Medical management of deep ulcerative keratitis in cats: 13 cases

Abstract

Case series summary: Described are 13 cats diagnosed with deep ulcerative keratitis and successfully managed medically without grafting procedures. Typical treatment involved frequent topical application of serum and antibiotics (usually a fluoroquinolone and a cephalosporin). Seven cats also received systemic antibiotics. Analgesia was achieved using various combinations of topical atropine and systemic buprenorphine, robenacoxib or corticosteroids. Six cats were hospitalized for a median (range) period of 2.5 (1-8) days, typically because of frequent medication administration. Median (range) follow-up time was 41.5 (9-103) days. Median (range) number of recheck examinations was 4 (2-6). Median (range) time to corneal re-epithelialization was 21 (9-103) days. Median (range) topical antibiotic course was 29.5 (16-103) days. Median (range) duration of Elizabethan collar use was 28 (13-73) days. At the time of writing, no further recheck examinations were recommended for 10 cats; median (range) time between initial to final examinations in these cats was 35 (20-103) days. All cats retained the affected globes and were apparently comfortable and visual at the latest recheck examination.

Relevance and novel information: These cases reveal that aggressive medical management is highly successful in select cats with deep ulcerative keratitis, and can result in a cosmetically acceptable, apparently comfortable and visual globe. However, therapy is intensive with frequent administration of multiple topical and sometimes systemic medications, and requires multiple veterinary visits over many weeks. Referral to a veterinary ophthalmologist for consideration of surgical stabilization is recommended, as not all cases may be amenable to the medical therapy described here.

Figure 1

External photographs showing clinical progress of four cats with medically-treated deep ulcerative keratitis. (a–c) Right eye of a 7-year-old male castrated Persian cat at (a) presentation, and on days (b) 11 and (c) 73 of medical therapy. The linear structure on the corneal surface on day 73 (c) is a mucus strand stained with fluorescein. Aerobic bacterial culture and sensitivity in this cat yielded growth of small numbers of a fastidious Corynebacterium species. (d–f) Left eye of a 6.5-year-old male castrated Persian cat at (d) presentation, and on days (e) 29 and (f) 35 of medical therapy. Aerobic bacterial culture and sensitivity, as well as fungal and mycoplasmal culture, in this cat yielded no growth. (g–i) Right eye of a 4-year-old male castrated Savannah cat at (g) presentation, and on days (h) 36 and (i) 103 of medical therapy. Aerobic bacterial culture and sensitivity in this cat yielded a coagulase-negative Staphylococcus species with broad antimicrobial resistance but susceptible to ofloxacin. (j–l) Right eye of an 8-month-old male intact Siamese cat with a full-thickness corneal rupture at (j) presentation, and on days (k) 28 and (l) 68 of medical therapy. Dyscoria was noted on (l) day 68. Aerobic bacterial, fungal and mycoplasmal cultures were not performed in this cat