma

Iris Cysts

Dogs Cats

copy Dr Dennis Brooks copy Dr Maria Joao Vieira

Iris cysts seen in numerous breeds

Husky Boston Terrier

copy Dr Carla Kolta copy Dr Brian Watson

Always Measure IOP Normal Intraocular Pressure normal range varies depending

upon how the IOP is measured

Indentation tonometry

Schioumltz tonometer

15 to 25 mmHg Applanation tonometry

Tonopen (XL or Vet) 15 to 20 mmHg

Rebound Tonometry

Tonovet

12 to 18 mmHg

Pigmentary Uveitis ndash early signs

copy Dr David Whitney copy Dr Sara Patton

Pigmentary Uveitis

copy Dr John Sapienza

Pigmentary Uveitis with Iris Cysts

copy Dr Michael Zigler

copy Dr John Sapienza

Pigmentary Uveitis

copy Dr John Sapienza copy Dr Doug Esson

Pigmentary Uveitis ndash later signs

copy Dr April Hahn copy Dr Alison Litchfield

Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and

pigmentarycystic glaucoma over a decade in western Canada

Holly V Sandmeyer LS Bauer BS etal (2015) Golden retriever cystic uveal disease a longitudinal study of

iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada

Veterinary Ophthalmology DOI 101111vop12293

Some cysts remain hidden behind the iris

displacing the iris root forward resulting in

a shallow anterior chamber and possible

compromise of the drainage angle

Use of high-resolution ultrasound as a diagnostic tool in

veterinary ophthalmology

Bentley E Miller PE Diehl KA (2003) JAVMA 223

1617-1622

Ultrasound biomicroscopy (UBM) for

detection of canine uveal cysts

UBM 50 MHz probe

Regular ocular ultrasound

probe is 75 or 12 MHz

Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts

Type of probe detected

Ocular us probe 0

UBM probe sensitivity 47

specificity 92

Pathogenesis of Uveitis

The pathogenesis of uveitis An imbalance between the regulatory mechanisms and

inflammatory mechanisms contribute to uveitis Only some examples of contributing role

players such as regulatory T cells versus Th17 cells are shown A combination of

environmental risk factors and genetic risk factors tip the balance towards the development

or chronicity of uveitis RPE retinal pigment epithelium PMNs polymorphonuclear cells

Pathogenesis of Pigmentary Uveitis

What comes first

Uveal Cysts

Uveal Cysts Uveitis

Uveitis Genetic

predisposition

Genetic

predisposition

Golden Retriever Foundation Health Survey of 1444 Goldens (1998-1999)

0 ndash 3 yrs 3 ndash 8 yrs 8 ndash 13 yrs 13+ yrs Total

Uveitis 0 2 11 3 16

Iris Cysts 0 5 7 0 12

Eye dx all 381 1444

COPLOW

Cases

numerator denominator percentage

Glaucoma 530 2176 24

Golden

Retreivers

25 530 5

Iridociliary

Cysts

13 25 52

COPLOW ndash Comparative Ophthalmic Pathology Laboratory of Wisconsin

survey of 2176 enucleated or eviscerated dog eye submissions

COPLOWrsquos Cases of Glaucoma with Iris

Cysts in Golden Retrievers

large thin-walled cysts lined with attenuated cuboidal epithelium filling most of the posterior chamber (1313 100)

thick walled cysts containing hyaluronic acid (813 62)

a solid cellular proliferation (213 15)

a retro-corneal membrane associated with a defect in Descemets membrane (713 54)

iris bombe (513 38)

a pre-iridal fibrovascular membranes (413 31)

hemorrhage (413 31)

a cellular membrane on the anterior lens surface (613 46)

retinal detachment (513 38)

peripheral anterior synechia (513 38)

posterior synechia (613 46)

Pathogenesis of Secondary Glaucoma

in Pigmentary Uveitis

Glaucoma

Uveitis

PIFM

Synechia Cataracts

Uveal and Iris Cysts

b

a Cytokines

b Inflammatory

debris blocks

drainage angle

c PIFM blocks

drainage angle

d Synechia blocks

drainage angle

e Lens induced

uveitis

Golden

Retriever

Histopathology ndash ciliary cysts

copy Dr John Sapienza

The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in

the Golden Retriever

Veterinary Ophthalmology

Volume 12 Issue 6 pages 361-368 26 OCT 2009 DOI 101111j1463-5224200900732x

httponlinelibrarywileycomdoi101111j1463-5224200900732xfullf1

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf4

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf5

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf6

Treatment Options - Topical

Treatment Options - Oral

Treatment Options - Injectable

Triamcinolone

Administer 02ml (8mg) by

subconjunctival injection

Intravitreal injection

TPA - Tissue Plasminogen

Activator

Administer 02ml by

intracameral injection

Preparation of Triamcinolone

for intravitreal injection

Method to wash out

preservatives

Diagrams

Triamcinolone can be purchased in 40 mgmL or 10 mgmL

concentrations both of which have significant preservatives

when taken straight from the bottle

For intravitreal injection the preservatives must be washed out

by removing the liquid carrier and re-suspend the triamcinolone

in sterile balanced salt solution

Step 1 Draw 1 cc of triamcinolone (40 mgmL) into a 5 cc

syringe

Step 2 Place a 022 microm filter on the syringe and reattach the

needle

Step 3 Expel the fluid through the filter and discard it thereby

trapping the triamcinolone particles in the filter

Step 4 Draw 4 cc of sterile balanced salt solution into the

syringe thereby re-suspending the triamcinolone particles

Step 5 Expel and discard the fluid again and re-suspend the

triamcinolone particles by drawing up 4 cc of balanced salt

solution again The triamcinolone is now washed

Step 6 Remove the filter and needle and attach a blunt canula

for intraocular use The final concentration of triamcinolone is

10 mgmL

A Retisertreg B I-vationtrade implant

C Suprachoroidal implant D E Intravitreal

implants (eg Ozurdexreg Illuvien) F

microparticles nanoparticles liposomes G

Verisome system H Cortiject emulsion

The Future

Sustained drug delivery Intravitreal Anti-metabolite agents

Anti-VEGF therapy has

been used in the treatment

of glaucoma amp ocular

neovascular diseases

anti-angiogenic properties

anti-fibrotic properties

Bevacizumab amp

Ranibizumab

References Bentley E Miller PE Diehl KA (2003) Use of high-resolution ultrasound as a diagnostic tool in veterinary ophthalmology JAVMA

223 1617-1622

Corcoran KA Koch SA (1993) Uveal cysts in dogs 28 cases (1989-1991) JAVMA 203545-6

Deehr AJ Dubielzig RR (2002) A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers Veterinary Ophthalmology 1153-158

Devgan U (2006) Intraocular use of triamcinolone Removing preservatives from triamcinolone can minimize ocular toxicity and side effects Ocular Surgery News US Edition Dec 15th 20016

Esson D Armour M Mundy P Schobert CS Dubielzig RR (2009) The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in the Golden Retriever Vet Ophthalmol 12361-8

Holly VL Sandmeyer LS Bauer BS Verges L Grahn BH (2015) Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada Vet Ophthalmol doi 101111vop12293

Lin P Suhler EBet al (2014) The Future of Uveitis Treatment Ophthalmology 121 365ndash376

Sapienza JS et al (2000) Golden Retreiver Uveitis 75 cases (1994-1999) Veterinary Ophthalmology vol 3 Pg 241-246

Taylor LN Townsend WM etal (2015) Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts AJVR 76540ndash546

Townsend WM1 Gornik KR (2013) Prevalence of uveal cysts and pigmentary uveitis in Golden Retrievers in three Midwestern states JAVMA 2431298-301

vonHoldt BM et al (2010) Neighbour-joining trees of domestic dogs and grey wolves Nature doi101038nature08837

Page 3: Pigmentary Uveitis - vetemergency.cavetemergency.ca/wp-content/uploads/2015/11/Pigmentary-Uveitis.pdfiridociliary cysts, pigmentary uveitis, ... Neighbour-joining trees of domestic

Pigmentary Uveitis - Clinical Signs Breed Predisposition

Golden Retriever Labrador Retriever Flat Coat Retriever Great Dane

No sex predisposition Age Ciliary Body Cysts 3 ndash 4 years Clinical Signs

In early cases it is hard to document overt inflammatory disease

Ciliary Body Cysts Iris cysts uveal cysts ciliary body cysts

Persistent or re-occurring conjunctivitis Progressive hyperpigmentation of the iris Pigment migration onto the anterior lens capsule Posterior synechia Focal cataracts - progressive Angle Closure Secondary Glaucoma

Iris Cysts

Dogs Cats

copy Dr Dennis Brooks copy Dr Maria Joao Vieira

Iris cysts seen in numerous breeds

Husky Boston Terrier

copy Dr Carla Kolta copy Dr Brian Watson

Always Measure IOP Normal Intraocular Pressure normal range varies depending

upon how the IOP is measured

Indentation tonometry

Schioumltz tonometer

15 to 25 mmHg Applanation tonometry

Tonopen (XL or Vet) 15 to 20 mmHg

Rebound Tonometry

Tonovet

12 to 18 mmHg

Pigmentary Uveitis ndash early signs

copy Dr David Whitney copy Dr Sara Patton

Pigmentary Uveitis

copy Dr John Sapienza

Pigmentary Uveitis with Iris Cysts

copy Dr Michael Zigler

copy Dr John Sapienza

Pigmentary Uveitis

copy Dr John Sapienza copy Dr Doug Esson

Pigmentary Uveitis ndash later signs

copy Dr April Hahn copy Dr Alison Litchfield

Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and

pigmentarycystic glaucoma over a decade in western Canada

Holly V Sandmeyer LS Bauer BS etal (2015) Golden retriever cystic uveal disease a longitudinal study of

iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada

Veterinary Ophthalmology DOI 101111vop12293

Some cysts remain hidden behind the iris

displacing the iris root forward resulting in

a shallow anterior chamber and possible

compromise of the drainage angle

Use of high-resolution ultrasound as a diagnostic tool in

veterinary ophthalmology

Bentley E Miller PE Diehl KA (2003) JAVMA 223

1617-1622

Ultrasound biomicroscopy (UBM) for

detection of canine uveal cysts

UBM 50 MHz probe

Regular ocular ultrasound

probe is 75 or 12 MHz

Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts

Type of probe detected

Ocular us probe 0

UBM probe sensitivity 47

specificity 92

Pathogenesis of Uveitis

The pathogenesis of uveitis An imbalance between the regulatory mechanisms and

inflammatory mechanisms contribute to uveitis Only some examples of contributing role

players such as regulatory T cells versus Th17 cells are shown A combination of

environmental risk factors and genetic risk factors tip the balance towards the development

or chronicity of uveitis RPE retinal pigment epithelium PMNs polymorphonuclear cells

Pathogenesis of Pigmentary Uveitis

What comes first

Uveal Cysts

Uveal Cysts Uveitis

Uveitis Genetic

predisposition

Genetic

predisposition

Golden Retriever Foundation Health Survey of 1444 Goldens (1998-1999)

0 ndash 3 yrs 3 ndash 8 yrs 8 ndash 13 yrs 13+ yrs Total

Uveitis 0 2 11 3 16

Iris Cysts 0 5 7 0 12

Eye dx all 381 1444

COPLOW

Cases

numerator denominator percentage

Glaucoma 530 2176 24

Golden

Retreivers

25 530 5

Iridociliary

Cysts

13 25 52

COPLOW ndash Comparative Ophthalmic Pathology Laboratory of Wisconsin

survey of 2176 enucleated or eviscerated dog eye submissions

COPLOWrsquos Cases of Glaucoma with Iris

Cysts in Golden Retrievers

large thin-walled cysts lined with attenuated cuboidal epithelium filling most of the posterior chamber (1313 100)

thick walled cysts containing hyaluronic acid (813 62)

a solid cellular proliferation (213 15)

a retro-corneal membrane associated with a defect in Descemets membrane (713 54)

iris bombe (513 38)

a pre-iridal fibrovascular membranes (413 31)

hemorrhage (413 31)

a cellular membrane on the anterior lens surface (613 46)

retinal detachment (513 38)

peripheral anterior synechia (513 38)

posterior synechia (613 46)

Pathogenesis of Secondary Glaucoma

in Pigmentary Uveitis

Glaucoma

Uveitis

PIFM

Synechia Cataracts

Uveal and Iris Cysts

b

a Cytokines

b Inflammatory

debris blocks

drainage angle

c PIFM blocks

drainage angle

d Synechia blocks

drainage angle

e Lens induced

uveitis

Golden

Retriever

Histopathology ndash ciliary cysts

copy Dr John Sapienza

The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in

the Golden Retriever

Veterinary Ophthalmology

Volume 12 Issue 6 pages 361-368 26 OCT 2009 DOI 101111j1463-5224200900732x

httponlinelibrarywileycomdoi101111j1463-5224200900732xfullf1

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf4

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf5

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf6

Treatment Options - Topical

Treatment Options - Oral

Treatment Options - Injectable

Triamcinolone

Administer 02ml (8mg) by

subconjunctival injection

Intravitreal injection

TPA - Tissue Plasminogen

Activator

Administer 02ml by

intracameral injection

Preparation of Triamcinolone

for intravitreal injection

Method to wash out

preservatives

Diagrams

Triamcinolone can be purchased in 40 mgmL or 10 mgmL

concentrations both of which have significant preservatives

when taken straight from the bottle

For intravitreal injection the preservatives must be washed out

by removing the liquid carrier and re-suspend the triamcinolone

in sterile balanced salt solution

Step 1 Draw 1 cc of triamcinolone (40 mgmL) into a 5 cc

syringe

Step 2 Place a 022 microm filter on the syringe and reattach the

needle

Step 3 Expel the fluid through the filter and discard it thereby

trapping the triamcinolone particles in the filter

Step 4 Draw 4 cc of sterile balanced salt solution into the

syringe thereby re-suspending the triamcinolone particles

Step 5 Expel and discard the fluid again and re-suspend the

triamcinolone particles by drawing up 4 cc of balanced salt

solution again The triamcinolone is now washed

Step 6 Remove the filter and needle and attach a blunt canula

for intraocular use The final concentration of triamcinolone is

10 mgmL

A Retisertreg B I-vationtrade implant

C Suprachoroidal implant D E Intravitreal

implants (eg Ozurdexreg Illuvien) F

microparticles nanoparticles liposomes G

Verisome system H Cortiject emulsion

The Future

Sustained drug delivery Intravitreal Anti-metabolite agents

Anti-VEGF therapy has

been used in the treatment

of glaucoma amp ocular

neovascular diseases

anti-angiogenic properties

anti-fibrotic properties

Bevacizumab amp

Ranibizumab

References Bentley E Miller PE Diehl KA (2003) Use of high-resolution ultrasound as a diagnostic tool in veterinary ophthalmology JAVMA

223 1617-1622

Corcoran KA Koch SA (1993) Uveal cysts in dogs 28 cases (1989-1991) JAVMA 203545-6

Deehr AJ Dubielzig RR (2002) A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers Veterinary Ophthalmology 1153-158

Devgan U (2006) Intraocular use of triamcinolone Removing preservatives from triamcinolone can minimize ocular toxicity and side effects Ocular Surgery News US Edition Dec 15th 20016

Esson D Armour M Mundy P Schobert CS Dubielzig RR (2009) The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in the Golden Retriever Vet Ophthalmol 12361-8

Holly VL Sandmeyer LS Bauer BS Verges L Grahn BH (2015) Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada Vet Ophthalmol doi 101111vop12293

Lin P Suhler EBet al (2014) The Future of Uveitis Treatment Ophthalmology 121 365ndash376

Sapienza JS et al (2000) Golden Retreiver Uveitis 75 cases (1994-1999) Veterinary Ophthalmology vol 3 Pg 241-246

Taylor LN Townsend WM etal (2015) Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts AJVR 76540ndash546

Townsend WM1 Gornik KR (2013) Prevalence of uveal cysts and pigmentary uveitis in Golden Retrievers in three Midwestern states JAVMA 2431298-301

vonHoldt BM et al (2010) Neighbour-joining trees of domestic dogs and grey wolves Nature doi101038nature08837

Page 4: Pigmentary Uveitis - vetemergency.cavetemergency.ca/wp-content/uploads/2015/11/Pigmentary-Uveitis.pdfiridociliary cysts, pigmentary uveitis, ... Neighbour-joining trees of domestic

Iris Cysts

Dogs Cats

copy Dr Dennis Brooks copy Dr Maria Joao Vieira

Iris cysts seen in numerous breeds

Husky Boston Terrier

copy Dr Carla Kolta copy Dr Brian Watson

Always Measure IOP Normal Intraocular Pressure normal range varies depending

upon how the IOP is measured

Indentation tonometry

Schioumltz tonometer

15 to 25 mmHg Applanation tonometry

Tonopen (XL or Vet) 15 to 20 mmHg

Rebound Tonometry

Tonovet

12 to 18 mmHg

Pigmentary Uveitis ndash early signs

copy Dr David Whitney copy Dr Sara Patton

Pigmentary Uveitis

copy Dr John Sapienza

Pigmentary Uveitis with Iris Cysts

copy Dr Michael Zigler

copy Dr John Sapienza

Pigmentary Uveitis

copy Dr John Sapienza copy Dr Doug Esson

Pigmentary Uveitis ndash later signs

copy Dr April Hahn copy Dr Alison Litchfield

Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and

pigmentarycystic glaucoma over a decade in western Canada

Holly V Sandmeyer LS Bauer BS etal (2015) Golden retriever cystic uveal disease a longitudinal study of

iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada

Veterinary Ophthalmology DOI 101111vop12293

Some cysts remain hidden behind the iris

displacing the iris root forward resulting in

a shallow anterior chamber and possible

compromise of the drainage angle

Use of high-resolution ultrasound as a diagnostic tool in

veterinary ophthalmology

Bentley E Miller PE Diehl KA (2003) JAVMA 223

1617-1622

Ultrasound biomicroscopy (UBM) for

detection of canine uveal cysts

UBM 50 MHz probe

Regular ocular ultrasound

probe is 75 or 12 MHz

Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts

Type of probe detected

Ocular us probe 0

UBM probe sensitivity 47

specificity 92

Pathogenesis of Uveitis

The pathogenesis of uveitis An imbalance between the regulatory mechanisms and

inflammatory mechanisms contribute to uveitis Only some examples of contributing role

players such as regulatory T cells versus Th17 cells are shown A combination of

environmental risk factors and genetic risk factors tip the balance towards the development

or chronicity of uveitis RPE retinal pigment epithelium PMNs polymorphonuclear cells

Pathogenesis of Pigmentary Uveitis

What comes first

Uveal Cysts

Uveal Cysts Uveitis

Uveitis Genetic

predisposition

Genetic

predisposition

Golden Retriever Foundation Health Survey of 1444 Goldens (1998-1999)

0 ndash 3 yrs 3 ndash 8 yrs 8 ndash 13 yrs 13+ yrs Total

Uveitis 0 2 11 3 16

Iris Cysts 0 5 7 0 12

Eye dx all 381 1444

COPLOW

Cases

numerator denominator percentage

Glaucoma 530 2176 24

Golden

Retreivers

25 530 5

Iridociliary

Cysts

13 25 52

COPLOW ndash Comparative Ophthalmic Pathology Laboratory of Wisconsin

survey of 2176 enucleated or eviscerated dog eye submissions

COPLOWrsquos Cases of Glaucoma with Iris

Cysts in Golden Retrievers

large thin-walled cysts lined with attenuated cuboidal epithelium filling most of the posterior chamber (1313 100)

thick walled cysts containing hyaluronic acid (813 62)

a solid cellular proliferation (213 15)

a retro-corneal membrane associated with a defect in Descemets membrane (713 54)

iris bombe (513 38)

a pre-iridal fibrovascular membranes (413 31)

hemorrhage (413 31)

a cellular membrane on the anterior lens surface (613 46)

retinal detachment (513 38)

peripheral anterior synechia (513 38)

posterior synechia (613 46)

