Veterinary Medicine - November 2007 - (Page 714)

OPEER-REVIEWED A challenging case: Uveitis and secondary glaucoma in a cat This cat’s acute onset of hyphema and uveitis was initially attributed to trauma, but the ocular problems progressed despite treatment. These clinicians narrowed a long list of differential diagnoses to identify the cause. Lyndsey Larson, VMD Todd Hammond, DVM, MS, DACVO A Vital Stats Signalment A 9-year-old male neutered domestic shorthaired cat History and presenting complaints • Progressive uveitis and irregularly shaped pupils in both eyes; glaucoma and blindness in the right eye; decreased IOP in the left eye • Mild lymphocytosis • Unsuccessful treatment with prednisolone, mannitol, and triamcinolone acetonide 9-year-old male neutered domestic shorthaired cat was referred to The Veterinary Eye Clinic in Wheat Ridge, Colo., for evaluation of acute, progressive uveitis in both eyes and glaucoma in the right eye. The cat went outside occasionally to hunt. It had no known history of trauma or travel and was receiving no medications, and its vaccination status was current for feline viral rhinotracheitis, calicivirus infection, panleukopenia, and rabies. HISTORY One month before referral, the cat had been presented to an emergency clinic because of acute hyphema in the right eye and uveitis in both eyes. The cat was mildly lethargic, and its temperature was 102.4 F. The intraocular pressure (IOP) was 16 mm Hg in both eyes (normal = 15 to 35 mm Hg).1 Trauma was suspected, and one drop of prednisone acetate was prescribed for use in both eyes four times a day. The referring veterinarian saw the cat for a recheck examination two days later, and the IOP was 45 mm Hg in the right eye and 5 mm Hg in the left eye. Hyphema had developed in the left eye, and hypopyon was present in the right eye. Neither eye had fluorescein stain uptake. The cat had also become more lethargic and exhibited inappetence. A serum chemistry profile had revealed a high normal globulin concentration (5.4 g/dl; reference range = 2.8 Ocular examination findings on referral • Right eye: Nonvisual, buphthalmos, with fibrin and a blood clot in the pupil, glaucoma • Left eye: Visual, inflamed, with a blood clot in the pupil to 5.4 g/dl). A complete blood count had shown a mild lymphocytosis (9,860/µl; reference range = 400 to 6,800/µl). The cat’s blood pressure was normal, and a thoracic radiographic examination revealed no abnormalities. The results of feline immunodeficiency virus (FIV) and feline leukemia virus (FeLV) tests (SNAP FIV/FeLV Combo—Idexx) were negative. Trauma, infectious disease, or idiopathic uveitis with secondary glaucoma were the top differential diagnoses. Treatment prescribed by the referring veterinarian included intravenous mannitol (1 g/kg) administered over 30 minutes and subcutaneous triamcinolone acetonide (0.25 mg/kg given once). A topical carbonic anhydrase inhibitor, dorzolamide (one drop in each eye twice a day), and oral prednisolone (1 mg/kg once a day) were also prescribed, and the cat was discharged. Over the next 20 days, the IOP in the right eye decreased and the cat’s ocular pain seemed to diminish. However, on Lyndsey Larson, VMD Wheat Ridge Animal Hospital 3695 Kipling St. Wheat Ridge, CO 80033 Todd Hammond, DVM, MS, DACVO The Veterinary Eye Clinic 7630 W. 39th Ave. Wheat Ridge, CO 80033 Continued on page 715. Initial suspicions • Trauma • Systemic infection • Neoplasia • Immune-mediated disease • Idiopathic uveitis 714 November 2007 VETERINARY MEDICINE

Table of Contents Feed for the Digital Edition of Veterinary Medicine - November 2007

Veterinary Medicine - November 2007 Contents Leading Off The Veterinary Medicine Interview: Dr. Lila Miller Clinical Exposures Idea Exchange A Challenging Case: Uveitis and Secondary Glaucoma in a Cat Is it Immune-Mediated Neutropenia? Pimobendan Treatment in Dogs with Congestive Heart Failure CE Form Product Preview Advertiser Index Marketplace/Classifieds Mind Over Miller Special Supplement by Lilly: Flea Bite Facts Q&A

Veterinary Medicine - November 2007

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