Date post: | 23-Mar-2018 |
Category: |
Documents |
Upload: | truongdang |
View: | 219 times |
Download: | 3 times |
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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