Pathogenesis of Secondary Glaucoma

in Pigmentary Uveitis

Glaucoma

Uveitis

PIFM

Synechia Cataracts

Uveal and Iris Cysts

b

a Cytokines

b Inflammatory

debris blocks

drainage angle

c PIFM blocks

drainage angle

d Synechia blocks

drainage angle

e Lens induced

uveitis

Golden

Retriever

Histopathology ndash ciliary cysts

copy Dr John Sapienza

The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in

the Golden Retriever

Veterinary Ophthalmology

Volume 12 Issue 6 pages 361-368 26 OCT 2009 DOI 101111j1463-5224200900732x

httponlinelibrarywileycomdoi101111j1463-5224200900732xfullf1

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf4

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf5

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf6

Treatment Options - Topical

Treatment Options - Oral

Treatment Options - Injectable

Triamcinolone

Administer 02ml (8mg) by

subconjunctival injection

Intravitreal injection

TPA - Tissue Plasminogen

Activator

Administer 02ml by

intracameral injection

Preparation of Triamcinolone

for intravitreal injection

Method to wash out

preservatives

Diagrams

Triamcinolone can be purchased in 40 mgmL or 10 mgmL

concentrations both of which have significant preservatives

when taken straight from the bottle

For intravitreal injection the preservatives must be washed out

by removing the liquid carrier and re-suspend the triamcinolone

in sterile balanced salt solution

Step 1 Draw 1 cc of triamcinolone (40 mgmL) into a 5 cc

syringe

Step 2 Place a 022 microm filter on the syringe and reattach the

needle

Step 3 Expel the fluid through the filter and discard it thereby

trapping the triamcinolone particles in the filter

Step 4 Draw 4 cc of sterile balanced salt solution into the

syringe thereby re-suspending the triamcinolone particles

Step 5 Expel and discard the fluid again and re-suspend the

triamcinolone particles by drawing up 4 cc of balanced salt

solution again The triamcinolone is now washed

Step 6 Remove the filter and needle and attach a blunt canula

for intraocular use The final concentration of triamcinolone is

10 mgmL

A Retisertreg B I-vationtrade implant

C Suprachoroidal implant D E Intravitreal

implants (eg Ozurdexreg Illuvien) F

microparticles nanoparticles liposomes G

Verisome system H Cortiject emulsion

The Future

Sustained drug delivery Intravitreal Anti-metabolite agents

Anti-VEGF therapy has

been used in the treatment

of glaucoma amp ocular

neovascular diseases

anti-angiogenic properties

anti-fibrotic properties

Bevacizumab amp

Ranibizumab

References Bentley E Miller PE Diehl KA (2003) Use of high-resolution ultrasound as a diagnostic tool in veterinary ophthalmology JAVMA

223 1617-1622

Corcoran KA Koch SA (1993) Uveal cysts in dogs 28 cases (1989-1991) JAVMA 203545-6

Deehr AJ Dubielzig RR (2002) A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers Veterinary Ophthalmology 1153-158

Devgan U (2006) Intraocular use of triamcinolone Removing preservatives from triamcinolone can minimize ocular toxicity and side effects Ocular Surgery News US Edition Dec 15th 20016

Esson D Armour M Mundy P Schobert CS Dubielzig RR (2009) The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in the Golden Retriever Vet Ophthalmol 12361-8

Holly VL Sandmeyer LS Bauer BS Verges L Grahn BH (2015) Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada Vet Ophthalmol doi 101111vop12293

Lin P Suhler EBet al (2014) The Future of Uveitis Treatment Ophthalmology 121 365ndash376

Sapienza JS et al (2000) Golden Retreiver Uveitis 75 cases (1994-1999) Veterinary Ophthalmology vol 3 Pg 241-246

Taylor LN Townsend WM etal (2015) Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts AJVR 76540ndash546

Townsend WM1 Gornik KR (2013) Prevalence of uveal cysts and pigmentary uveitis in Golden Retrievers in three Midwestern states JAVMA 2431298-301

vonHoldt BM et al (2010) Neighbour-joining trees of domestic dogs and grey wolves Nature doi101038nature08837

Page 5: Pigmentary Uveitis - vetemergency.cavetemergency.ca/wp-content/uploads/2015/11/Pigmentary-Uveitis.pdfiridociliary cysts, pigmentary uveitis, ... Neighbour-joining trees of domestic

Iris cysts seen in numerous breeds

Husky Boston Terrier

copy Dr Carla Kolta copy Dr Brian Watson

Always Measure IOP Normal Intraocular Pressure normal range varies depending

upon how the IOP is measured

Indentation tonometry

Schioumltz tonometer

15 to 25 mmHg Applanation tonometry

Tonopen (XL or Vet) 15 to 20 mmHg

Rebound Tonometry

Tonovet

12 to 18 mmHg

Pigmentary Uveitis ndash early signs

copy Dr David Whitney copy Dr Sara Patton

Pigmentary Uveitis

copy Dr John Sapienza

Pigmentary Uveitis with Iris Cysts

copy Dr Michael Zigler

copy Dr John Sapienza

Pigmentary Uveitis

copy Dr John Sapienza copy Dr Doug Esson

Pigmentary Uveitis ndash later signs

copy Dr April Hahn copy Dr Alison Litchfield

Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and

pigmentarycystic glaucoma over a decade in western Canada

Holly V Sandmeyer LS Bauer BS etal (2015) Golden retriever cystic uveal disease a longitudinal study of

iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada

Veterinary Ophthalmology DOI 101111vop12293

Some cysts remain hidden behind the iris

displacing the iris root forward resulting in

a shallow anterior chamber and possible

compromise of the drainage angle

Use of high-resolution ultrasound as a diagnostic tool in

veterinary ophthalmology

Bentley E Miller PE Diehl KA (2003) JAVMA 223

1617-1622

Ultrasound biomicroscopy (UBM) for

detection of canine uveal cysts

UBM 50 MHz probe

Regular ocular ultrasound

probe is 75 or 12 MHz

Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts

Type of probe detected

Ocular us probe 0

UBM probe sensitivity 47

specificity 92

Pathogenesis of Uveitis

The pathogenesis of uveitis An imbalance between the regulatory mechanisms and

inflammatory mechanisms contribute to uveitis Only some examples of contributing role

players such as regulatory T cells versus Th17 cells are shown A combination of

environmental risk factors and genetic risk factors tip the balance towards the development

or chronicity of uveitis RPE retinal pigment epithelium PMNs polymorphonuclear cells

Pathogenesis of Pigmentary Uveitis

What comes first

Uveal Cysts

Uveal Cysts Uveitis

Uveitis Genetic

predisposition

Genetic

predisposition

Golden Retriever Foundation Health Survey of 1444 Goldens (1998-1999)

0 ndash 3 yrs 3 ndash 8 yrs 8 ndash 13 yrs 13+ yrs Total

Uveitis 0 2 11 3 16

Iris Cysts 0 5 7 0 12

Eye dx all 381 1444

COPLOW

Cases

numerator denominator percentage

Glaucoma 530 2176 24

Golden

Retreivers

25 530 5

Iridociliary

Cysts

13 25 52

COPLOW ndash Comparative Ophthalmic Pathology Laboratory of Wisconsin

survey of 2176 enucleated or eviscerated dog eye submissions

COPLOWrsquos Cases of Glaucoma with Iris

Cysts in Golden Retrievers

large thin-walled cysts lined with attenuated cuboidal epithelium filling most of the posterior chamber (1313 100)

thick walled cysts containing hyaluronic acid (813 62)

a solid cellular proliferation (213 15)

a retro-corneal membrane associated with a defect in Descemets membrane (713 54)

iris bombe (513 38)

a pre-iridal fibrovascular membranes (413 31)

hemorrhage (413 31)

a cellular membrane on the anterior lens surface (613 46)

retinal detachment (513 38)

peripheral anterior synechia (513 38)

posterior synechia (613 46)

Pathogenesis of Secondary Glaucoma

in Pigmentary Uveitis

Glaucoma

Uveitis

PIFM

Synechia Cataracts

Uveal and Iris Cysts

b

a Cytokines

b Inflammatory

debris blocks

drainage angle

c PIFM blocks

drainage angle

d Synechia blocks

drainage angle

e Lens induced

uveitis

Golden

Retriever

Histopathology ndash ciliary cysts

copy Dr John Sapienza

The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in

the Golden Retriever

Veterinary Ophthalmology

Volume 12 Issue 6 pages 361-368 26 OCT 2009 DOI 101111j1463-5224200900732x

httponlinelibrarywileycomdoi101111j1463-5224200900732xfullf1

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf4

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf5

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf6

Treatment Options - Topical

Treatment Options - Oral

Treatment Options - Injectable

Triamcinolone

Administer 02ml (8mg) by

subconjunctival injection

Intravitreal injection

TPA - Tissue Plasminogen

Activator

Administer 02ml by

intracameral injection

Preparation of Triamcinolone

for intravitreal injection

Method to wash out

preservatives

Diagrams

Triamcinolone can be purchased in 40 mgmL or 10 mgmL

concentrations both of which have significant preservatives

when taken straight from the bottle

For intravitreal injection the preservatives must be washed out

by removing the liquid carrier and re-suspend the triamcinolone

in sterile balanced salt solution

Step 1 Draw 1 cc of triamcinolone (40 mgmL) into a 5 cc

syringe

Step 2 Place a 022 microm filter on the syringe and reattach the

needle

Step 3 Expel the fluid through the filter and discard it thereby

trapping the triamcinolone particles in the filter

Step 4 Draw 4 cc of sterile balanced salt solution into the

syringe thereby re-suspending the triamcinolone particles

Step 5 Expel and discard the fluid again and re-suspend the

triamcinolone particles by drawing up 4 cc of balanced salt

solution again The triamcinolone is now washed

Step 6 Remove the filter and needle and attach a blunt canula

for intraocular use The final concentration of triamcinolone is

10 mgmL

A Retisertreg B I-vationtrade implant

C Suprachoroidal implant D E Intravitreal

implants (eg Ozurdexreg Illuvien) F

microparticles nanoparticles liposomes G

Verisome system H Cortiject emulsion

The Future

Sustained drug delivery Intravitreal Anti-metabolite agents

Anti-VEGF therapy has

been used in the treatment

of glaucoma amp ocular

neovascular diseases

anti-angiogenic properties

anti-fibrotic properties

Bevacizumab amp

Ranibizumab

References Bentley E Miller PE Diehl KA (2003) Use of high-resolution ultrasound as a diagnostic tool in veterinary ophthalmology JAVMA

223 1617-1622

Corcoran KA Koch SA (1993) Uveal cysts in dogs 28 cases (1989-1991) JAVMA 203545-6

Deehr AJ Dubielzig RR (2002) A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers Veterinary Ophthalmology 1153-158

Devgan U (2006) Intraocular use of triamcinolone Removing preservatives from triamcinolone can minimize ocular toxicity and side effects Ocular Surgery News US Edition Dec 15th 20016

Esson D Armour M Mundy P Schobert CS Dubielzig RR (2009) The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in the Golden Retriever Vet Ophthalmol 12361-8

Holly VL Sandmeyer LS Bauer BS Verges L Grahn BH (2015) Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada Vet Ophthalmol doi 101111vop12293

Lin P Suhler EBet al (2014) The Future of Uveitis Treatment Ophthalmology 121 365ndash376

Sapienza JS et al (2000) Golden Retreiver Uveitis 75 cases (1994-1999) Veterinary Ophthalmology vol 3 Pg 241-246

Taylor LN Townsend WM etal (2015) Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts AJVR 76540ndash546

Townsend WM1 Gornik KR (2013) Prevalence of uveal cysts and pigmentary uveitis in Golden Retrievers in three Midwestern states JAVMA 2431298-301

vonHoldt BM et al (2010) Neighbour-joining trees of domestic dogs and grey wolves Nature doi101038nature08837

Page 6: Pigmentary Uveitis - vetemergency.cavetemergency.ca/wp-content/uploads/2015/11/Pigmentary-Uveitis.pdfiridociliary cysts, pigmentary uveitis, ... Neighbour-joining trees of domestic

Always Measure IOP Normal Intraocular Pressure normal range varies depending

upon how the IOP is measured

Indentation tonometry

Schioumltz tonometer

15 to 25 mmHg Applanation tonometry

Tonopen (XL or Vet) 15 to 20 mmHg

Rebound Tonometry

Tonovet

12 to 18 mmHg

Pigmentary Uveitis ndash early signs

copy Dr David Whitney copy Dr Sara Patton

Pigmentary Uveitis

copy Dr John Sapienza

Pigmentary Uveitis with Iris Cysts

copy Dr Michael Zigler

copy Dr John Sapienza

Pigmentary Uveitis

copy Dr John Sapienza copy Dr Doug Esson

Pigmentary Uveitis ndash later signs

copy Dr April Hahn copy Dr Alison Litchfield

Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and

pigmentarycystic glaucoma over a decade in western Canada

Holly V Sandmeyer LS Bauer BS etal (2015) Golden retriever cystic uveal disease a longitudinal study of

iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada

Veterinary Ophthalmology DOI 101111vop12293

Some cysts remain hidden behind the iris

displacing the iris root forward resulting in

a shallow anterior chamber and possible

compromise of the drainage angle

Use of high-resolution ultrasound as a diagnostic tool in

veterinary ophthalmology

Bentley E Miller PE Diehl KA (2003) JAVMA 223

1617-1622

Ultrasound biomicroscopy (UBM) for

detection of canine uveal cysts

UBM 50 MHz probe

Regular ocular ultrasound

probe is 75 or 12 MHz

Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts

Type of probe detected

Ocular us probe 0

UBM probe sensitivity 47

specificity 92

Pathogenesis of Uveitis

The pathogenesis of uveitis An imbalance between the regulatory mechanisms and

inflammatory mechanisms contribute to uveitis Only some examples of contributing role

players such as regulatory T cells versus Th17 cells are shown A combination of

environmental risk factors and genetic risk factors tip the balance towards the development

or chronicity of uveitis RPE retinal pigment epithelium PMNs polymorphonuclear cells

Pathogenesis of Pigmentary Uveitis

What comes first

Uveal Cysts

Uveal Cysts Uveitis

Uveitis Genetic

predisposition

Genetic

predisposition

Golden Retriever Foundation Health Survey of 1444 Goldens (1998-1999)

0 ndash 3 yrs 3 ndash 8 yrs 8 ndash 13 yrs 13+ yrs Total

Uveitis 0 2 11 3 16

Iris Cysts 0 5 7 0 12

Eye dx all 381 1444

COPLOW

Cases

numerator denominator percentage

Glaucoma 530 2176 24

Golden

Retreivers

25 530 5

Iridociliary

Cysts

13 25 52

COPLOW ndash Comparative Ophthalmic Pathology Laboratory of Wisconsin

survey of 2176 enucleated or eviscerated dog eye submissions

COPLOWrsquos Cases of Glaucoma with Iris

Cysts in Golden Retrievers

large thin-walled cysts lined with attenuated cuboidal epithelium filling most of the posterior chamber (1313 100)

thick walled cysts containing hyaluronic acid (813 62)

a solid cellular proliferation (213 15)

a retro-corneal membrane associated with a defect in Descemets membrane (713 54)

iris bombe (513 38)

a pre-iridal fibrovascular membranes (413 31)

hemorrhage (413 31)

a cellular membrane on the anterior lens surface (613 46)

retinal detachment (513 38)

peripheral anterior synechia (513 38)

posterior synechia (613 46)

Pathogenesis of Secondary Glaucoma

in Pigmentary Uveitis

Glaucoma

Uveitis

PIFM

Synechia Cataracts

Uveal and Iris Cysts

b

a Cytokines

b Inflammatory

debris blocks

drainage angle

c PIFM blocks

drainage angle

d Synechia blocks

drainage angle

e Lens induced

uveitis

Golden

Retriever

Histopathology ndash ciliary cysts

copy Dr John Sapienza

The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in

the Golden Retriever

Veterinary Ophthalmology

Volume 12 Issue 6 pages 361-368 26 OCT 2009 DOI 101111j1463-5224200900732x

httponlinelibrarywileycomdoi101111j1463-5224200900732xfullf1

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf4

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf5

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf6

Treatment Options - Topical

Treatment Options - Oral

Treatment Options - Injectable

Triamcinolone

Administer 02ml (8mg) by

subconjunctival injection

Intravitreal injection

TPA - Tissue Plasminogen

Activator

Administer 02ml by

intracameral injection

Preparation of Triamcinolone

for intravitreal injection

Method to wash out

preservatives

Diagrams

Triamcinolone can be purchased in 40 mgmL or 10 mgmL

concentrations both of which have significant preservatives

when taken straight from the bottle

For intravitreal injection the preservatives must be washed out

by removing the liquid carrier and re-suspend the triamcinolone

in sterile balanced salt solution

Step 1 Draw 1 cc of triamcinolone (40 mgmL) into a 5 cc

syringe

Step 2 Place a 022 microm filter on the syringe and reattach the

needle

Step 3 Expel the fluid through the filter and discard it thereby

trapping the triamcinolone particles in the filter

Step 4 Draw 4 cc of sterile balanced salt solution into the

syringe thereby re-suspending the triamcinolone particles

Step 5 Expel and discard the fluid again and re-suspend the

triamcinolone particles by drawing up 4 cc of balanced salt

solution again The triamcinolone is now washed

Step 6 Remove the filter and needle and attach a blunt canula

for intraocular use The final concentration of triamcinolone is

10 mgmL

A Retisertreg B I-vationtrade implant

C Suprachoroidal implant D E Intravitreal

implants (eg Ozurdexreg Illuvien) F

microparticles nanoparticles liposomes G

Verisome system H Cortiject emulsion

The Future

Sustained drug delivery Intravitreal Anti-metabolite agents

Anti-VEGF therapy has

been used in the treatment

of glaucoma amp ocular

neovascular diseases

anti-angiogenic properties

anti-fibrotic properties

Bevacizumab amp

Ranibizumab

References Bentley E Miller PE Diehl KA (2003) Use of high-resolution ultrasound as a diagnostic tool in veterinary ophthalmology JAVMA

223 1617-1622

Corcoran KA Koch SA (1993) Uveal cysts in dogs 28 cases (1989-1991) JAVMA 203545-6

Deehr AJ Dubielzig RR (2002) A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers Veterinary Ophthalmology 1153-158

Devgan U (2006) Intraocular use of triamcinolone Removing preservatives from triamcinolone can minimize ocular toxicity and side effects Ocular Surgery News US Edition Dec 15th 20016

Esson D Armour M Mundy P Schobert CS Dubielzig RR (2009) The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in the Golden Retriever Vet Ophthalmol 12361-8

Holly VL Sandmeyer LS Bauer BS Verges L Grahn BH (2015) Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada Vet Ophthalmol doi 101111vop12293

Lin P Suhler EBet al (2014) The Future of Uveitis Treatment Ophthalmology 121 365ndash376

Sapienza JS et al (2000) Golden Retreiver Uveitis 75 cases (1994-1999) Veterinary Ophthalmology vol 3 Pg 241-246

Taylor LN Townsend WM etal (2015) Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts AJVR 76540ndash546

Townsend WM1 Gornik KR (2013) Prevalence of uveal cysts and pigmentary uveitis in Golden Retrievers in three Midwestern states JAVMA 2431298-301

vonHoldt BM et al (2010) Neighbour-joining trees of domestic dogs and grey wolves Nature doi101038nature08837

