Preston Juliette F, Mustikka Minna P, Priestnall Simon L, Dunkel Bettina, Fischer Maria-Christine
Department of Clinical Science and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK.
Department of Equine and Small Animal Medicine, University of Helsinki, Helsinki, Finland.
Equine Vet J. 2025 May;57(3):598-610. doi: 10.1111/evj.14213. Epub 2024 Aug 26.
There is limited literature regarding equine immune mediated keratitis (IMMK) in Europe. North America-based publications describe minimal blepharospasm, rare corneal ulceration and no uveitis; clinical impression suggests these are seen in Europe.
Assess the prevalence of blepharospasm, corneal ulceration and uveitis and their impact on outcome in horses diagnosed with IMMK in Europe (UK and Finland).
Retrospective case series.
Clinical records of 94 horses with IMMK were evaluated. The UK and Finland populations were comparable; therefore, descriptive statistics were performed on combined data on subtypes of IMMK and clinical features. Odds ratios (OR) and confidence intervals (CI) were calculated for impact of blepharospasm, ulceration or presence of uveitis on the outcome of enucleation and treatment duration.
IMMK subtype was classified as 10/94 (10.6%) epithelial, 50/94 (53.2%) anterior stromal, 14/94 (14.9%) mid-stromal, 4/94 (4.25%) endothelial and 16/94 (17.0%) unrecorded. After excluding three horses with incidental corneal ulceration, blepharospasm was documented in 34/91 (37.4%), corneal ulceration in 26/91 (28.6%), and signs of uveitis in 23/91 (25.3%) horses. Increased odds of enucleation were significantly associated with the presence of blepharospasm (OR 5.5, 95% CI 1.6-19.4, p = 0.008) and signs of uveitis (OR 8.9, 95% CI 2.6-30.8, p < 0.001), but not corneal ulceration. The presence of blepharospasm, corneal ulceration or uveitis did not significantly alter the odds of ongoing medication.
Data were collected over a wide timeframe; the diagnosis was mainly made without histopathology; a broad definition of uveitis was used and there was a bias towards complicated cases being retained for follow-up.
The clinical features of IMMK were similar between two European countries but differed to USA descriptions. Blepharospasm, corneal ulceration and signs of uveitis can occur with IMMK; presence of blepharospasm and uveitis increase the odds of enucleation.
欧洲关于马免疫介导性角膜炎（IMMK）的文献有限。北美地区的出版物描述其睑痉挛轻微、角膜溃疡罕见且无葡萄膜炎；但临床观察表明这些情况在欧洲较为常见。
评估欧洲（英国和芬兰）被诊断为IMMK的马匹中睑痉挛、角膜溃疡和葡萄膜炎的患病率及其对预后的影响。
回顾性病例系列研究。
评估了94例IMMK马匹的临床记录。英国和芬兰的病例情况具有可比性；因此，对IMMK亚型和临床特征的综合数据进行了描述性统计。计算了睑痉挛、溃疡或葡萄膜炎对眼球摘除术预后和治疗持续时间影响的比值比（OR）及置信区间（CI）。
IMMK亚型分类为上皮型10/94（10.6%）、前基质型50/94（53.2%）、中基质型14/94（14.9%）、内皮型4/94（4.25%）和未记录型16/94（17.0%）。排除3例伴有偶然性角膜溃疡的马匹后，91例马匹中有34例（37.4%）记录有睑痉挛，26例（28.6%）有角膜溃疡，23例（25.3%）有葡萄膜炎体征。眼球摘除术几率增加与睑痉挛（OR 5.5，95% CI 1.6 - 19.4，p = 0.008）和葡萄膜炎体征（OR 8.9，95% CI 2.6 - 30.8，p < 0.001）显著相关，但与角膜溃疡无关。睑痉挛、角膜溃疡或葡萄膜炎的存在并未显著改变持续用药的几率。
数据收集时间跨度大；诊断主要未经组织病理学检查；对葡萄膜炎采用了宽泛的定义，且倾向于保留复杂病例进行随访。
两个欧洲国家的IMMK临床特征相似，但与美国的描述不同。IMMK可伴有睑痉挛、角膜溃疡和葡萄膜炎体征；睑痉挛和葡萄膜炎的存在增加了眼球摘除术的几率。
