Romaneck Amanda K, Sebbag Lionel
Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, United States.
Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel.
Front Vet Sci. 2021 Apr 30;8:580396. doi: 10.3389/fvets.2021.580396. eCollection 2021.
A 2-year-old domestic shorthair cat was examined for severe keratitis of 10 months duration, non-responsive to 0.1% dexamethasone q8-12h. Patient and owner compliance were poor given ocular discomfort and hiding behavior. On presentation, both eyes (OU) had severe ulcerative keratitis that masked examination of deeper structures and resulted in absent menace response OU. Corneal cytology was consistent with eosinophilic keratitis (EK) OU. Initial therapy included subcutaneous triamcinolone acetonide injection (0.2 mg/kg), 0.3% ciprofloxacin OU q12h, and two compounded drugs started 5 days later upon receipt: 0.5% tacrolimus OU q6h, 0.5% cidofovir OU q12h. Visual behavior and ocular comfort were reportedly much improved within 24 h. At the first recheck (Day 11), patient and owner compliance were reported to be excellent, menace response was positive OU, and keratitis was dramatically reduced OU with absent fluorescein uptake. Subcutaneous triamcinolone acetonide was repeated (0.2 mg/kg), ciprofloxacin was discontinued, cidofovir was continued q12h, and tacrolimus was slowly tapered (q8h × 3 weeks then q12h). Keratitis was nearly 100% resolved at the second recheck (Day 38); cidofovir was discontinued and tacrolimus was slowly tapered (q12h × 1 week, q24h × 4 weeks, q48h × 4 weeks) then discontinued. A third recheck (Day 101) confirmed clinical remission OU, and disease did not reoccur within a 1 year follow up period (photographic documentation by owner). In sum, adjunct use of triamcinolone acetonide greatly improved therapeutic compliance and helped control severe EK in a rapid and effective manner.
一只2岁的家养短毛猫因持续10个月的严重角膜炎接受检查，对每8 - 12小时一次的0.1%地塞米松无反应。由于眼部不适和躲藏行为，患者（猫）和主人的依从性较差。就诊时，双眼均有严重的溃疡性角膜炎，掩盖了对更深层结构的检查，导致双眼均无威胁反应。角膜细胞学检查结果与双眼嗜酸性粒细胞性角膜炎（EK）一致。初始治疗包括皮下注射曲安奈德（0.2 mg/kg）、每12小时一次的0.3%环丙沙星双眼给药，以及在收到药物5天后开始使用的两种复方药物：每6小时一次的0.5%他克莫司双眼给药、每12小时一次的0.5%西多福韦双眼给药。据报道，视觉行为和眼部舒适度在24小时内有很大改善。在第一次复查（第11天）时，据报告患者和主人的依从性极佳，双眼威胁反应为阳性，角膜炎显著减轻，无荧光素摄取。重复皮下注射曲安奈德（0.2 mg/kg），停用环丙沙星，继续每12小时一次的西多福韦给药，他克莫司逐渐减量（每8小时一次，持续3周，然后每12小时一次）。在第二次复查（第38天）时，角膜炎几乎100%消退；停用西多福韦，他克莫司逐渐减量（每12小时一次，持续1周，每24小时一次，持续4周，每48小时一次，持续4周），然后停药。第三次复查（第101天）确认双眼临床缓解，在1年的随访期内疾病未复发（主人提供照片记录）。总之，辅助使用曲安奈德极大地提高了治疗依从性，并有助于快速有效地控制严重的EK。