Page 7: Pigmentary Uveitis - vetemergency.cavetemergency.ca/wp-content/uploads/2015/11/Pigmentary-Uveitis.pdfiridociliary cysts, pigmentary uveitis, ... Neighbour-joining trees of domestic

Pigmentary Uveitis ndash early signs

copy Dr David Whitney copy Dr Sara Patton

Pigmentary Uveitis

copy Dr John Sapienza

Pigmentary Uveitis with Iris Cysts

copy Dr Michael Zigler

copy Dr John Sapienza

Pigmentary Uveitis

copy Dr John Sapienza copy Dr Doug Esson

Pigmentary Uveitis ndash later signs

copy Dr April Hahn copy Dr Alison Litchfield

Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and

pigmentarycystic glaucoma over a decade in western Canada

Holly V Sandmeyer LS Bauer BS etal (2015) Golden retriever cystic uveal disease a longitudinal study of

iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada

Veterinary Ophthalmology DOI 101111vop12293

Some cysts remain hidden behind the iris

displacing the iris root forward resulting in

a shallow anterior chamber and possible

compromise of the drainage angle

Use of high-resolution ultrasound as a diagnostic tool in

veterinary ophthalmology

Bentley E Miller PE Diehl KA (2003) JAVMA 223

1617-1622

Ultrasound biomicroscopy (UBM) for

detection of canine uveal cysts

UBM 50 MHz probe

Regular ocular ultrasound

probe is 75 or 12 MHz

Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts

Type of probe detected

Ocular us probe 0

UBM probe sensitivity 47

specificity 92

Pathogenesis of Uveitis

The pathogenesis of uveitis An imbalance between the regulatory mechanisms and

inflammatory mechanisms contribute to uveitis Only some examples of contributing role

players such as regulatory T cells versus Th17 cells are shown A combination of

environmental risk factors and genetic risk factors tip the balance towards the development

or chronicity of uveitis RPE retinal pigment epithelium PMNs polymorphonuclear cells

Pathogenesis of Pigmentary Uveitis

What comes first

Uveal Cysts

Uveal Cysts Uveitis

Uveitis Genetic

predisposition

Genetic

predisposition

Golden Retriever Foundation Health Survey of 1444 Goldens (1998-1999)

0 ndash 3 yrs 3 ndash 8 yrs 8 ndash 13 yrs 13+ yrs Total

Uveitis 0 2 11 3 16

Iris Cysts 0 5 7 0 12

Eye dx all 381 1444

COPLOW

Cases

numerator denominator percentage

Glaucoma 530 2176 24

Golden

Retreivers

25 530 5

Iridociliary

Cysts

13 25 52

COPLOW ndash Comparative Ophthalmic Pathology Laboratory of Wisconsin

survey of 2176 enucleated or eviscerated dog eye submissions

COPLOWrsquos Cases of Glaucoma with Iris

Cysts in Golden Retrievers

large thin-walled cysts lined with attenuated cuboidal epithelium filling most of the posterior chamber (1313 100)

thick walled cysts containing hyaluronic acid (813 62)

a solid cellular proliferation (213 15)

a retro-corneal membrane associated with a defect in Descemets membrane (713 54)

iris bombe (513 38)

a pre-iridal fibrovascular membranes (413 31)

hemorrhage (413 31)

a cellular membrane on the anterior lens surface (613 46)

retinal detachment (513 38)

peripheral anterior synechia (513 38)

posterior synechia (613 46)

Pathogenesis of Secondary Glaucoma

in Pigmentary Uveitis

Glaucoma

Uveitis

PIFM

Synechia Cataracts

Uveal and Iris Cysts

b

a Cytokines

b Inflammatory

debris blocks

drainage angle

c PIFM blocks

drainage angle

d Synechia blocks

drainage angle

e Lens induced

uveitis

Golden

Retriever

Histopathology ndash ciliary cysts

copy Dr John Sapienza

The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in

the Golden Retriever

Veterinary Ophthalmology

Volume 12 Issue 6 pages 361-368 26 OCT 2009 DOI 101111j1463-5224200900732x

httponlinelibrarywileycomdoi101111j1463-5224200900732xfullf1

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf4

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf5

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf6

Treatment Options - Topical

Treatment Options - Oral

Treatment Options - Injectable

Triamcinolone

Administer 02ml (8mg) by

subconjunctival injection

Intravitreal injection

TPA - Tissue Plasminogen

Activator

Administer 02ml by

intracameral injection

Preparation of Triamcinolone

for intravitreal injection

Method to wash out

preservatives

Diagrams

Triamcinolone can be purchased in 40 mgmL or 10 mgmL

concentrations both of which have significant preservatives

when taken straight from the bottle

For intravitreal injection the preservatives must be washed out

by removing the liquid carrier and re-suspend the triamcinolone

in sterile balanced salt solution

Step 1 Draw 1 cc of triamcinolone (40 mgmL) into a 5 cc

syringe

Step 2 Place a 022 microm filter on the syringe and reattach the

needle

Step 3 Expel the fluid through the filter and discard it thereby

trapping the triamcinolone particles in the filter

Step 4 Draw 4 cc of sterile balanced salt solution into the

syringe thereby re-suspending the triamcinolone particles

Step 5 Expel and discard the fluid again and re-suspend the

triamcinolone particles by drawing up 4 cc of balanced salt

solution again The triamcinolone is now washed

Step 6 Remove the filter and needle and attach a blunt canula

for intraocular use The final concentration of triamcinolone is

10 mgmL

A Retisertreg B I-vationtrade implant

C Suprachoroidal implant D E Intravitreal

implants (eg Ozurdexreg Illuvien) F

microparticles nanoparticles liposomes G

Verisome system H Cortiject emulsion

The Future

Sustained drug delivery Intravitreal Anti-metabolite agents

Anti-VEGF therapy has

been used in the treatment

of glaucoma amp ocular

neovascular diseases

anti-angiogenic properties

anti-fibrotic properties

Bevacizumab amp

Ranibizumab

References Bentley E Miller PE Diehl KA (2003) Use of high-resolution ultrasound as a diagnostic tool in veterinary ophthalmology JAVMA

223 1617-1622

Corcoran KA Koch SA (1993) Uveal cysts in dogs 28 cases (1989-1991) JAVMA 203545-6

Deehr AJ Dubielzig RR (2002) A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers Veterinary Ophthalmology 1153-158

Devgan U (2006) Intraocular use of triamcinolone Removing preservatives from triamcinolone can minimize ocular toxicity and side effects Ocular Surgery News US Edition Dec 15th 20016

Esson D Armour M Mundy P Schobert CS Dubielzig RR (2009) The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in the Golden Retriever Vet Ophthalmol 12361-8

Holly VL Sandmeyer LS Bauer BS Verges L Grahn BH (2015) Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada Vet Ophthalmol doi 101111vop12293

Lin P Suhler EBet al (2014) The Future of Uveitis Treatment Ophthalmology 121 365ndash376

Sapienza JS et al (2000) Golden Retreiver Uveitis 75 cases (1994-1999) Veterinary Ophthalmology vol 3 Pg 241-246

Taylor LN Townsend WM etal (2015) Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts AJVR 76540ndash546

Townsend WM1 Gornik KR (2013) Prevalence of uveal cysts and pigmentary uveitis in Golden Retrievers in three Midwestern states JAVMA 2431298-301

vonHoldt BM et al (2010) Neighbour-joining trees of domestic dogs and grey wolves Nature doi101038nature08837

Page 8: Pigmentary Uveitis - vetemergency.cavetemergency.ca/wp-content/uploads/2015/11/Pigmentary-Uveitis.pdfiridociliary cysts, pigmentary uveitis, ... Neighbour-joining trees of domestic

Pigmentary Uveitis

copy Dr John Sapienza

Pigmentary Uveitis with Iris Cysts

copy Dr Michael Zigler

copy Dr John Sapienza

Pigmentary Uveitis

copy Dr John Sapienza copy Dr Doug Esson

Pigmentary Uveitis ndash later signs

copy Dr April Hahn copy Dr Alison Litchfield

Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and

pigmentarycystic glaucoma over a decade in western Canada

Holly V Sandmeyer LS Bauer BS etal (2015) Golden retriever cystic uveal disease a longitudinal study of

iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada

Veterinary Ophthalmology DOI 101111vop12293

Some cysts remain hidden behind the iris

displacing the iris root forward resulting in

a shallow anterior chamber and possible

compromise of the drainage angle

Use of high-resolution ultrasound as a diagnostic tool in

veterinary ophthalmology

Bentley E Miller PE Diehl KA (2003) JAVMA 223

1617-1622

Ultrasound biomicroscopy (UBM) for

detection of canine uveal cysts

UBM 50 MHz probe

Regular ocular ultrasound

probe is 75 or 12 MHz

Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts

Type of probe detected

Ocular us probe 0

UBM probe sensitivity 47

specificity 92

Pathogenesis of Uveitis

The pathogenesis of uveitis An imbalance between the regulatory mechanisms and

inflammatory mechanisms contribute to uveitis Only some examples of contributing role

players such as regulatory T cells versus Th17 cells are shown A combination of

environmental risk factors and genetic risk factors tip the balance towards the development

or chronicity of uveitis RPE retinal pigment epithelium PMNs polymorphonuclear cells

Pathogenesis of Pigmentary Uveitis

What comes first

Uveal Cysts

Uveal Cysts Uveitis

Uveitis Genetic

predisposition

Genetic

predisposition

Golden Retriever Foundation Health Survey of 1444 Goldens (1998-1999)

0 ndash 3 yrs 3 ndash 8 yrs 8 ndash 13 yrs 13+ yrs Total

Uveitis 0 2 11 3 16

Iris Cysts 0 5 7 0 12

Eye dx all 381 1444

COPLOW

Cases

numerator denominator percentage

Glaucoma 530 2176 24

Golden

Retreivers

25 530 5

Iridociliary

Cysts

13 25 52

COPLOW ndash Comparative Ophthalmic Pathology Laboratory of Wisconsin

survey of 2176 enucleated or eviscerated dog eye submissions

COPLOWrsquos Cases of Glaucoma with Iris

Cysts in Golden Retrievers

large thin-walled cysts lined with attenuated cuboidal epithelium filling most of the posterior chamber (1313 100)

thick walled cysts containing hyaluronic acid (813 62)

a solid cellular proliferation (213 15)

a retro-corneal membrane associated with a defect in Descemets membrane (713 54)

iris bombe (513 38)

a pre-iridal fibrovascular membranes (413 31)

hemorrhage (413 31)

a cellular membrane on the anterior lens surface (613 46)

retinal detachment (513 38)

peripheral anterior synechia (513 38)

posterior synechia (613 46)

Pathogenesis of Secondary Glaucoma

in Pigmentary Uveitis

Glaucoma

Uveitis

PIFM

Synechia Cataracts

Uveal and Iris Cysts

b

a Cytokines

b Inflammatory

debris blocks

drainage angle

c PIFM blocks

drainage angle

d Synechia blocks

drainage angle

e Lens induced

uveitis

Golden

Retriever

Histopathology ndash ciliary cysts

copy Dr John Sapienza

The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in

the Golden Retriever

Veterinary Ophthalmology

Volume 12 Issue 6 pages 361-368 26 OCT 2009 DOI 101111j1463-5224200900732x

httponlinelibrarywileycomdoi101111j1463-5224200900732xfullf1

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf4

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf5

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf6

Treatment Options - Topical

Treatment Options - Oral

Treatment Options - Injectable

Triamcinolone

Administer 02ml (8mg) by

subconjunctival injection

Intravitreal injection

TPA - Tissue Plasminogen

Activator

Administer 02ml by

intracameral injection

Preparation of Triamcinolone

for intravitreal injection

Method to wash out

preservatives

Diagrams

Triamcinolone can be purchased in 40 mgmL or 10 mgmL

concentrations both of which have significant preservatives

when taken straight from the bottle

For intravitreal injection the preservatives must be washed out

by removing the liquid carrier and re-suspend the triamcinolone

in sterile balanced salt solution

Step 1 Draw 1 cc of triamcinolone (40 mgmL) into a 5 cc

syringe

Step 2 Place a 022 microm filter on the syringe and reattach the

needle

Step 3 Expel the fluid through the filter and discard it thereby

trapping the triamcinolone particles in the filter

Step 4 Draw 4 cc of sterile balanced salt solution into the

syringe thereby re-suspending the triamcinolone particles

Step 5 Expel and discard the fluid again and re-suspend the

triamcinolone particles by drawing up 4 cc of balanced salt

solution again The triamcinolone is now washed

Step 6 Remove the filter and needle and attach a blunt canula

for intraocular use The final concentration of triamcinolone is

10 mgmL

A Retisertreg B I-vationtrade implant

C Suprachoroidal implant D E Intravitreal

implants (eg Ozurdexreg Illuvien) F

microparticles nanoparticles liposomes G

Verisome system H Cortiject emulsion

The Future

Sustained drug delivery Intravitreal Anti-metabolite agents

Anti-VEGF therapy has

been used in the treatment

of glaucoma amp ocular

neovascular diseases

anti-angiogenic properties

anti-fibrotic properties

Bevacizumab amp

Ranibizumab

References Bentley E Miller PE Diehl KA (2003) Use of high-resolution ultrasound as a diagnostic tool in veterinary ophthalmology JAVMA

223 1617-1622

Corcoran KA Koch SA (1993) Uveal cysts in dogs 28 cases (1989-1991) JAVMA 203545-6

Deehr AJ Dubielzig RR (2002) A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers Veterinary Ophthalmology 1153-158

Devgan U (2006) Intraocular use of triamcinolone Removing preservatives from triamcinolone can minimize ocular toxicity and side effects Ocular Surgery News US Edition Dec 15th 20016

Esson D Armour M Mundy P Schobert CS Dubielzig RR (2009) The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in the Golden Retriever Vet Ophthalmol 12361-8

Holly VL Sandmeyer LS Bauer BS Verges L Grahn BH (2015) Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada Vet Ophthalmol doi 101111vop12293

Lin P Suhler EBet al (2014) The Future of Uveitis Treatment Ophthalmology 121 365ndash376

Sapienza JS et al (2000) Golden Retreiver Uveitis 75 cases (1994-1999) Veterinary Ophthalmology vol 3 Pg 241-246

Taylor LN Townsend WM etal (2015) Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts AJVR 76540ndash546

Townsend WM1 Gornik KR (2013) Prevalence of uveal cysts and pigmentary uveitis in Golden Retrievers in three Midwestern states JAVMA 2431298-301

vonHoldt BM et al (2010) Neighbour-joining trees of domestic dogs and grey wolves Nature doi101038nature08837

Page 9: Pigmentary Uveitis - vetemergency.cavetemergency.ca/wp-content/uploads/2015/11/Pigmentary-Uveitis.pdfiridociliary cysts, pigmentary uveitis, ... Neighbour-joining trees of domestic

Pigmentary Uveitis with Iris Cysts

copy Dr Michael Zigler

copy Dr John Sapienza

Pigmentary Uveitis

copy Dr John Sapienza copy Dr Doug Esson

Pigmentary Uveitis ndash later signs

copy Dr April Hahn copy Dr Alison Litchfield

Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and

pigmentarycystic glaucoma over a decade in western Canada

Holly V Sandmeyer LS Bauer BS etal (2015) Golden retriever cystic uveal disease a longitudinal study of

iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada

Veterinary Ophthalmology DOI 101111vop12293

Some cysts remain hidden behind the iris

displacing the iris root forward resulting in

a shallow anterior chamber and possible

compromise of the drainage angle

Use of high-resolution ultrasound as a diagnostic tool in

veterinary ophthalmology

Bentley E Miller PE Diehl KA (2003) JAVMA 223

1617-1622

Ultrasound biomicroscopy (UBM) for

detection of canine uveal cysts

UBM 50 MHz probe

Regular ocular ultrasound

probe is 75 or 12 MHz

Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts

Type of probe detected

Ocular us probe 0

UBM probe sensitivity 47

specificity 92

Pathogenesis of Uveitis

The pathogenesis of uveitis An imbalance between the regulatory mechanisms and

inflammatory mechanisms contribute to uveitis Only some examples of contributing role

players such as regulatory T cells versus Th17 cells are shown A combination of

environmental risk factors and genetic risk factors tip the balance towards the development

or chronicity of uveitis RPE retinal pigment epithelium PMNs polymorphonuclear cells

Pathogenesis of Pigmentary Uveitis

What comes first

Uveal Cysts

Uveal Cysts Uveitis

Uveitis Genetic

predisposition

Genetic

predisposition

Golden Retriever Foundation Health Survey of 1444 Goldens (1998-1999)

0 ndash 3 yrs 3 ndash 8 yrs 8 ndash 13 yrs 13+ yrs Total

Uveitis 0 2 11 3 16

Iris Cysts 0 5 7 0 12

Eye dx all 381 1444

COPLOW

Cases

numerator denominator percentage

Glaucoma 530 2176 24

Golden

Retreivers

25 530 5

Iridociliary

Cysts

13 25 52

COPLOW ndash Comparative Ophthalmic Pathology Laboratory of Wisconsin

survey of 2176 enucleated or eviscerated dog eye submissions

COPLOWrsquos Cases of Glaucoma with Iris

Cysts in Golden Retrievers

large thin-walled cysts lined with attenuated cuboidal epithelium filling most of the posterior chamber (1313 100)

thick walled cysts containing hyaluronic acid (813 62)

a solid cellular proliferation (213 15)

a retro-corneal membrane associated with a defect in Descemets membrane (713 54)

iris bombe (513 38)

a pre-iridal fibrovascular membranes (413 31)

hemorrhage (413 31)

a cellular membrane on the anterior lens surface (613 46)

retinal detachment (513 38)

peripheral anterior synechia (513 38)

posterior synechia (613 46)

Pathogenesis of Secondary Glaucoma

in Pigmentary Uveitis

Glaucoma

Uveitis

PIFM

Synechia Cataracts

Uveal and Iris Cysts

b

a Cytokines

b Inflammatory

debris blocks

drainage angle

c PIFM blocks

drainage angle

d Synechia blocks

drainage angle

e Lens induced

uveitis

Golden

Retriever

Histopathology ndash ciliary cysts

copy Dr John Sapienza

The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in

the Golden Retriever

Veterinary Ophthalmology

Volume 12 Issue 6 pages 361-368 26 OCT 2009 DOI 101111j1463-5224200900732x

httponlinelibrarywileycomdoi101111j1463-5224200900732xfullf1

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf4

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf5

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf6

Treatment Options - Topical

Treatment Options - Oral

Treatment Options - Injectable

Triamcinolone

Administer 02ml (8mg) by

subconjunctival injection

Intravitreal injection

TPA - Tissue Plasminogen

Activator

Administer 02ml by

intracameral injection

Preparation of Triamcinolone

for intravitreal injection

Method to wash out

preservatives

Diagrams

Triamcinolone can be purchased in 40 mgmL or 10 mgmL

concentrations both of which have significant preservatives

when taken straight from the bottle

For intravitreal injection the preservatives must be washed out

by removing the liquid carrier and re-suspend the triamcinolone

in sterile balanced salt solution

Step 1 Draw 1 cc of triamcinolone (40 mgmL) into a 5 cc

syringe

Step 2 Place a 022 microm filter on the syringe and reattach the

needle

Step 3 Expel the fluid through the filter and discard it thereby

trapping the triamcinolone particles in the filter

Step 4 Draw 4 cc of sterile balanced salt solution into the

syringe thereby re-suspending the triamcinolone particles

Step 5 Expel and discard the fluid again and re-suspend the

triamcinolone particles by drawing up 4 cc of balanced salt

solution again The triamcinolone is now washed

Step 6 Remove the filter and needle and attach a blunt canula

for intraocular use The final concentration of triamcinolone is

10 mgmL

A Retisertreg B I-vationtrade implant

C Suprachoroidal implant D E Intravitreal

implants (eg Ozurdexreg Illuvien) F

microparticles nanoparticles liposomes G

Verisome system H Cortiject emulsion

The Future

Sustained drug delivery Intravitreal Anti-metabolite agents

Anti-VEGF therapy has

been used in the treatment

of glaucoma amp ocular

neovascular diseases

anti-angiogenic properties

anti-fibrotic properties

Bevacizumab amp

Ranibizumab

References Bentley E Miller PE Diehl KA (2003) Use of high-resolution ultrasound as a diagnostic tool in veterinary ophthalmology JAVMA

223 1617-1622

Corcoran KA Koch SA (1993) Uveal cysts in dogs 28 cases (1989-1991) JAVMA 203545-6

Deehr AJ Dubielzig RR (2002) A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers Veterinary Ophthalmology 1153-158

Devgan U (2006) Intraocular use of triamcinolone Removing preservatives from triamcinolone can minimize ocular toxicity and side effects Ocular Surgery News US Edition Dec 15th 20016

Esson D Armour M Mundy P Schobert CS Dubielzig RR (2009) The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in the Golden Retriever Vet Ophthalmol 12361-8

Holly VL Sandmeyer LS Bauer BS Verges L Grahn BH (2015) Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada Vet Ophthalmol doi 101111vop12293

Lin P Suhler EBet al (2014) The Future of Uveitis Treatment Ophthalmology 121 365ndash376

Sapienza JS et al (2000) Golden Retreiver Uveitis 75 cases (1994-1999) Veterinary Ophthalmology vol 3 Pg 241-246

Taylor LN Townsend WM etal (2015) Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts AJVR 76540ndash546

Townsend WM1 Gornik KR (2013) Prevalence of uveal cysts and pigmentary uveitis in Golden Retrievers in three Midwestern states JAVMA 2431298-301

vonHoldt BM et al (2010) Neighbour-joining trees of domestic dogs and grey wolves Nature doi101038nature08837

Page 10: Pigmentary Uveitis - vetemergency.cavetemergency.ca/wp-content/uploads/2015/11/Pigmentary-Uveitis.pdfiridociliary cysts, pigmentary uveitis, ... Neighbour-joining trees of domestic

Pigmentary Uveitis

copy Dr John Sapienza copy Dr Doug Esson

Pigmentary Uveitis ndash later signs

copy Dr April Hahn copy Dr Alison Litchfield

Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and

pigmentarycystic glaucoma over a decade in western Canada

Holly V Sandmeyer LS Bauer BS etal (2015) Golden retriever cystic uveal disease a longitudinal study of

iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada

Veterinary Ophthalmology DOI 101111vop12293

Some cysts remain hidden behind the iris

displacing the iris root forward resulting in

a shallow anterior chamber and possible

compromise of the drainage angle

Use of high-resolution ultrasound as a diagnostic tool in

veterinary ophthalmology

Bentley E Miller PE Diehl KA (2003) JAVMA 223

1617-1622

Ultrasound biomicroscopy (UBM) for

detection of canine uveal cysts

UBM 50 MHz probe

Regular ocular ultrasound

probe is 75 or 12 MHz

Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts

Type of probe detected

Ocular us probe 0

UBM probe sensitivity 47

specificity 92

Pathogenesis of Uveitis

The pathogenesis of uveitis An imbalance between the regulatory mechanisms and

inflammatory mechanisms contribute to uveitis Only some examples of contributing role

players such as regulatory T cells versus Th17 cells are shown A combination of

environmental risk factors and genetic risk factors tip the balance towards the development

or chronicity of uveitis RPE retinal pigment epithelium PMNs polymorphonuclear cells

Pathogenesis of Pigmentary Uveitis

What comes first

Uveal Cysts

Uveal Cysts Uveitis

Uveitis Genetic

predisposition

Genetic

predisposition

Golden Retriever Foundation Health Survey of 1444 Goldens (1998-1999)

0 ndash 3 yrs 3 ndash 8 yrs 8 ndash 13 yrs 13+ yrs Total

Uveitis 0 2 11 3 16

Iris Cysts 0 5 7 0 12

Eye dx all 381 1444

COPLOW

Cases

numerator denominator percentage

Glaucoma 530 2176 24

Golden

Retreivers

25 530 5

Iridociliary

Cysts

13 25 52

COPLOW ndash Comparative Ophthalmic Pathology Laboratory of Wisconsin

survey of 2176 enucleated or eviscerated dog eye submissions

COPLOWrsquos Cases of Glaucoma with Iris

Cysts in Golden Retrievers

large thin-walled cysts lined with attenuated cuboidal epithelium filling most of the posterior chamber (1313 100)

thick walled cysts containing hyaluronic acid (813 62)

a solid cellular proliferation (213 15)

a retro-corneal membrane associated with a defect in Descemets membrane (713 54)

iris bombe (513 38)

a pre-iridal fibrovascular membranes (413 31)

hemorrhage (413 31)

a cellular membrane on the anterior lens surface (613 46)

retinal detachment (513 38)

peripheral anterior synechia (513 38)

posterior synechia (613 46)

Pathogenesis of Secondary Glaucoma

in Pigmentary Uveitis

Glaucoma

Uveitis

PIFM

Synechia Cataracts

Uveal and Iris Cysts

b

a Cytokines

b Inflammatory

debris blocks

drainage angle

c PIFM blocks

drainage angle

d Synechia blocks

drainage angle

e Lens induced

uveitis

Golden

Retriever

Histopathology ndash ciliary cysts

copy Dr John Sapienza

The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in

the Golden Retriever

Veterinary Ophthalmology

Volume 12 Issue 6 pages 361-368 26 OCT 2009 DOI 101111j1463-5224200900732x

httponlinelibrarywileycomdoi101111j1463-5224200900732xfullf1

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf4

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf5

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf6

Treatment Options - Topical

Treatment Options - Oral

Treatment Options - Injectable

Triamcinolone

Administer 02ml (8mg) by

subconjunctival injection

Intravitreal injection

TPA - Tissue Plasminogen

Activator

Administer 02ml by

intracameral injection

Preparation of Triamcinolone

for intravitreal injection

Method to wash out

preservatives

Diagrams

Triamcinolone can be purchased in 40 mgmL or 10 mgmL

concentrations both of which have significant preservatives

when taken straight from the bottle

For intravitreal injection the preservatives must be washed out

by removing the liquid carrier and re-suspend the triamcinolone

in sterile balanced salt solution

Step 1 Draw 1 cc of triamcinolone (40 mgmL) into a 5 cc

syringe

Step 2 Place a 022 microm filter on the syringe and reattach the

needle

Step 3 Expel the fluid through the filter and discard it thereby

trapping the triamcinolone particles in the filter

Step 4 Draw 4 cc of sterile balanced salt solution into the

syringe thereby re-suspending the triamcinolone particles

Step 5 Expel and discard the fluid again and re-suspend the

triamcinolone particles by drawing up 4 cc of balanced salt

solution again The triamcinolone is now washed

Step 6 Remove the filter and needle and attach a blunt canula

for intraocular use The final concentration of triamcinolone is

10 mgmL

A Retisertreg B I-vationtrade implant

C Suprachoroidal implant D E Intravitreal

implants (eg Ozurdexreg Illuvien) F

microparticles nanoparticles liposomes G

Verisome system H Cortiject emulsion

The Future

Sustained drug delivery Intravitreal Anti-metabolite agents

Anti-VEGF therapy has

been used in the treatment

of glaucoma amp ocular

neovascular diseases

anti-angiogenic properties

anti-fibrotic properties

Bevacizumab amp

Ranibizumab

References Bentley E Miller PE Diehl KA (2003) Use of high-resolution ultrasound as a diagnostic tool in veterinary ophthalmology JAVMA

223 1617-1622

Corcoran KA Koch SA (1993) Uveal cysts in dogs 28 cases (1989-1991) JAVMA 203545-6

Deehr AJ Dubielzig RR (2002) A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers Veterinary Ophthalmology 1153-158

Devgan U (2006) Intraocular use of triamcinolone Removing preservatives from triamcinolone can minimize ocular toxicity and side effects Ocular Surgery News US Edition Dec 15th 20016

Esson D Armour M Mundy P Schobert CS Dubielzig RR (2009) The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in the Golden Retriever Vet Ophthalmol 12361-8

Holly VL Sandmeyer LS Bauer BS Verges L Grahn BH (2015) Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada Vet Ophthalmol doi 101111vop12293

Lin P Suhler EBet al (2014) The Future of Uveitis Treatment Ophthalmology 121 365ndash376

Sapienza JS et al (2000) Golden Retreiver Uveitis 75 cases (1994-1999) Veterinary Ophthalmology vol 3 Pg 241-246

Taylor LN Townsend WM etal (2015) Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts AJVR 76540ndash546

Townsend WM1 Gornik KR (2013) Prevalence of uveal cysts and pigmentary uveitis in Golden Retrievers in three Midwestern states JAVMA 2431298-301

vonHoldt BM et al (2010) Neighbour-joining trees of domestic dogs and grey wolves Nature doi101038nature08837

Page 11: Pigmentary Uveitis - vetemergency.cavetemergency.ca/wp-content/uploads/2015/11/Pigmentary-Uveitis.pdfiridociliary cysts, pigmentary uveitis, ... Neighbour-joining trees of domestic

Pigmentary Uveitis ndash later signs

copy Dr April Hahn copy Dr Alison Litchfield

Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and

pigmentarycystic glaucoma over a decade in western Canada

Holly V Sandmeyer LS Bauer BS etal (2015) Golden retriever cystic uveal disease a longitudinal study of

iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada

Veterinary Ophthalmology DOI 101111vop12293

Some cysts remain hidden behind the iris

displacing the iris root forward resulting in

a shallow anterior chamber and possible

compromise of the drainage angle

Use of high-resolution ultrasound as a diagnostic tool in

veterinary ophthalmology

Bentley E Miller PE Diehl KA (2003) JAVMA 223

1617-1622

Ultrasound biomicroscopy (UBM) for

detection of canine uveal cysts

UBM 50 MHz probe

Regular ocular ultrasound

probe is 75 or 12 MHz

Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts

Type of probe detected

Ocular us probe 0

UBM probe sensitivity 47

specificity 92

Pathogenesis of Uveitis

The pathogenesis of uveitis An imbalance between the regulatory mechanisms and

inflammatory mechanisms contribute to uveitis Only some examples of contributing role

players such as regulatory T cells versus Th17 cells are shown A combination of

environmental risk factors and genetic risk factors tip the balance towards the development

or chronicity of uveitis RPE retinal pigment epithelium PMNs polymorphonuclear cells

Pathogenesis of Pigmentary Uveitis

What comes first

Uveal Cysts

Uveal Cysts Uveitis

Uveitis Genetic

predisposition

Genetic

predisposition

Golden Retriever Foundation Health Survey of 1444 Goldens (1998-1999)

0 ndash 3 yrs 3 ndash 8 yrs 8 ndash 13 yrs 13+ yrs Total

Uveitis 0 2 11 3 16

Iris Cysts 0 5 7 0 12

Eye dx all 381 1444

COPLOW

Cases

numerator denominator percentage

Glaucoma 530 2176 24

Golden

Retreivers

25 530 5

Iridociliary

Cysts

13 25 52

COPLOW ndash Comparative Ophthalmic Pathology Laboratory of Wisconsin

survey of 2176 enucleated or eviscerated dog eye submissions

COPLOWrsquos Cases of Glaucoma with Iris

Cysts in Golden Retrievers

large thin-walled cysts lined with attenuated cuboidal epithelium filling most of the posterior chamber (1313 100)

thick walled cysts containing hyaluronic acid (813 62)

a solid cellular proliferation (213 15)

a retro-corneal membrane associated with a defect in Descemets membrane (713 54)

iris bombe (513 38)

a pre-iridal fibrovascular membranes (413 31)

hemorrhage (413 31)

a cellular membrane on the anterior lens surface (613 46)

retinal detachment (513 38)

peripheral anterior synechia (513 38)

posterior synechia (613 46)

Pathogenesis of Secondary Glaucoma

in Pigmentary Uveitis

Glaucoma

Uveitis

PIFM

Synechia Cataracts

Uveal and Iris Cysts

b

a Cytokines

b Inflammatory

debris blocks

drainage angle

c PIFM blocks

drainage angle

d Synechia blocks

drainage angle

e Lens induced

uveitis

Golden

Retriever

Histopathology ndash ciliary cysts

copy Dr John Sapienza

The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in

the Golden Retriever

Veterinary Ophthalmology

Volume 12 Issue 6 pages 361-368 26 OCT 2009 DOI 101111j1463-5224200900732x

httponlinelibrarywileycomdoi101111j1463-5224200900732xfullf1

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf4

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf5

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf6

Treatment Options - Topical

Treatment Options - Oral

Treatment Options - Injectable

Triamcinolone

Administer 02ml (8mg) by

subconjunctival injection

Intravitreal injection

TPA - Tissue Plasminogen

Activator

Administer 02ml by

intracameral injection

Preparation of Triamcinolone

for intravitreal injection

Method to wash out

preservatives

Diagrams

Triamcinolone can be purchased in 40 mgmL or 10 mgmL

concentrations both of which have significant preservatives

when taken straight from the bottle

For intravitreal injection the preservatives must be washed out

by removing the liquid carrier and re-suspend the triamcinolone

in sterile balanced salt solution

Step 1 Draw 1 cc of triamcinolone (40 mgmL) into a 5 cc

syringe

Step 2 Place a 022 microm filter on the syringe and reattach the

needle

Step 3 Expel the fluid through the filter and discard it thereby

trapping the triamcinolone particles in the filter

Step 4 Draw 4 cc of sterile balanced salt solution into the

syringe thereby re-suspending the triamcinolone particles

Step 5 Expel and discard the fluid again and re-suspend the

triamcinolone particles by drawing up 4 cc of balanced salt

solution again The triamcinolone is now washed

Step 6 Remove the filter and needle and attach a blunt canula

for intraocular use The final concentration of triamcinolone is

10 mgmL

A Retisertreg B I-vationtrade implant

C Suprachoroidal implant D E Intravitreal

implants (eg Ozurdexreg Illuvien) F

microparticles nanoparticles liposomes G

Verisome system H Cortiject emulsion

The Future

Sustained drug delivery Intravitreal Anti-metabolite agents

Anti-VEGF therapy has

been used in the treatment

of glaucoma amp ocular

neovascular diseases

anti-angiogenic properties

anti-fibrotic properties

Bevacizumab amp

Ranibizumab

References Bentley E Miller PE Diehl KA (2003) Use of high-resolution ultrasound as a diagnostic tool in veterinary ophthalmology JAVMA

223 1617-1622

Corcoran KA Koch SA (1993) Uveal cysts in dogs 28 cases (1989-1991) JAVMA 203545-6

Deehr AJ Dubielzig RR (2002) A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers Veterinary Ophthalmology 1153-158

Devgan U (2006) Intraocular use of triamcinolone Removing preservatives from triamcinolone can minimize ocular toxicity and side effects Ocular Surgery News US Edition Dec 15th 20016

Esson D Armour M Mundy P Schobert CS Dubielzig RR (2009) The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in the Golden Retriever Vet Ophthalmol 12361-8

Holly VL Sandmeyer LS Bauer BS Verges L Grahn BH (2015) Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada Vet Ophthalmol doi 101111vop12293

Lin P Suhler EBet al (2014) The Future of Uveitis Treatment Ophthalmology 121 365ndash376

Sapienza JS et al (2000) Golden Retreiver Uveitis 75 cases (1994-1999) Veterinary Ophthalmology vol 3 Pg 241-246

Taylor LN Townsend WM etal (2015) Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts AJVR 76540ndash546

Townsend WM1 Gornik KR (2013) Prevalence of uveal cysts and pigmentary uveitis in Golden Retrievers in three Midwestern states JAVMA 2431298-301

vonHoldt BM et al (2010) Neighbour-joining trees of domestic dogs and grey wolves Nature doi101038nature08837

Page 12: Pigmentary Uveitis - vetemergency.cavetemergency.ca/wp-content/uploads/2015/11/Pigmentary-Uveitis.pdfiridociliary cysts, pigmentary uveitis, ... Neighbour-joining trees of domestic

Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and

pigmentarycystic glaucoma over a decade in western Canada

Holly V Sandmeyer LS Bauer BS etal (2015) Golden retriever cystic uveal disease a longitudinal study of

iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada

Veterinary Ophthalmology DOI 101111vop12293

Some cysts remain hidden behind the iris

displacing the iris root forward resulting in

a shallow anterior chamber and possible

compromise of the drainage angle

Use of high-resolution ultrasound as a diagnostic tool in

veterinary ophthalmology

Bentley E Miller PE Diehl KA (2003) JAVMA 223

1617-1622

Ultrasound biomicroscopy (UBM) for

detection of canine uveal cysts

UBM 50 MHz probe

Regular ocular ultrasound

probe is 75 or 12 MHz

Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts

Type of probe detected

Ocular us probe 0

UBM probe sensitivity 47

specificity 92

Pathogenesis of Uveitis

The pathogenesis of uveitis An imbalance between the regulatory mechanisms and

inflammatory mechanisms contribute to uveitis Only some examples of contributing role

players such as regulatory T cells versus Th17 cells are shown A combination of

environmental risk factors and genetic risk factors tip the balance towards the development

or chronicity of uveitis RPE retinal pigment epithelium PMNs polymorphonuclear cells

Pathogenesis of Pigmentary Uveitis

What comes first

Uveal Cysts

Uveal Cysts Uveitis

Uveitis Genetic

predisposition

Genetic

predisposition

Golden Retriever Foundation Health Survey of 1444 Goldens (1998-1999)

0 ndash 3 yrs 3 ndash 8 yrs 8 ndash 13 yrs 13+ yrs Total

Uveitis 0 2 11 3 16

Iris Cysts 0 5 7 0 12

Eye dx all 381 1444

COPLOW

Cases

numerator denominator percentage

Glaucoma 530 2176 24

Golden

Retreivers

25 530 5

Iridociliary

Cysts

13 25 52

COPLOW ndash Comparative Ophthalmic Pathology Laboratory of Wisconsin

survey of 2176 enucleated or eviscerated dog eye submissions

COPLOWrsquos Cases of Glaucoma with Iris

Cysts in Golden Retrievers

large thin-walled cysts lined with attenuated cuboidal epithelium filling most of the posterior chamber (1313 100)

thick walled cysts containing hyaluronic acid (813 62)

a solid cellular proliferation (213 15)

a retro-corneal membrane associated with a defect in Descemets membrane (713 54)

iris bombe (513 38)

a pre-iridal fibrovascular membranes (413 31)

hemorrhage (413 31)

a cellular membrane on the anterior lens surface (613 46)

retinal detachment (513 38)

peripheral anterior synechia (513 38)

posterior synechia (613 46)

Pathogenesis of Secondary Glaucoma

in Pigmentary Uveitis

Glaucoma

Uveitis

PIFM

Synechia Cataracts

Uveal and Iris Cysts

b

a Cytokines

b Inflammatory

debris blocks

drainage angle

c PIFM blocks

drainage angle

d Synechia blocks

drainage angle

e Lens induced

uveitis

Golden

Retriever

Histopathology ndash ciliary cysts

copy Dr John Sapienza

The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in

the Golden Retriever

Veterinary Ophthalmology

Volume 12 Issue 6 pages 361-368 26 OCT 2009 DOI 101111j1463-5224200900732x

httponlinelibrarywileycomdoi101111j1463-5224200900732xfullf1

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf4

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf5

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf6

Treatment Options - Topical

Treatment Options - Oral

Treatment Options - Injectable

Triamcinolone

Administer 02ml (8mg) by

subconjunctival injection

Intravitreal injection

TPA - Tissue Plasminogen

Activator

Administer 02ml by

intracameral injection

Preparation of Triamcinolone

for intravitreal injection

Method to wash out

preservatives

Diagrams

Triamcinolone can be purchased in 40 mgmL or 10 mgmL

concentrations both of which have significant preservatives

when taken straight from the bottle

For intravitreal injection the preservatives must be washed out

by removing the liquid carrier and re-suspend the triamcinolone

in sterile balanced salt solution

Step 1 Draw 1 cc of triamcinolone (40 mgmL) into a 5 cc

syringe

Step 2 Place a 022 microm filter on the syringe and reattach the

needle

Step 3 Expel the fluid through the filter and discard it thereby

trapping the triamcinolone particles in the filter

Step 4 Draw 4 cc of sterile balanced salt solution into the

syringe thereby re-suspending the triamcinolone particles

Step 5 Expel and discard the fluid again and re-suspend the

triamcinolone particles by drawing up 4 cc of balanced salt

solution again The triamcinolone is now washed

Step 6 Remove the filter and needle and attach a blunt canula

for intraocular use The final concentration of triamcinolone is

10 mgmL

A Retisertreg B I-vationtrade implant

C Suprachoroidal implant D E Intravitreal

implants (eg Ozurdexreg Illuvien) F

microparticles nanoparticles liposomes G

Verisome system H Cortiject emulsion

The Future

Sustained drug delivery Intravitreal Anti-metabolite agents

Anti-VEGF therapy has

been used in the treatment

of glaucoma amp ocular

neovascular diseases

anti-angiogenic properties

anti-fibrotic properties

Bevacizumab amp

Ranibizumab

References Bentley E Miller PE Diehl KA (2003) Use of high-resolution ultrasound as a diagnostic tool in veterinary ophthalmology JAVMA

223 1617-1622

Corcoran KA Koch SA (1993) Uveal cysts in dogs 28 cases (1989-1991) JAVMA 203545-6

Deehr AJ Dubielzig RR (2002) A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers Veterinary Ophthalmology 1153-158

Devgan U (2006) Intraocular use of triamcinolone Removing preservatives from triamcinolone can minimize ocular toxicity and side effects Ocular Surgery News US Edition Dec 15th 20016

Esson D Armour M Mundy P Schobert CS Dubielzig RR (2009) The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in the Golden Retriever Vet Ophthalmol 12361-8

Holly VL Sandmeyer LS Bauer BS Verges L Grahn BH (2015) Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada Vet Ophthalmol doi 101111vop12293

Lin P Suhler EBet al (2014) The Future of Uveitis Treatment Ophthalmology 121 365ndash376

Sapienza JS et al (2000) Golden Retreiver Uveitis 75 cases (1994-1999) Veterinary Ophthalmology vol 3 Pg 241-246

Taylor LN Townsend WM etal (2015) Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts AJVR 76540ndash546

Townsend WM1 Gornik KR (2013) Prevalence of uveal cysts and pigmentary uveitis in Golden Retrievers in three Midwestern states JAVMA 2431298-301

vonHoldt BM et al (2010) Neighbour-joining trees of domestic dogs and grey wolves Nature doi101038nature08837

Page 13: Pigmentary Uveitis - vetemergency.cavetemergency.ca/wp-content/uploads/2015/11/Pigmentary-Uveitis.pdfiridociliary cysts, pigmentary uveitis, ... Neighbour-joining trees of domestic

Some cysts remain hidden behind the iris

displacing the iris root forward resulting in

a shallow anterior chamber and possible

compromise of the drainage angle

Use of high-resolution ultrasound as a diagnostic tool in

veterinary ophthalmology

Bentley E Miller PE Diehl KA (2003) JAVMA 223

1617-1622

Ultrasound biomicroscopy (UBM) for

detection of canine uveal cysts

UBM 50 MHz probe

Regular ocular ultrasound

probe is 75 or 12 MHz

Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts

Type of probe detected

Ocular us probe 0

UBM probe sensitivity 47

specificity 92

Pathogenesis of Uveitis

The pathogenesis of uveitis An imbalance between the regulatory mechanisms and

inflammatory mechanisms contribute to uveitis Only some examples of contributing role

players such as regulatory T cells versus Th17 cells are shown A combination of

environmental risk factors and genetic risk factors tip the balance towards the development

or chronicity of uveitis RPE retinal pigment epithelium PMNs polymorphonuclear cells

Pathogenesis of Pigmentary Uveitis

What comes first

Uveal Cysts

Uveal Cysts Uveitis

Uveitis Genetic

predisposition

Genetic

predisposition

Golden Retriever Foundation Health Survey of 1444 Goldens (1998-1999)

0 ndash 3 yrs 3 ndash 8 yrs 8 ndash 13 yrs 13+ yrs Total

Uveitis 0 2 11 3 16

Iris Cysts 0 5 7 0 12

Eye dx all 381 1444

COPLOW

Cases

numerator denominator percentage

Glaucoma 530 2176 24

Golden

Retreivers

25 530 5

Iridociliary

Cysts

13 25 52

COPLOW ndash Comparative Ophthalmic Pathology Laboratory of Wisconsin

survey of 2176 enucleated or eviscerated dog eye submissions

COPLOWrsquos Cases of Glaucoma with Iris

Cysts in Golden Retrievers

large thin-walled cysts lined with attenuated cuboidal epithelium filling most of the posterior chamber (1313 100)

thick walled cysts containing hyaluronic acid (813 62)

a solid cellular proliferation (213 15)

a retro-corneal membrane associated with a defect in Descemets membrane (713 54)

iris bombe (513 38)

a pre-iridal fibrovascular membranes (413 31)

hemorrhage (413 31)

a cellular membrane on the anterior lens surface (613 46)

retinal detachment (513 38)

peripheral anterior synechia (513 38)

posterior synechia (613 46)

Pathogenesis of Secondary Glaucoma

in Pigmentary Uveitis

Glaucoma

Uveitis

PIFM

Synechia Cataracts

Uveal and Iris Cysts

b

a Cytokines

b Inflammatory

debris blocks

drainage angle

c PIFM blocks

drainage angle

d Synechia blocks

drainage angle

e Lens induced

uveitis

Golden

Retriever

Histopathology ndash ciliary cysts

copy Dr John Sapienza

The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in

the Golden Retriever

Veterinary Ophthalmology

Volume 12 Issue 6 pages 361-368 26 OCT 2009 DOI 101111j1463-5224200900732x

httponlinelibrarywileycomdoi101111j1463-5224200900732xfullf1

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf4

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf5

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf6

Treatment Options - Topical

Treatment Options - Oral

Treatment Options - Injectable

Triamcinolone

Administer 02ml (8mg) by

subconjunctival injection

Intravitreal injection

TPA - Tissue Plasminogen

Activator

Administer 02ml by

intracameral injection

Preparation of Triamcinolone

for intravitreal injection

Method to wash out

preservatives

Diagrams

Triamcinolone can be purchased in 40 mgmL or 10 mgmL

concentrations both of which have significant preservatives

when taken straight from the bottle

For intravitreal injection the preservatives must be washed out

by removing the liquid carrier and re-suspend the triamcinolone

in sterile balanced salt solution

Step 1 Draw 1 cc of triamcinolone (40 mgmL) into a 5 cc

syringe

Step 2 Place a 022 microm filter on the syringe and reattach the

needle

Step 3 Expel the fluid through the filter and discard it thereby

trapping the triamcinolone particles in the filter

Step 4 Draw 4 cc of sterile balanced salt solution into the

syringe thereby re-suspending the triamcinolone particles

Step 5 Expel and discard the fluid again and re-suspend the

triamcinolone particles by drawing up 4 cc of balanced salt

solution again The triamcinolone is now washed

Step 6 Remove the filter and needle and attach a blunt canula

for intraocular use The final concentration of triamcinolone is

10 mgmL

A Retisertreg B I-vationtrade implant

C Suprachoroidal implant D E Intravitreal

implants (eg Ozurdexreg Illuvien) F

microparticles nanoparticles liposomes G

Verisome system H Cortiject emulsion

The Future

Sustained drug delivery Intravitreal Anti-metabolite agents

Anti-VEGF therapy has

been used in the treatment

of glaucoma amp ocular

neovascular diseases

anti-angiogenic properties

anti-fibrotic properties

Bevacizumab amp

Ranibizumab

References Bentley E Miller PE Diehl KA (2003) Use of high-resolution ultrasound as a diagnostic tool in veterinary ophthalmology JAVMA

223 1617-1622

Corcoran KA Koch SA (1993) Uveal cysts in dogs 28 cases (1989-1991) JAVMA 203545-6

Deehr AJ Dubielzig RR (2002) A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers Veterinary Ophthalmology 1153-158

Devgan U (2006) Intraocular use of triamcinolone Removing preservatives from triamcinolone can minimize ocular toxicity and side effects Ocular Surgery News US Edition Dec 15th 20016

Esson D Armour M Mundy P Schobert CS Dubielzig RR (2009) The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in the Golden Retriever Vet Ophthalmol 12361-8

Holly VL Sandmeyer LS Bauer BS Verges L Grahn BH (2015) Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada Vet Ophthalmol doi 101111vop12293

Lin P Suhler EBet al (2014) The Future of Uveitis Treatment Ophthalmology 121 365ndash376

Sapienza JS et al (2000) Golden Retreiver Uveitis 75 cases (1994-1999) Veterinary Ophthalmology vol 3 Pg 241-246

Taylor LN Townsend WM etal (2015) Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts AJVR 76540ndash546

Townsend WM1 Gornik KR (2013) Prevalence of uveal cysts and pigmentary uveitis in Golden Retrievers in three Midwestern states JAVMA 2431298-301

vonHoldt BM et al (2010) Neighbour-joining trees of domestic dogs and grey wolves Nature doi101038nature08837

Page 14: Pigmentary Uveitis - vetemergency.cavetemergency.ca/wp-content/uploads/2015/11/Pigmentary-Uveitis.pdfiridociliary cysts, pigmentary uveitis, ... Neighbour-joining trees of domestic

Ultrasound biomicroscopy (UBM) for

detection of canine uveal cysts

UBM 50 MHz probe

Regular ocular ultrasound

probe is 75 or 12 MHz

Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts

Type of probe detected

Ocular us probe 0

UBM probe sensitivity 47

specificity 92

Pathogenesis of Uveitis

The pathogenesis of uveitis An imbalance between the regulatory mechanisms and

inflammatory mechanisms contribute to uveitis Only some examples of contributing role

players such as regulatory T cells versus Th17 cells are shown A combination of

environmental risk factors and genetic risk factors tip the balance towards the development

or chronicity of uveitis RPE retinal pigment epithelium PMNs polymorphonuclear cells

Pathogenesis of Pigmentary Uveitis

What comes first

Uveal Cysts

Uveal Cysts Uveitis

Uveitis Genetic

predisposition

Genetic

predisposition

Golden Retriever Foundation Health Survey of 1444 Goldens (1998-1999)

0 ndash 3 yrs 3 ndash 8 yrs 8 ndash 13 yrs 13+ yrs Total

Uveitis 0 2 11 3 16

Iris Cysts 0 5 7 0 12

Eye dx all 381 1444

COPLOW

Cases

numerator denominator percentage

Glaucoma 530 2176 24

Golden

Retreivers

25 530 5

Iridociliary

Cysts

13 25 52

COPLOW ndash Comparative Ophthalmic Pathology Laboratory of Wisconsin

survey of 2176 enucleated or eviscerated dog eye submissions

COPLOWrsquos Cases of Glaucoma with Iris

Cysts in Golden Retrievers

large thin-walled cysts lined with attenuated cuboidal epithelium filling most of the posterior chamber (1313 100)

thick walled cysts containing hyaluronic acid (813 62)

a solid cellular proliferation (213 15)

a retro-corneal membrane associated with a defect in Descemets membrane (713 54)

iris bombe (513 38)

a pre-iridal fibrovascular membranes (413 31)

hemorrhage (413 31)

a cellular membrane on the anterior lens surface (613 46)

retinal detachment (513 38)

peripheral anterior synechia (513 38)

posterior synechia (613 46)

Pathogenesis of Secondary Glaucoma

in Pigmentary Uveitis

Glaucoma

Uveitis

PIFM

Synechia Cataracts

Uveal and Iris Cysts

b

a Cytokines

b Inflammatory

debris blocks

drainage angle

c PIFM blocks

drainage angle

d Synechia blocks

drainage angle

e Lens induced

uveitis

Golden

Retriever

Histopathology ndash ciliary cysts

copy Dr John Sapienza

The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in

the Golden Retriever

Veterinary Ophthalmology

Volume 12 Issue 6 pages 361-368 26 OCT 2009 DOI 101111j1463-5224200900732x

httponlinelibrarywileycomdoi101111j1463-5224200900732xfullf1

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf4

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf5

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf6

Treatment Options - Topical

Treatment Options - Oral

Treatment Options - Injectable

Triamcinolone

Administer 02ml (8mg) by

subconjunctival injection

Intravitreal injection

TPA - Tissue Plasminogen

Activator

Administer 02ml by

intracameral injection

Preparation of Triamcinolone

for intravitreal injection

Method to wash out

preservatives

Diagrams

Triamcinolone can be purchased in 40 mgmL or 10 mgmL

concentrations both of which have significant preservatives

when taken straight from the bottle

For intravitreal injection the preservatives must be washed out

by removing the liquid carrier and re-suspend the triamcinolone

in sterile balanced salt solution

Step 1 Draw 1 cc of triamcinolone (40 mgmL) into a 5 cc

syringe

Step 2 Place a 022 microm filter on the syringe and reattach the

needle

Step 3 Expel the fluid through the filter and discard it thereby

trapping the triamcinolone particles in the filter

Step 4 Draw 4 cc of sterile balanced salt solution into the

syringe thereby re-suspending the triamcinolone particles

Step 5 Expel and discard the fluid again and re-suspend the

triamcinolone particles by drawing up 4 cc of balanced salt

solution again The triamcinolone is now washed

Step 6 Remove the filter and needle and attach a blunt canula

for intraocular use The final concentration of triamcinolone is

10 mgmL

A Retisertreg B I-vationtrade implant

C Suprachoroidal implant D E Intravitreal

implants (eg Ozurdexreg Illuvien) F

microparticles nanoparticles liposomes G

Verisome system H Cortiject emulsion

The Future

Sustained drug delivery Intravitreal Anti-metabolite agents

Anti-VEGF therapy has

been used in the treatment

of glaucoma amp ocular

neovascular diseases

anti-angiogenic properties

anti-fibrotic properties

Bevacizumab amp

Ranibizumab

References Bentley E Miller PE Diehl KA (2003) Use of high-resolution ultrasound as a diagnostic tool in veterinary ophthalmology JAVMA

223 1617-1622

Corcoran KA Koch SA (1993) Uveal cysts in dogs 28 cases (1989-1991) JAVMA 203545-6

Deehr AJ Dubielzig RR (2002) A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers Veterinary Ophthalmology 1153-158

Devgan U (2006) Intraocular use of triamcinolone Removing preservatives from triamcinolone can minimize ocular toxicity and side effects Ocular Surgery News US Edition Dec 15th 20016

Esson D Armour M Mundy P Schobert CS Dubielzig RR (2009) The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in the Golden Retriever Vet Ophthalmol 12361-8

Holly VL Sandmeyer LS Bauer BS Verges L Grahn BH (2015) Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada Vet Ophthalmol doi 101111vop12293

Lin P Suhler EBet al (2014) The Future of Uveitis Treatment Ophthalmology 121 365ndash376

Sapienza JS et al (2000) Golden Retreiver Uveitis 75 cases (1994-1999) Veterinary Ophthalmology vol 3 Pg 241-246

Taylor LN Townsend WM etal (2015) Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts AJVR 76540ndash546

Townsend WM1 Gornik KR (2013) Prevalence of uveal cysts and pigmentary uveitis in Golden Retrievers in three Midwestern states JAVMA 2431298-301

vonHoldt BM et al (2010) Neighbour-joining trees of domestic dogs and grey wolves Nature doi101038nature08837

Page 15: Pigmentary Uveitis - vetemergency.cavetemergency.ca/wp-content/uploads/2015/11/Pigmentary-Uveitis.pdfiridociliary cysts, pigmentary uveitis, ... Neighbour-joining trees of domestic

Pathogenesis of Uveitis

The pathogenesis of uveitis An imbalance between the regulatory mechanisms and

inflammatory mechanisms contribute to uveitis Only some examples of contributing role

players such as regulatory T cells versus Th17 cells are shown A combination of

environmental risk factors and genetic risk factors tip the balance towards the development

or chronicity of uveitis RPE retinal pigment epithelium PMNs polymorphonuclear cells

Pathogenesis of Pigmentary Uveitis

What comes first

Uveal Cysts

Uveal Cysts Uveitis

Uveitis Genetic

predisposition

Genetic

predisposition

Golden Retriever Foundation Health Survey of 1444 Goldens (1998-1999)

0 ndash 3 yrs 3 ndash 8 yrs 8 ndash 13 yrs 13+ yrs Total

Uveitis 0 2 11 3 16

Iris Cysts 0 5 7 0 12

Eye dx all 381 1444

COPLOW

Cases

numerator denominator percentage

Glaucoma 530 2176 24

Golden

Retreivers

25 530 5

Iridociliary

Cysts

13 25 52

COPLOW ndash Comparative Ophthalmic Pathology Laboratory of Wisconsin

survey of 2176 enucleated or eviscerated dog eye submissions

COPLOWrsquos Cases of Glaucoma with Iris

Cysts in Golden Retrievers

large thin-walled cysts lined with attenuated cuboidal epithelium filling most of the posterior chamber (1313 100)

thick walled cysts containing hyaluronic acid (813 62)

a solid cellular proliferation (213 15)

a retro-corneal membrane associated with a defect in Descemets membrane (713 54)

iris bombe (513 38)

a pre-iridal fibrovascular membranes (413 31)

hemorrhage (413 31)

a cellular membrane on the anterior lens surface (613 46)

retinal detachment (513 38)

peripheral anterior synechia (513 38)

posterior synechia (613 46)

Pathogenesis of Secondary Glaucoma

in Pigmentary Uveitis

Glaucoma

Uveitis

PIFM

Synechia Cataracts

Uveal and Iris Cysts

b

a Cytokines

b Inflammatory

debris blocks

drainage angle

c PIFM blocks

drainage angle

d Synechia blocks

drainage angle

e Lens induced

uveitis

Golden

Retriever

Histopathology ndash ciliary cysts

copy Dr John Sapienza

The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in

the Golden Retriever

Veterinary Ophthalmology

Volume 12 Issue 6 pages 361-368 26 OCT 2009 DOI 101111j1463-5224200900732x

httponlinelibrarywileycomdoi101111j1463-5224200900732xfullf1

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf4

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf5

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf6

Treatment Options - Topical

Treatment Options - Oral

Treatment Options - Injectable

Triamcinolone

Administer 02ml (8mg) by

subconjunctival injection

Intravitreal injection

TPA - Tissue Plasminogen

Activator

Administer 02ml by

intracameral injection

Preparation of Triamcinolone

for intravitreal injection

Method to wash out

preservatives

Diagrams

Triamcinolone can be purchased in 40 mgmL or 10 mgmL

concentrations both of which have significant preservatives

when taken straight from the bottle

For intravitreal injection the preservatives must be washed out

by removing the liquid carrier and re-suspend the triamcinolone

in sterile balanced salt solution

Step 1 Draw 1 cc of triamcinolone (40 mgmL) into a 5 cc

syringe

Step 2 Place a 022 microm filter on the syringe and reattach the

needle

Step 3 Expel the fluid through the filter and discard it thereby

trapping the triamcinolone particles in the filter

Step 4 Draw 4 cc of sterile balanced salt solution into the

syringe thereby re-suspending the triamcinolone particles

Step 5 Expel and discard the fluid again and re-suspend the

triamcinolone particles by drawing up 4 cc of balanced salt

solution again The triamcinolone is now washed

Step 6 Remove the filter and needle and attach a blunt canula

for intraocular use The final concentration of triamcinolone is

10 mgmL

A Retisertreg B I-vationtrade implant

C Suprachoroidal implant D E Intravitreal

implants (eg Ozurdexreg Illuvien) F

microparticles nanoparticles liposomes G

Verisome system H Cortiject emulsion

The Future

Sustained drug delivery Intravitreal Anti-metabolite agents

Anti-VEGF therapy has

been used in the treatment

of glaucoma amp ocular

neovascular diseases

anti-angiogenic properties

anti-fibrotic properties

Bevacizumab amp

Ranibizumab

References Bentley E Miller PE Diehl KA (2003) Use of high-resolution ultrasound as a diagnostic tool in veterinary ophthalmology JAVMA

223 1617-1622

Corcoran KA Koch SA (1993) Uveal cysts in dogs 28 cases (1989-1991) JAVMA 203545-6

Deehr AJ Dubielzig RR (2002) A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers Veterinary Ophthalmology 1153-158

Devgan U (2006) Intraocular use of triamcinolone Removing preservatives from triamcinolone can minimize ocular toxicity and side effects Ocular Surgery News US Edition Dec 15th 20016

Esson D Armour M Mundy P Schobert CS Dubielzig RR (2009) The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in the Golden Retriever Vet Ophthalmol 12361-8

Holly VL Sandmeyer LS Bauer BS Verges L Grahn BH (2015) Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada Vet Ophthalmol doi 101111vop12293

Lin P Suhler EBet al (2014) The Future of Uveitis Treatment Ophthalmology 121 365ndash376

Sapienza JS et al (2000) Golden Retreiver Uveitis 75 cases (1994-1999) Veterinary Ophthalmology vol 3 Pg 241-246

Taylor LN Townsend WM etal (2015) Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts AJVR 76540ndash546

Townsend WM1 Gornik KR (2013) Prevalence of uveal cysts and pigmentary uveitis in Golden Retrievers in three Midwestern states JAVMA 2431298-301

vonHoldt BM et al (2010) Neighbour-joining trees of domestic dogs and grey wolves Nature doi101038nature08837

Page 16: Pigmentary Uveitis - vetemergency.cavetemergency.ca/wp-content/uploads/2015/11/Pigmentary-Uveitis.pdfiridociliary cysts, pigmentary uveitis, ... Neighbour-joining trees of domestic

Pathogenesis of Pigmentary Uveitis

What comes first

Uveal Cysts

Uveal Cysts Uveitis

Uveitis Genetic

predisposition

Genetic

predisposition

Golden Retriever Foundation Health Survey of 1444 Goldens (1998-1999)

0 ndash 3 yrs 3 ndash 8 yrs 8 ndash 13 yrs 13+ yrs Total

Uveitis 0 2 11 3 16

Iris Cysts 0 5 7 0 12

Eye dx all 381 1444

COPLOW

Cases

numerator denominator percentage

Glaucoma 530 2176 24

Golden

Retreivers

25 530 5

Iridociliary

Cysts

13 25 52

COPLOW ndash Comparative Ophthalmic Pathology Laboratory of Wisconsin

survey of 2176 enucleated or eviscerated dog eye submissions

COPLOWrsquos Cases of Glaucoma with Iris

Cysts in Golden Retrievers

large thin-walled cysts lined with attenuated cuboidal epithelium filling most of the posterior chamber (1313 100)

thick walled cysts containing hyaluronic acid (813 62)

a solid cellular proliferation (213 15)

a retro-corneal membrane associated with a defect in Descemets membrane (713 54)

iris bombe (513 38)

a pre-iridal fibrovascular membranes (413 31)

hemorrhage (413 31)

a cellular membrane on the anterior lens surface (613 46)

retinal detachment (513 38)

peripheral anterior synechia (513 38)

posterior synechia (613 46)

Pathogenesis of Secondary Glaucoma

in Pigmentary Uveitis

Glaucoma

Uveitis

PIFM

Synechia Cataracts

Uveal and Iris Cysts

b

a Cytokines

b Inflammatory

debris blocks

drainage angle

c PIFM blocks

drainage angle

d Synechia blocks

drainage angle

e Lens induced

uveitis

Golden

Retriever

Histopathology ndash ciliary cysts

copy Dr John Sapienza

The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in

the Golden Retriever

Veterinary Ophthalmology

Volume 12 Issue 6 pages 361-368 26 OCT 2009 DOI 101111j1463-5224200900732x

httponlinelibrarywileycomdoi101111j1463-5224200900732xfullf1

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf4

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf5

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf6

Treatment Options - Topical

Treatment Options - Oral

Treatment Options - Injectable

Triamcinolone

Administer 02ml (8mg) by

subconjunctival injection

Intravitreal injection

TPA - Tissue Plasminogen

Activator

Administer 02ml by

intracameral injection

Preparation of Triamcinolone

for intravitreal injection

Method to wash out

preservatives

Diagrams

Triamcinolone can be purchased in 40 mgmL or 10 mgmL

concentrations both of which have significant preservatives

when taken straight from the bottle

For intravitreal injection the preservatives must be washed out

by removing the liquid carrier and re-suspend the triamcinolone

in sterile balanced salt solution

Step 1 Draw 1 cc of triamcinolone (40 mgmL) into a 5 cc

syringe

Step 2 Place a 022 microm filter on the syringe and reattach the

needle

Step 3 Expel the fluid through the filter and discard it thereby

trapping the triamcinolone particles in the filter

Step 4 Draw 4 cc of sterile balanced salt solution into the

syringe thereby re-suspending the triamcinolone particles

Step 5 Expel and discard the fluid again and re-suspend the

triamcinolone particles by drawing up 4 cc of balanced salt

solution again The triamcinolone is now washed

Step 6 Remove the filter and needle and attach a blunt canula

for intraocular use The final concentration of triamcinolone is

10 mgmL

A Retisertreg B I-vationtrade implant

C Suprachoroidal implant D E Intravitreal

implants (eg Ozurdexreg Illuvien) F

microparticles nanoparticles liposomes G

Verisome system H Cortiject emulsion

The Future

Sustained drug delivery Intravitreal Anti-metabolite agents

Anti-VEGF therapy has

been used in the treatment

of glaucoma amp ocular

neovascular diseases

anti-angiogenic properties

anti-fibrotic properties

Bevacizumab amp

Ranibizumab

References Bentley E Miller PE Diehl KA (2003) Use of high-resolution ultrasound as a diagnostic tool in veterinary ophthalmology JAVMA

223 1617-1622

Corcoran KA Koch SA (1993) Uveal cysts in dogs 28 cases (1989-1991) JAVMA 203545-6

Deehr AJ Dubielzig RR (2002) A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers Veterinary Ophthalmology 1153-158

Devgan U (2006) Intraocular use of triamcinolone Removing preservatives from triamcinolone can minimize ocular toxicity and side effects Ocular Surgery News US Edition Dec 15th 20016

Esson D Armour M Mundy P Schobert CS Dubielzig RR (2009) The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in the Golden Retriever Vet Ophthalmol 12361-8

Holly VL Sandmeyer LS Bauer BS Verges L Grahn BH (2015) Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada Vet Ophthalmol doi 101111vop12293

Lin P Suhler EBet al (2014) The Future of Uveitis Treatment Ophthalmology 121 365ndash376

Sapienza JS et al (2000) Golden Retreiver Uveitis 75 cases (1994-1999) Veterinary Ophthalmology vol 3 Pg 241-246

Taylor LN Townsend WM etal (2015) Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts AJVR 76540ndash546

Townsend WM1 Gornik KR (2013) Prevalence of uveal cysts and pigmentary uveitis in Golden Retrievers in three Midwestern states JAVMA 2431298-301

vonHoldt BM et al (2010) Neighbour-joining trees of domestic dogs and grey wolves Nature doi101038nature08837

Page 17: Pigmentary Uveitis - vetemergency.cavetemergency.ca/wp-content/uploads/2015/11/Pigmentary-Uveitis.pdfiridociliary cysts, pigmentary uveitis, ... Neighbour-joining trees of domestic

Golden Retriever Foundation Health Survey of 1444 Goldens (1998-1999)

0 ndash 3 yrs 3 ndash 8 yrs 8 ndash 13 yrs 13+ yrs Total

Uveitis 0 2 11 3 16

Iris Cysts 0 5 7 0 12

Eye dx all 381 1444

COPLOW

Cases

numerator denominator percentage

Glaucoma 530 2176 24

Golden

Retreivers

25 530 5

Iridociliary

Cysts

13 25 52

COPLOW ndash Comparative Ophthalmic Pathology Laboratory of Wisconsin

survey of 2176 enucleated or eviscerated dog eye submissions

COPLOWrsquos Cases of Glaucoma with Iris

Cysts in Golden Retrievers

large thin-walled cysts lined with attenuated cuboidal epithelium filling most of the posterior chamber (1313 100)

thick walled cysts containing hyaluronic acid (813 62)

a solid cellular proliferation (213 15)

a retro-corneal membrane associated with a defect in Descemets membrane (713 54)

iris bombe (513 38)

a pre-iridal fibrovascular membranes (413 31)

hemorrhage (413 31)

a cellular membrane on the anterior lens surface (613 46)

retinal detachment (513 38)

peripheral anterior synechia (513 38)

posterior synechia (613 46)

Pathogenesis of Secondary Glaucoma

in Pigmentary Uveitis

Glaucoma

Uveitis

PIFM

Synechia Cataracts

Uveal and Iris Cysts

b

a Cytokines

b Inflammatory

debris blocks

drainage angle

c PIFM blocks

drainage angle

d Synechia blocks

drainage angle

e Lens induced

uveitis

Golden

Retriever

Histopathology ndash ciliary cysts

copy Dr John Sapienza

The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in

the Golden Retriever

Veterinary Ophthalmology

Volume 12 Issue 6 pages 361-368 26 OCT 2009 DOI 101111j1463-5224200900732x

httponlinelibrarywileycomdoi101111j1463-5224200900732xfullf1

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf4

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf5

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf6

Treatment Options - Topical

Treatment Options - Oral

Treatment Options - Injectable

Triamcinolone

Administer 02ml (8mg) by

subconjunctival injection

Intravitreal injection

TPA - Tissue Plasminogen

Activator

Administer 02ml by

intracameral injection

Preparation of Triamcinolone

for intravitreal injection

Method to wash out

preservatives

Diagrams

Triamcinolone can be purchased in 40 mgmL or 10 mgmL

concentrations both of which have significant preservatives

when taken straight from the bottle

For intravitreal injection the preservatives must be washed out

by removing the liquid carrier and re-suspend the triamcinolone

in sterile balanced salt solution

Step 1 Draw 1 cc of triamcinolone (40 mgmL) into a 5 cc

syringe

Step 2 Place a 022 microm filter on the syringe and reattach the

needle

Step 3 Expel the fluid through the filter and discard it thereby

trapping the triamcinolone particles in the filter

Step 4 Draw 4 cc of sterile balanced salt solution into the

syringe thereby re-suspending the triamcinolone particles

Step 5 Expel and discard the fluid again and re-suspend the

triamcinolone particles by drawing up 4 cc of balanced salt

solution again The triamcinolone is now washed

Step 6 Remove the filter and needle and attach a blunt canula

for intraocular use The final concentration of triamcinolone is

10 mgmL

A Retisertreg B I-vationtrade implant

C Suprachoroidal implant D E Intravitreal

implants (eg Ozurdexreg Illuvien) F

microparticles nanoparticles liposomes G

Verisome system H Cortiject emulsion

The Future

Sustained drug delivery Intravitreal Anti-metabolite agents

Anti-VEGF therapy has

been used in the treatment

of glaucoma amp ocular

neovascular diseases

anti-angiogenic properties

anti-fibrotic properties

Bevacizumab amp

Ranibizumab

References Bentley E Miller PE Diehl KA (2003) Use of high-resolution ultrasound as a diagnostic tool in veterinary ophthalmology JAVMA

223 1617-1622

Corcoran KA Koch SA (1993) Uveal cysts in dogs 28 cases (1989-1991) JAVMA 203545-6

Deehr AJ Dubielzig RR (2002) A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers Veterinary Ophthalmology 1153-158

Devgan U (2006) Intraocular use of triamcinolone Removing preservatives from triamcinolone can minimize ocular toxicity and side effects Ocular Surgery News US Edition Dec 15th 20016

Esson D Armour M Mundy P Schobert CS Dubielzig RR (2009) The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in the Golden Retriever Vet Ophthalmol 12361-8

Holly VL Sandmeyer LS Bauer BS Verges L Grahn BH (2015) Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada Vet Ophthalmol doi 101111vop12293

Lin P Suhler EBet al (2014) The Future of Uveitis Treatment Ophthalmology 121 365ndash376

Sapienza JS et al (2000) Golden Retreiver Uveitis 75 cases (1994-1999) Veterinary Ophthalmology vol 3 Pg 241-246

Taylor LN Townsend WM etal (2015) Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts AJVR 76540ndash546

Townsend WM1 Gornik KR (2013) Prevalence of uveal cysts and pigmentary uveitis in Golden Retrievers in three Midwestern states JAVMA 2431298-301

vonHoldt BM et al (2010) Neighbour-joining trees of domestic dogs and grey wolves Nature doi101038nature08837

Page 18: Pigmentary Uveitis - vetemergency.cavetemergency.ca/wp-content/uploads/2015/11/Pigmentary-Uveitis.pdfiridociliary cysts, pigmentary uveitis, ... Neighbour-joining trees of domestic

COPLOWrsquos Cases of Glaucoma with Iris

Cysts in Golden Retrievers

large thin-walled cysts lined with attenuated cuboidal epithelium filling most of the posterior chamber (1313 100)

thick walled cysts containing hyaluronic acid (813 62)

a solid cellular proliferation (213 15)

a retro-corneal membrane associated with a defect in Descemets membrane (713 54)

iris bombe (513 38)

a pre-iridal fibrovascular membranes (413 31)

hemorrhage (413 31)

a cellular membrane on the anterior lens surface (613 46)

retinal detachment (513 38)

peripheral anterior synechia (513 38)

posterior synechia (613 46)

Pathogenesis of Secondary Glaucoma

in Pigmentary Uveitis

Glaucoma

Uveitis

PIFM

Synechia Cataracts

Uveal and Iris Cysts

b

a Cytokines

b Inflammatory

debris blocks

drainage angle

c PIFM blocks

drainage angle

d Synechia blocks

drainage angle

e Lens induced

uveitis

Golden

Retriever

Histopathology ndash ciliary cysts

copy Dr John Sapienza

The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in

the Golden Retriever

Veterinary Ophthalmology

Volume 12 Issue 6 pages 361-368 26 OCT 2009 DOI 101111j1463-5224200900732x

httponlinelibrarywileycomdoi101111j1463-5224200900732xfullf1

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf4

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf5

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf6

Treatment Options - Topical

Treatment Options - Oral

Treatment Options - Injectable

Triamcinolone

Administer 02ml (8mg) by

subconjunctival injection

Intravitreal injection

TPA - Tissue Plasminogen

Activator

Administer 02ml by

intracameral injection

Preparation of Triamcinolone

for intravitreal injection

Method to wash out

preservatives

Diagrams

Triamcinolone can be purchased in 40 mgmL or 10 mgmL

concentrations both of which have significant preservatives

when taken straight from the bottle

For intravitreal injection the preservatives must be washed out

by removing the liquid carrier and re-suspend the triamcinolone

in sterile balanced salt solution

Step 1 Draw 1 cc of triamcinolone (40 mgmL) into a 5 cc

syringe

Step 2 Place a 022 microm filter on the syringe and reattach the

needle

Step 3 Expel the fluid through the filter and discard it thereby

trapping the triamcinolone particles in the filter

Step 4 Draw 4 cc of sterile balanced salt solution into the

syringe thereby re-suspending the triamcinolone particles

Step 5 Expel and discard the fluid again and re-suspend the

triamcinolone particles by drawing up 4 cc of balanced salt

solution again The triamcinolone is now washed

Step 6 Remove the filter and needle and attach a blunt canula

for intraocular use The final concentration of triamcinolone is

10 mgmL

A Retisertreg B I-vationtrade implant

C Suprachoroidal implant D E Intravitreal

implants (eg Ozurdexreg Illuvien) F

microparticles nanoparticles liposomes G

Verisome system H Cortiject emulsion

The Future

Sustained drug delivery Intravitreal Anti-metabolite agents

Anti-VEGF therapy has

been used in the treatment

of glaucoma amp ocular

neovascular diseases

anti-angiogenic properties

anti-fibrotic properties

Bevacizumab amp

Ranibizumab

References Bentley E Miller PE Diehl KA (2003) Use of high-resolution ultrasound as a diagnostic tool in veterinary ophthalmology JAVMA

223 1617-1622

Corcoran KA Koch SA (1993) Uveal cysts in dogs 28 cases (1989-1991) JAVMA 203545-6

Deehr AJ Dubielzig RR (2002) A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers Veterinary Ophthalmology 1153-158

Devgan U (2006) Intraocular use of triamcinolone Removing preservatives from triamcinolone can minimize ocular toxicity and side effects Ocular Surgery News US Edition Dec 15th 20016

Esson D Armour M Mundy P Schobert CS Dubielzig RR (2009) The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in the Golden Retriever Vet Ophthalmol 12361-8

Holly VL Sandmeyer LS Bauer BS Verges L Grahn BH (2015) Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada Vet Ophthalmol doi 101111vop12293

Lin P Suhler EBet al (2014) The Future of Uveitis Treatment Ophthalmology 121 365ndash376

Sapienza JS et al (2000) Golden Retreiver Uveitis 75 cases (1994-1999) Veterinary Ophthalmology vol 3 Pg 241-246

Taylor LN Townsend WM etal (2015) Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts AJVR 76540ndash546

Townsend WM1 Gornik KR (2013) Prevalence of uveal cysts and pigmentary uveitis in Golden Retrievers in three Midwestern states JAVMA 2431298-301

vonHoldt BM et al (2010) Neighbour-joining trees of domestic dogs and grey wolves Nature doi101038nature08837

Page 19: Pigmentary Uveitis - vetemergency.cavetemergency.ca/wp-content/uploads/2015/11/Pigmentary-Uveitis.pdfiridociliary cysts, pigmentary uveitis, ... Neighbour-joining trees of domestic

Pathogenesis of Secondary Glaucoma

in Pigmentary Uveitis

Glaucoma

Uveitis

PIFM

Synechia Cataracts

Uveal and Iris Cysts

b

a Cytokines

b Inflammatory

debris blocks

drainage angle

c PIFM blocks

drainage angle

d Synechia blocks

drainage angle

e Lens induced

uveitis

Golden

Retriever

Histopathology ndash ciliary cysts

copy Dr John Sapienza

The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in

the Golden Retriever

Veterinary Ophthalmology

Volume 12 Issue 6 pages 361-368 26 OCT 2009 DOI 101111j1463-5224200900732x

httponlinelibrarywileycomdoi101111j1463-5224200900732xfullf1

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf4

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf5

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf6

Treatment Options - Topical

Treatment Options - Oral

Treatment Options - Injectable

Triamcinolone

Administer 02ml (8mg) by

subconjunctival injection

Intravitreal injection

TPA - Tissue Plasminogen

Activator

Administer 02ml by

intracameral injection

Preparation of Triamcinolone

for intravitreal injection

Method to wash out

preservatives

Diagrams

Triamcinolone can be purchased in 40 mgmL or 10 mgmL

concentrations both of which have significant preservatives

when taken straight from the bottle

For intravitreal injection the preservatives must be washed out

by removing the liquid carrier and re-suspend the triamcinolone

in sterile balanced salt solution

Step 1 Draw 1 cc of triamcinolone (40 mgmL) into a 5 cc

syringe

Step 2 Place a 022 microm filter on the syringe and reattach the

needle

Step 3 Expel the fluid through the filter and discard it thereby

trapping the triamcinolone particles in the filter

Step 4 Draw 4 cc of sterile balanced salt solution into the

syringe thereby re-suspending the triamcinolone particles

Step 5 Expel and discard the fluid again and re-suspend the

triamcinolone particles by drawing up 4 cc of balanced salt

solution again The triamcinolone is now washed

Step 6 Remove the filter and needle and attach a blunt canula

for intraocular use The final concentration of triamcinolone is

10 mgmL

A Retisertreg B I-vationtrade implant

C Suprachoroidal implant D E Intravitreal

implants (eg Ozurdexreg Illuvien) F

microparticles nanoparticles liposomes G

Verisome system H Cortiject emulsion

The Future

Sustained drug delivery Intravitreal Anti-metabolite agents

Anti-VEGF therapy has

been used in the treatment

of glaucoma amp ocular

neovascular diseases

anti-angiogenic properties

anti-fibrotic properties

Bevacizumab amp

Ranibizumab

References Bentley E Miller PE Diehl KA (2003) Use of high-resolution ultrasound as a diagnostic tool in veterinary ophthalmology JAVMA

223 1617-1622

Corcoran KA Koch SA (1993) Uveal cysts in dogs 28 cases (1989-1991) JAVMA 203545-6

Deehr AJ Dubielzig RR (2002) A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers Veterinary Ophthalmology 1153-158

Devgan U (2006) Intraocular use of triamcinolone Removing preservatives from triamcinolone can minimize ocular toxicity and side effects Ocular Surgery News US Edition Dec 15th 20016

Esson D Armour M Mundy P Schobert CS Dubielzig RR (2009) The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in the Golden Retriever Vet Ophthalmol 12361-8

Holly VL Sandmeyer LS Bauer BS Verges L Grahn BH (2015) Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada Vet Ophthalmol doi 101111vop12293

Lin P Suhler EBet al (2014) The Future of Uveitis Treatment Ophthalmology 121 365ndash376

Sapienza JS et al (2000) Golden Retreiver Uveitis 75 cases (1994-1999) Veterinary Ophthalmology vol 3 Pg 241-246

Taylor LN Townsend WM etal (2015) Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts AJVR 76540ndash546

Townsend WM1 Gornik KR (2013) Prevalence of uveal cysts and pigmentary uveitis in Golden Retrievers in three Midwestern states JAVMA 2431298-301

vonHoldt BM et al (2010) Neighbour-joining trees of domestic dogs and grey wolves Nature doi101038nature08837

Page 20: Pigmentary Uveitis - vetemergency.cavetemergency.ca/wp-content/uploads/2015/11/Pigmentary-Uveitis.pdfiridociliary cysts, pigmentary uveitis, ... Neighbour-joining trees of domestic

Histopathology ndash ciliary cysts

copy Dr John Sapienza

The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in

the Golden Retriever

Veterinary Ophthalmology

Volume 12 Issue 6 pages 361-368 26 OCT 2009 DOI 101111j1463-5224200900732x

httponlinelibrarywileycomdoi101111j1463-5224200900732xfullf1

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf4

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf5

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf6

Treatment Options - Topical

Treatment Options - Oral

Treatment Options - Injectable

Triamcinolone

Administer 02ml (8mg) by

subconjunctival injection

Intravitreal injection

TPA - Tissue Plasminogen

Activator

Administer 02ml by

intracameral injection

Preparation of Triamcinolone

for intravitreal injection

Method to wash out

preservatives

Diagrams

Triamcinolone can be purchased in 40 mgmL or 10 mgmL

concentrations both of which have significant preservatives

when taken straight from the bottle

For intravitreal injection the preservatives must be washed out

by removing the liquid carrier and re-suspend the triamcinolone

in sterile balanced salt solution

Step 1 Draw 1 cc of triamcinolone (40 mgmL) into a 5 cc

syringe

Step 2 Place a 022 microm filter on the syringe and reattach the

needle

Step 3 Expel the fluid through the filter and discard it thereby

trapping the triamcinolone particles in the filter

Step 4 Draw 4 cc of sterile balanced salt solution into the

syringe thereby re-suspending the triamcinolone particles

Step 5 Expel and discard the fluid again and re-suspend the

triamcinolone particles by drawing up 4 cc of balanced salt

solution again The triamcinolone is now washed

Step 6 Remove the filter and needle and attach a blunt canula

for intraocular use The final concentration of triamcinolone is

10 mgmL

A Retisertreg B I-vationtrade implant

C Suprachoroidal implant D E Intravitreal

implants (eg Ozurdexreg Illuvien) F

microparticles nanoparticles liposomes G

Verisome system H Cortiject emulsion

The Future

Sustained drug delivery Intravitreal Anti-metabolite agents

Anti-VEGF therapy has

been used in the treatment

of glaucoma amp ocular

neovascular diseases

anti-angiogenic properties

anti-fibrotic properties

Bevacizumab amp

Ranibizumab

References Bentley E Miller PE Diehl KA (2003) Use of high-resolution ultrasound as a diagnostic tool in veterinary ophthalmology JAVMA

223 1617-1622

Corcoran KA Koch SA (1993) Uveal cysts in dogs 28 cases (1989-1991) JAVMA 203545-6

Deehr AJ Dubielzig RR (2002) A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers Veterinary Ophthalmology 1153-158

Devgan U (2006) Intraocular use of triamcinolone Removing preservatives from triamcinolone can minimize ocular toxicity and side effects Ocular Surgery News US Edition Dec 15th 20016

Esson D Armour M Mundy P Schobert CS Dubielzig RR (2009) The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in the Golden Retriever Vet Ophthalmol 12361-8

Holly VL Sandmeyer LS Bauer BS Verges L Grahn BH (2015) Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada Vet Ophthalmol doi 101111vop12293

Lin P Suhler EBet al (2014) The Future of Uveitis Treatment Ophthalmology 121 365ndash376

Sapienza JS et al (2000) Golden Retreiver Uveitis 75 cases (1994-1999) Veterinary Ophthalmology vol 3 Pg 241-246

Taylor LN Townsend WM etal (2015) Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts AJVR 76540ndash546

Townsend WM1 Gornik KR (2013) Prevalence of uveal cysts and pigmentary uveitis in Golden Retrievers in three Midwestern states JAVMA 2431298-301

vonHoldt BM et al (2010) Neighbour-joining trees of domestic dogs and grey wolves Nature doi101038nature08837

Page 21: Pigmentary Uveitis - vetemergency.cavetemergency.ca/wp-content/uploads/2015/11/Pigmentary-Uveitis.pdfiridociliary cysts, pigmentary uveitis, ... Neighbour-joining trees of domestic

The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in

the Golden Retriever

Veterinary Ophthalmology

Volume 12 Issue 6 pages 361-368 26 OCT 2009 DOI 101111j1463-5224200900732x

httponlinelibrarywileycomdoi101111j1463-5224200900732xfullf1

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf4

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf5

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf6

Treatment Options - Topical

Treatment Options - Oral

Treatment Options - Injectable

Triamcinolone

Administer 02ml (8mg) by

subconjunctival injection

Intravitreal injection

TPA - Tissue Plasminogen

Activator

Administer 02ml by

intracameral injection

Preparation of Triamcinolone

for intravitreal injection

Method to wash out

preservatives

Diagrams

Triamcinolone can be purchased in 40 mgmL or 10 mgmL

concentrations both of which have significant preservatives

when taken straight from the bottle

For intravitreal injection the preservatives must be washed out

by removing the liquid carrier and re-suspend the triamcinolone

in sterile balanced salt solution

Step 1 Draw 1 cc of triamcinolone (40 mgmL) into a 5 cc

syringe

Step 2 Place a 022 microm filter on the syringe and reattach the

needle

Step 3 Expel the fluid through the filter and discard it thereby

trapping the triamcinolone particles in the filter

Step 4 Draw 4 cc of sterile balanced salt solution into the

syringe thereby re-suspending the triamcinolone particles

Step 5 Expel and discard the fluid again and re-suspend the

triamcinolone particles by drawing up 4 cc of balanced salt

solution again The triamcinolone is now washed

Step 6 Remove the filter and needle and attach a blunt canula

for intraocular use The final concentration of triamcinolone is

10 mgmL

A Retisertreg B I-vationtrade implant

C Suprachoroidal implant D E Intravitreal

implants (eg Ozurdexreg Illuvien) F

microparticles nanoparticles liposomes G

Verisome system H Cortiject emulsion

The Future

Sustained drug delivery Intravitreal Anti-metabolite agents

Anti-VEGF therapy has

been used in the treatment

of glaucoma amp ocular

neovascular diseases

anti-angiogenic properties

anti-fibrotic properties

Bevacizumab amp

Ranibizumab

References Bentley E Miller PE Diehl KA (2003) Use of high-resolution ultrasound as a diagnostic tool in veterinary ophthalmology JAVMA

223 1617-1622

Corcoran KA Koch SA (1993) Uveal cysts in dogs 28 cases (1989-1991) JAVMA 203545-6

Deehr AJ Dubielzig RR (2002) A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers Veterinary Ophthalmology 1153-158

Devgan U (2006) Intraocular use of triamcinolone Removing preservatives from triamcinolone can minimize ocular toxicity and side effects Ocular Surgery News US Edition Dec 15th 20016

Esson D Armour M Mundy P Schobert CS Dubielzig RR (2009) The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in the Golden Retriever Vet Ophthalmol 12361-8

Holly VL Sandmeyer LS Bauer BS Verges L Grahn BH (2015) Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada Vet Ophthalmol doi 101111vop12293

Lin P Suhler EBet al (2014) The Future of Uveitis Treatment Ophthalmology 121 365ndash376

Sapienza JS et al (2000) Golden Retreiver Uveitis 75 cases (1994-1999) Veterinary Ophthalmology vol 3 Pg 241-246

Taylor LN Townsend WM etal (2015) Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts AJVR 76540ndash546

Townsend WM1 Gornik KR (2013) Prevalence of uveal cysts and pigmentary uveitis in Golden Retrievers in three Midwestern states JAVMA 2431298-301

vonHoldt BM et al (2010) Neighbour-joining trees of domestic dogs and grey wolves Nature doi101038nature08837

Page 22: Pigmentary Uveitis - vetemergency.cavetemergency.ca/wp-content/uploads/2015/11/Pigmentary-Uveitis.pdfiridociliary cysts, pigmentary uveitis, ... Neighbour-joining trees of domestic

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf4

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf5

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf6

Treatment Options - Topical

Treatment Options - Oral

Treatment Options - Injectable

Triamcinolone

Administer 02ml (8mg) by

subconjunctival injection

Intravitreal injection

TPA - Tissue Plasminogen

Activator

Administer 02ml by

intracameral injection

Preparation of Triamcinolone

for intravitreal injection

Method to wash out

preservatives

Diagrams

Triamcinolone can be purchased in 40 mgmL or 10 mgmL

concentrations both of which have significant preservatives

when taken straight from the bottle

For intravitreal injection the preservatives must be washed out

by removing the liquid carrier and re-suspend the triamcinolone

in sterile balanced salt solution

Step 1 Draw 1 cc of triamcinolone (40 mgmL) into a 5 cc

syringe

Step 2 Place a 022 microm filter on the syringe and reattach the

needle

Step 3 Expel the fluid through the filter and discard it thereby

trapping the triamcinolone particles in the filter

Step 4 Draw 4 cc of sterile balanced salt solution into the

syringe thereby re-suspending the triamcinolone particles

Step 5 Expel and discard the fluid again and re-suspend the

triamcinolone particles by drawing up 4 cc of balanced salt

solution again The triamcinolone is now washed

Step 6 Remove the filter and needle and attach a blunt canula

for intraocular use The final concentration of triamcinolone is

10 mgmL

A Retisertreg B I-vationtrade implant

C Suprachoroidal implant D E Intravitreal

implants (eg Ozurdexreg Illuvien) F

microparticles nanoparticles liposomes G

Verisome system H Cortiject emulsion

The Future

Sustained drug delivery Intravitreal Anti-metabolite agents

Anti-VEGF therapy has

been used in the treatment

of glaucoma amp ocular

neovascular diseases

anti-angiogenic properties

anti-fibrotic properties

Bevacizumab amp

Ranibizumab

References Bentley E Miller PE Diehl KA (2003) Use of high-resolution ultrasound as a diagnostic tool in veterinary ophthalmology JAVMA

223 1617-1622

Corcoran KA Koch SA (1993) Uveal cysts in dogs 28 cases (1989-1991) JAVMA 203545-6

Deehr AJ Dubielzig RR (2002) A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers Veterinary Ophthalmology 1153-158

Devgan U (2006) Intraocular use of triamcinolone Removing preservatives from triamcinolone can minimize ocular toxicity and side effects Ocular Surgery News US Edition Dec 15th 20016

Esson D Armour M Mundy P Schobert CS Dubielzig RR (2009) The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in the Golden Retriever Vet Ophthalmol 12361-8

Holly VL Sandmeyer LS Bauer BS Verges L Grahn BH (2015) Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada Vet Ophthalmol doi 101111vop12293

Lin P Suhler EBet al (2014) The Future of Uveitis Treatment Ophthalmology 121 365ndash376

Sapienza JS et al (2000) Golden Retreiver Uveitis 75 cases (1994-1999) Veterinary Ophthalmology vol 3 Pg 241-246

Taylor LN Townsend WM etal (2015) Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts AJVR 76540ndash546

Townsend WM1 Gornik KR (2013) Prevalence of uveal cysts and pigmentary uveitis in Golden Retrievers in three Midwestern states JAVMA 2431298-301

vonHoldt BM et al (2010) Neighbour-joining trees of domestic dogs and grey wolves Nature doi101038nature08837

Page 23: Pigmentary Uveitis - vetemergency.cavetemergency.ca/wp-content/uploads/2015/11/Pigmentary-Uveitis.pdfiridociliary cysts, pigmentary uveitis, ... Neighbour-joining trees of domestic

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf5

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf6

Treatment Options - Topical

Treatment Options - Oral

Treatment Options - Injectable

Triamcinolone

Administer 02ml (8mg) by

subconjunctival injection

Intravitreal injection

TPA - Tissue Plasminogen

Activator

Administer 02ml by

intracameral injection

Preparation of Triamcinolone

for intravitreal injection

Method to wash out

preservatives

Diagrams

Triamcinolone can be purchased in 40 mgmL or 10 mgmL

concentrations both of which have significant preservatives

when taken straight from the bottle

For intravitreal injection the preservatives must be washed out

by removing the liquid carrier and re-suspend the triamcinolone

in sterile balanced salt solution

Step 1 Draw 1 cc of triamcinolone (40 mgmL) into a 5 cc

syringe

Step 2 Place a 022 microm filter on the syringe and reattach the

needle

Step 3 Expel the fluid through the filter and discard it thereby

trapping the triamcinolone particles in the filter

Step 4 Draw 4 cc of sterile balanced salt solution into the

syringe thereby re-suspending the triamcinolone particles

Step 5 Expel and discard the fluid again and re-suspend the

triamcinolone particles by drawing up 4 cc of balanced salt

solution again The triamcinolone is now washed

Step 6 Remove the filter and needle and attach a blunt canula

for intraocular use The final concentration of triamcinolone is

10 mgmL

A Retisertreg B I-vationtrade implant

C Suprachoroidal implant D E Intravitreal

implants (eg Ozurdexreg Illuvien) F

microparticles nanoparticles liposomes G

Verisome system H Cortiject emulsion

The Future

Sustained drug delivery Intravitreal Anti-metabolite agents

Anti-VEGF therapy has

been used in the treatment

of glaucoma amp ocular

neovascular diseases

anti-angiogenic properties

anti-fibrotic properties

Bevacizumab amp

Ranibizumab

References Bentley E Miller PE Diehl KA (2003) Use of high-resolution ultrasound as a diagnostic tool in veterinary ophthalmology JAVMA

223 1617-1622

Corcoran KA Koch SA (1993) Uveal cysts in dogs 28 cases (1989-1991) JAVMA 203545-6

Deehr AJ Dubielzig RR (2002) A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers Veterinary Ophthalmology 1153-158

Devgan U (2006) Intraocular use of triamcinolone Removing preservatives from triamcinolone can minimize ocular toxicity and side effects Ocular Surgery News US Edition Dec 15th 20016

Esson D Armour M Mundy P Schobert CS Dubielzig RR (2009) The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in the Golden Retriever Vet Ophthalmol 12361-8

Holly VL Sandmeyer LS Bauer BS Verges L Grahn BH (2015) Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada Vet Ophthalmol doi 101111vop12293

Lin P Suhler EBet al (2014) The Future of Uveitis Treatment Ophthalmology 121 365ndash376

Sapienza JS et al (2000) Golden Retreiver Uveitis 75 cases (1994-1999) Veterinary Ophthalmology vol 3 Pg 241-246

Taylor LN Townsend WM etal (2015) Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts AJVR 76540ndash546

Townsend WM1 Gornik KR (2013) Prevalence of uveal cysts and pigmentary uveitis in Golden Retrievers in three Midwestern states JAVMA 2431298-301

vonHoldt BM et al (2010) Neighbour-joining trees of domestic dogs and grey wolves Nature doi101038nature08837

Page 24: Pigmentary Uveitis - vetemergency.cavetemergency.ca/wp-content/uploads/2015/11/Pigmentary-Uveitis.pdfiridociliary cysts, pigmentary uveitis, ... Neighbour-joining trees of domestic

A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers

Veterinary Ophthalmology

Volume 1 Issue 2‐3 pages 153-158 2 OCT 2002 DOI 101046j1463-5224199800018x

httponlinelibrarywileycomdoi101046j1463-5224199800018xfullf6

Treatment Options - Topical

Treatment Options - Oral

Treatment Options - Injectable

Triamcinolone

Administer 02ml (8mg) by

subconjunctival injection

Intravitreal injection

TPA - Tissue Plasminogen

Activator

Administer 02ml by

intracameral injection

Preparation of Triamcinolone

for intravitreal injection

Method to wash out

preservatives

Diagrams

Triamcinolone can be purchased in 40 mgmL or 10 mgmL

concentrations both of which have significant preservatives

when taken straight from the bottle

For intravitreal injection the preservatives must be washed out

by removing the liquid carrier and re-suspend the triamcinolone

in sterile balanced salt solution

Step 1 Draw 1 cc of triamcinolone (40 mgmL) into a 5 cc

syringe

Step 2 Place a 022 microm filter on the syringe and reattach the

needle

Step 3 Expel the fluid through the filter and discard it thereby

trapping the triamcinolone particles in the filter

Step 4 Draw 4 cc of sterile balanced salt solution into the

syringe thereby re-suspending the triamcinolone particles

Step 5 Expel and discard the fluid again and re-suspend the

triamcinolone particles by drawing up 4 cc of balanced salt

solution again The triamcinolone is now washed

Step 6 Remove the filter and needle and attach a blunt canula

for intraocular use The final concentration of triamcinolone is

10 mgmL

A Retisertreg B I-vationtrade implant

C Suprachoroidal implant D E Intravitreal

implants (eg Ozurdexreg Illuvien) F

microparticles nanoparticles liposomes G

Verisome system H Cortiject emulsion

The Future

Sustained drug delivery Intravitreal Anti-metabolite agents

Anti-VEGF therapy has

been used in the treatment

of glaucoma amp ocular

neovascular diseases

anti-angiogenic properties

anti-fibrotic properties

Bevacizumab amp

Ranibizumab

References Bentley E Miller PE Diehl KA (2003) Use of high-resolution ultrasound as a diagnostic tool in veterinary ophthalmology JAVMA

223 1617-1622

Corcoran KA Koch SA (1993) Uveal cysts in dogs 28 cases (1989-1991) JAVMA 203545-6

Deehr AJ Dubielzig RR (2002) A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers Veterinary Ophthalmology 1153-158

Devgan U (2006) Intraocular use of triamcinolone Removing preservatives from triamcinolone can minimize ocular toxicity and side effects Ocular Surgery News US Edition Dec 15th 20016

Esson D Armour M Mundy P Schobert CS Dubielzig RR (2009) The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in the Golden Retriever Vet Ophthalmol 12361-8

Holly VL Sandmeyer LS Bauer BS Verges L Grahn BH (2015) Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada Vet Ophthalmol doi 101111vop12293

Lin P Suhler EBet al (2014) The Future of Uveitis Treatment Ophthalmology 121 365ndash376

Sapienza JS et al (2000) Golden Retreiver Uveitis 75 cases (1994-1999) Veterinary Ophthalmology vol 3 Pg 241-246

Taylor LN Townsend WM etal (2015) Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts AJVR 76540ndash546

Townsend WM1 Gornik KR (2013) Prevalence of uveal cysts and pigmentary uveitis in Golden Retrievers in three Midwestern states JAVMA 2431298-301

vonHoldt BM et al (2010) Neighbour-joining trees of domestic dogs and grey wolves Nature doi101038nature08837

Page 25: Pigmentary Uveitis - vetemergency.cavetemergency.ca/wp-content/uploads/2015/11/Pigmentary-Uveitis.pdfiridociliary cysts, pigmentary uveitis, ... Neighbour-joining trees of domestic

Treatment Options - Topical

Treatment Options - Oral

Treatment Options - Injectable

Triamcinolone

Administer 02ml (8mg) by

subconjunctival injection

Intravitreal injection

TPA - Tissue Plasminogen

Activator

Administer 02ml by

intracameral injection

Preparation of Triamcinolone

for intravitreal injection

Method to wash out

preservatives

Diagrams

Triamcinolone can be purchased in 40 mgmL or 10 mgmL

concentrations both of which have significant preservatives

when taken straight from the bottle

For intravitreal injection the preservatives must be washed out

by removing the liquid carrier and re-suspend the triamcinolone

in sterile balanced salt solution

Step 1 Draw 1 cc of triamcinolone (40 mgmL) into a 5 cc

syringe

Step 2 Place a 022 microm filter on the syringe and reattach the

needle

Step 3 Expel the fluid through the filter and discard it thereby

trapping the triamcinolone particles in the filter

Step 4 Draw 4 cc of sterile balanced salt solution into the

syringe thereby re-suspending the triamcinolone particles

Step 5 Expel and discard the fluid again and re-suspend the

triamcinolone particles by drawing up 4 cc of balanced salt

solution again The triamcinolone is now washed

Step 6 Remove the filter and needle and attach a blunt canula

for intraocular use The final concentration of triamcinolone is

10 mgmL

A Retisertreg B I-vationtrade implant

C Suprachoroidal implant D E Intravitreal

implants (eg Ozurdexreg Illuvien) F

microparticles nanoparticles liposomes G

Verisome system H Cortiject emulsion

The Future

Sustained drug delivery Intravitreal Anti-metabolite agents

Anti-VEGF therapy has

been used in the treatment

of glaucoma amp ocular

neovascular diseases

anti-angiogenic properties

anti-fibrotic properties

Bevacizumab amp

Ranibizumab

References Bentley E Miller PE Diehl KA (2003) Use of high-resolution ultrasound as a diagnostic tool in veterinary ophthalmology JAVMA

223 1617-1622

Corcoran KA Koch SA (1993) Uveal cysts in dogs 28 cases (1989-1991) JAVMA 203545-6

Deehr AJ Dubielzig RR (2002) A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers Veterinary Ophthalmology 1153-158

Devgan U (2006) Intraocular use of triamcinolone Removing preservatives from triamcinolone can minimize ocular toxicity and side effects Ocular Surgery News US Edition Dec 15th 20016

Esson D Armour M Mundy P Schobert CS Dubielzig RR (2009) The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in the Golden Retriever Vet Ophthalmol 12361-8

Holly VL Sandmeyer LS Bauer BS Verges L Grahn BH (2015) Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada Vet Ophthalmol doi 101111vop12293

Lin P Suhler EBet al (2014) The Future of Uveitis Treatment Ophthalmology 121 365ndash376

Sapienza JS et al (2000) Golden Retreiver Uveitis 75 cases (1994-1999) Veterinary Ophthalmology vol 3 Pg 241-246

Taylor LN Townsend WM etal (2015) Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts AJVR 76540ndash546

Townsend WM1 Gornik KR (2013) Prevalence of uveal cysts and pigmentary uveitis in Golden Retrievers in three Midwestern states JAVMA 2431298-301

vonHoldt BM et al (2010) Neighbour-joining trees of domestic dogs and grey wolves Nature doi101038nature08837

Page 26: Pigmentary Uveitis - vetemergency.cavetemergency.ca/wp-content/uploads/2015/11/Pigmentary-Uveitis.pdfiridociliary cysts, pigmentary uveitis, ... Neighbour-joining trees of domestic

Treatment Options - Oral

Treatment Options - Injectable

Triamcinolone

Administer 02ml (8mg) by

subconjunctival injection

Intravitreal injection

TPA - Tissue Plasminogen

Activator

Administer 02ml by

intracameral injection

Preparation of Triamcinolone

for intravitreal injection

Method to wash out

preservatives

Diagrams

Triamcinolone can be purchased in 40 mgmL or 10 mgmL

concentrations both of which have significant preservatives

when taken straight from the bottle

For intravitreal injection the preservatives must be washed out

by removing the liquid carrier and re-suspend the triamcinolone

in sterile balanced salt solution

Step 1 Draw 1 cc of triamcinolone (40 mgmL) into a 5 cc

syringe

Step 2 Place a 022 microm filter on the syringe and reattach the

needle

Step 3 Expel the fluid through the filter and discard it thereby

trapping the triamcinolone particles in the filter

Step 4 Draw 4 cc of sterile balanced salt solution into the

syringe thereby re-suspending the triamcinolone particles

Step 5 Expel and discard the fluid again and re-suspend the

triamcinolone particles by drawing up 4 cc of balanced salt

solution again The triamcinolone is now washed

Step 6 Remove the filter and needle and attach a blunt canula

for intraocular use The final concentration of triamcinolone is

10 mgmL

A Retisertreg B I-vationtrade implant

C Suprachoroidal implant D E Intravitreal

implants (eg Ozurdexreg Illuvien) F

microparticles nanoparticles liposomes G

Verisome system H Cortiject emulsion

The Future

Sustained drug delivery Intravitreal Anti-metabolite agents

Anti-VEGF therapy has

been used in the treatment

of glaucoma amp ocular

neovascular diseases

anti-angiogenic properties

anti-fibrotic properties

Bevacizumab amp

Ranibizumab

References Bentley E Miller PE Diehl KA (2003) Use of high-resolution ultrasound as a diagnostic tool in veterinary ophthalmology JAVMA

223 1617-1622

Corcoran KA Koch SA (1993) Uveal cysts in dogs 28 cases (1989-1991) JAVMA 203545-6

Deehr AJ Dubielzig RR (2002) A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers Veterinary Ophthalmology 1153-158

Devgan U (2006) Intraocular use of triamcinolone Removing preservatives from triamcinolone can minimize ocular toxicity and side effects Ocular Surgery News US Edition Dec 15th 20016

Esson D Armour M Mundy P Schobert CS Dubielzig RR (2009) The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in the Golden Retriever Vet Ophthalmol 12361-8

Holly VL Sandmeyer LS Bauer BS Verges L Grahn BH (2015) Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada Vet Ophthalmol doi 101111vop12293

Lin P Suhler EBet al (2014) The Future of Uveitis Treatment Ophthalmology 121 365ndash376

Sapienza JS et al (2000) Golden Retreiver Uveitis 75 cases (1994-1999) Veterinary Ophthalmology vol 3 Pg 241-246

Taylor LN Townsend WM etal (2015) Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts AJVR 76540ndash546

Townsend WM1 Gornik KR (2013) Prevalence of uveal cysts and pigmentary uveitis in Golden Retrievers in three Midwestern states JAVMA 2431298-301

vonHoldt BM et al (2010) Neighbour-joining trees of domestic dogs and grey wolves Nature doi101038nature08837

Page 27: Pigmentary Uveitis - vetemergency.cavetemergency.ca/wp-content/uploads/2015/11/Pigmentary-Uveitis.pdfiridociliary cysts, pigmentary uveitis, ... Neighbour-joining trees of domestic

Treatment Options - Injectable

Triamcinolone

Administer 02ml (8mg) by

subconjunctival injection

Intravitreal injection

TPA - Tissue Plasminogen

Activator

Administer 02ml by

intracameral injection

Preparation of Triamcinolone

for intravitreal injection

Method to wash out

preservatives

Diagrams

Triamcinolone can be purchased in 40 mgmL or 10 mgmL

concentrations both of which have significant preservatives

when taken straight from the bottle

For intravitreal injection the preservatives must be washed out

by removing the liquid carrier and re-suspend the triamcinolone

in sterile balanced salt solution

Step 1 Draw 1 cc of triamcinolone (40 mgmL) into a 5 cc

syringe

Step 2 Place a 022 microm filter on the syringe and reattach the

needle

Step 3 Expel the fluid through the filter and discard it thereby

trapping the triamcinolone particles in the filter

Step 4 Draw 4 cc of sterile balanced salt solution into the

syringe thereby re-suspending the triamcinolone particles

Step 5 Expel and discard the fluid again and re-suspend the

triamcinolone particles by drawing up 4 cc of balanced salt

solution again The triamcinolone is now washed

Step 6 Remove the filter and needle and attach a blunt canula

for intraocular use The final concentration of triamcinolone is

10 mgmL

A Retisertreg B I-vationtrade implant

C Suprachoroidal implant D E Intravitreal

implants (eg Ozurdexreg Illuvien) F

microparticles nanoparticles liposomes G

Verisome system H Cortiject emulsion

The Future

Sustained drug delivery Intravitreal Anti-metabolite agents

Anti-VEGF therapy has

been used in the treatment

of glaucoma amp ocular

neovascular diseases

anti-angiogenic properties

anti-fibrotic properties

Bevacizumab amp

Ranibizumab

References Bentley E Miller PE Diehl KA (2003) Use of high-resolution ultrasound as a diagnostic tool in veterinary ophthalmology JAVMA

223 1617-1622

Corcoran KA Koch SA (1993) Uveal cysts in dogs 28 cases (1989-1991) JAVMA 203545-6

Deehr AJ Dubielzig RR (2002) A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers Veterinary Ophthalmology 1153-158

Devgan U (2006) Intraocular use of triamcinolone Removing preservatives from triamcinolone can minimize ocular toxicity and side effects Ocular Surgery News US Edition Dec 15th 20016

Esson D Armour M Mundy P Schobert CS Dubielzig RR (2009) The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in the Golden Retriever Vet Ophthalmol 12361-8

Holly VL Sandmeyer LS Bauer BS Verges L Grahn BH (2015) Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada Vet Ophthalmol doi 101111vop12293

Lin P Suhler EBet al (2014) The Future of Uveitis Treatment Ophthalmology 121 365ndash376

Sapienza JS et al (2000) Golden Retreiver Uveitis 75 cases (1994-1999) Veterinary Ophthalmology vol 3 Pg 241-246

Taylor LN Townsend WM etal (2015) Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts AJVR 76540ndash546

Townsend WM1 Gornik KR (2013) Prevalence of uveal cysts and pigmentary uveitis in Golden Retrievers in three Midwestern states JAVMA 2431298-301

vonHoldt BM et al (2010) Neighbour-joining trees of domestic dogs and grey wolves Nature doi101038nature08837

Page 28: Pigmentary Uveitis - vetemergency.cavetemergency.ca/wp-content/uploads/2015/11/Pigmentary-Uveitis.pdfiridociliary cysts, pigmentary uveitis, ... Neighbour-joining trees of domestic

Preparation of Triamcinolone

for intravitreal injection

Method to wash out

preservatives

Diagrams

Triamcinolone can be purchased in 40 mgmL or 10 mgmL

concentrations both of which have significant preservatives

when taken straight from the bottle

For intravitreal injection the preservatives must be washed out

by removing the liquid carrier and re-suspend the triamcinolone

in sterile balanced salt solution

Step 1 Draw 1 cc of triamcinolone (40 mgmL) into a 5 cc

syringe

Step 2 Place a 022 microm filter on the syringe and reattach the

needle

Step 3 Expel the fluid through the filter and discard it thereby

trapping the triamcinolone particles in the filter

Step 4 Draw 4 cc of sterile balanced salt solution into the

syringe thereby re-suspending the triamcinolone particles

Step 5 Expel and discard the fluid again and re-suspend the

triamcinolone particles by drawing up 4 cc of balanced salt

solution again The triamcinolone is now washed

Step 6 Remove the filter and needle and attach a blunt canula

for intraocular use The final concentration of triamcinolone is

10 mgmL

A Retisertreg B I-vationtrade implant

C Suprachoroidal implant D E Intravitreal

implants (eg Ozurdexreg Illuvien) F

microparticles nanoparticles liposomes G

Verisome system H Cortiject emulsion

The Future

Sustained drug delivery Intravitreal Anti-metabolite agents

Anti-VEGF therapy has

been used in the treatment

of glaucoma amp ocular

neovascular diseases

anti-angiogenic properties

anti-fibrotic properties

Bevacizumab amp

Ranibizumab

References Bentley E Miller PE Diehl KA (2003) Use of high-resolution ultrasound as a diagnostic tool in veterinary ophthalmology JAVMA

223 1617-1622

Corcoran KA Koch SA (1993) Uveal cysts in dogs 28 cases (1989-1991) JAVMA 203545-6

Deehr AJ Dubielzig RR (2002) A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers Veterinary Ophthalmology 1153-158

Devgan U (2006) Intraocular use of triamcinolone Removing preservatives from triamcinolone can minimize ocular toxicity and side effects Ocular Surgery News US Edition Dec 15th 20016

Esson D Armour M Mundy P Schobert CS Dubielzig RR (2009) The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in the Golden Retriever Vet Ophthalmol 12361-8

Holly VL Sandmeyer LS Bauer BS Verges L Grahn BH (2015) Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada Vet Ophthalmol doi 101111vop12293

Lin P Suhler EBet al (2014) The Future of Uveitis Treatment Ophthalmology 121 365ndash376

Sapienza JS et al (2000) Golden Retreiver Uveitis 75 cases (1994-1999) Veterinary Ophthalmology vol 3 Pg 241-246

Taylor LN Townsend WM etal (2015) Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts AJVR 76540ndash546

Townsend WM1 Gornik KR (2013) Prevalence of uveal cysts and pigmentary uveitis in Golden Retrievers in three Midwestern states JAVMA 2431298-301

vonHoldt BM et al (2010) Neighbour-joining trees of domestic dogs and grey wolves Nature doi101038nature08837

Page 29: Pigmentary Uveitis - vetemergency.cavetemergency.ca/wp-content/uploads/2015/11/Pigmentary-Uveitis.pdfiridociliary cysts, pigmentary uveitis, ... Neighbour-joining trees of domestic

A Retisertreg B I-vationtrade implant

C Suprachoroidal implant D E Intravitreal

implants (eg Ozurdexreg Illuvien) F

microparticles nanoparticles liposomes G

Verisome system H Cortiject emulsion

The Future

Sustained drug delivery Intravitreal Anti-metabolite agents

Anti-VEGF therapy has

been used in the treatment

of glaucoma amp ocular

neovascular diseases

anti-angiogenic properties

anti-fibrotic properties

Bevacizumab amp

Ranibizumab

References Bentley E Miller PE Diehl KA (2003) Use of high-resolution ultrasound as a diagnostic tool in veterinary ophthalmology JAVMA

223 1617-1622

Corcoran KA Koch SA (1993) Uveal cysts in dogs 28 cases (1989-1991) JAVMA 203545-6

Deehr AJ Dubielzig RR (2002) A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers Veterinary Ophthalmology 1153-158

Devgan U (2006) Intraocular use of triamcinolone Removing preservatives from triamcinolone can minimize ocular toxicity and side effects Ocular Surgery News US Edition Dec 15th 20016

Esson D Armour M Mundy P Schobert CS Dubielzig RR (2009) The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in the Golden Retriever Vet Ophthalmol 12361-8

Holly VL Sandmeyer LS Bauer BS Verges L Grahn BH (2015) Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada Vet Ophthalmol doi 101111vop12293

Lin P Suhler EBet al (2014) The Future of Uveitis Treatment Ophthalmology 121 365ndash376

Sapienza JS et al (2000) Golden Retreiver Uveitis 75 cases (1994-1999) Veterinary Ophthalmology vol 3 Pg 241-246

Taylor LN Townsend WM etal (2015) Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts AJVR 76540ndash546

Townsend WM1 Gornik KR (2013) Prevalence of uveal cysts and pigmentary uveitis in Golden Retrievers in three Midwestern states JAVMA 2431298-301

vonHoldt BM et al (2010) Neighbour-joining trees of domestic dogs and grey wolves Nature doi101038nature08837

Page 30: Pigmentary Uveitis - vetemergency.cavetemergency.ca/wp-content/uploads/2015/11/Pigmentary-Uveitis.pdfiridociliary cysts, pigmentary uveitis, ... Neighbour-joining trees of domestic

References Bentley E Miller PE Diehl KA (2003) Use of high-resolution ultrasound as a diagnostic tool in veterinary ophthalmology JAVMA

223 1617-1622

Corcoran KA Koch SA (1993) Uveal cysts in dogs 28 cases (1989-1991) JAVMA 203545-6

Deehr AJ Dubielzig RR (2002) A histopathological study of iridociliary cysts and glaucoma in Golden Retrievers Veterinary Ophthalmology 1153-158

Devgan U (2006) Intraocular use of triamcinolone Removing preservatives from triamcinolone can minimize ocular toxicity and side effects Ocular Surgery News US Edition Dec 15th 20016

Esson D Armour M Mundy P Schobert CS Dubielzig RR (2009) The histopathological and immunohistochemical characteristics of pigmentary and cystic glaucoma in the Golden Retriever Vet Ophthalmol 12361-8

Holly VL Sandmeyer LS Bauer BS Verges L Grahn BH (2015) Golden retriever cystic uveal disease a longitudinal study of iridociliary cysts pigmentary uveitis and pigmentarycystic glaucoma over a decade in western Canada Vet Ophthalmol doi 101111vop12293

Lin P Suhler EBet al (2014) The Future of Uveitis Treatment Ophthalmology 121 365ndash376

Sapienza JS et al (2000) Golden Retreiver Uveitis 75 cases (1994-1999) Veterinary Ophthalmology vol 3 Pg 241-246

Taylor LN Townsend WM etal (2015) Comparison of ultrasound biomicroscopy and standard ocular ultrasonography for detection of canine uveal cysts AJVR 76540ndash546

Townsend WM1 Gornik KR (2013) Prevalence of uveal cysts and pigmentary uveitis in Golden Retrievers in three Midwestern states JAVMA 2431298-301

vonHoldt BM et al (2010) Neighbour-joining trees of domestic dogs and grey wolves Nature doi101038nature08837