Today's Veterinary Practice

MAR-APR 2018

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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PEER REVIEWED 46 ACUTE GLAUCOMA: A TRUE EMERGENCY exacerbate IOP elevation. 15 Oral anti-inflammatories are considered important to treat the posterior segment (retina and optic nerve) inflammation that develops during an acute IOP spike. 1–3 ■ Topical anti-inflammatories: Prednisolone acetate 1% Dexamethasone 0.1% ■ Oral anti-inflammatories: Carprofen, 2.2 mg/kg PO q12h Meloxicam, 0.1 mg/kg PO q24h Prednisone, 0.5 mg/kg PO q12h Prophylactic Therapy Primary glaucoma is a bilateral disease, and prophylactic therapy of the contralateral eye should be recommended. Therapy with 0.5% betaxolol q24h delays the onset of glaucoma from an average of 8 months to 31 months in dogs. 13 MONITORING OF IOP Once the IOP has been reduced, the patient should be monitored for 8 to 12 hours on maintenance therapy to ensure continued control of the pressure. A recheck examination is recommended within 2 to 5 days of discharge, and all medications must be given as directed on the day of the recheck exam. It is always important to note the time that medications were given in relation to the IOP measurement and to keep tonometer types consistent. In cases of primary glaucoma, medications become less effective over time, and the IOP will again rise. It is important to educate owners that combination therapy and increasing medication frequencies are often necessary, and eventually all medical therapies fail. Referral to an ophthalmologist for advanced surgical procedures (ciliary body laser ablation, anterior chamber shunts) should be considered in visual patients, while chronically blind patients eventually require a salvage procedure (enucleation, evisceration, chemical ciliary body ablation). References 1. Plummer C, Regnier A, Gelatt K. The canine glaucomas. In: Gelatt K, Gilger B, Kern T, eds. Veterinary Ophthalmology. 5 th ed. Ames, IA: John Wiley & Sons, Inc.; 2013:1050-1145. 2. Reinstein S, Rankin A, Allbaugh R. Canine glaucoma: pathophysiology and diagnosis. Compend Contin Educ Vet 2009;31(10):450-452. 3. Reinstein S, Rankin A, Allbaugh R. Canine glaucoma: medical and surgical treatment options. Compend Contin Educ Vet 2009;31(10):454-458. 4. Klein HE, Krohne SG, Moore GE, et al. Effect of eyelid manipulation and manual jugular compression on intraocular pressure measurement in dogs. JAVMA 2011;238(10):1292-1295. 5. Lorimer DW, Hakanson NE, Pion PD, Merideth RE. The effect of intravenous mannitol or oral glycerol on intraocular pressure in dogs. Cornell Vet 1989;79(3):249-258. 6. Gelatt KN, MacKay EO. Effect of different dose schedules of latanoprost on intraocular pressure and pupil size in the glaucomatous Beagle. Vet Ophthalmol 2001;4(4):283-288. 7. Studer ME, Martin CL, Stiles J. Effects of 0.005% latanoprost solution on intraocular pressure in healthy dogs and cats. Am J Vet Res 2000;61(10):1220-1224. 8. Tofflemire KL, Whitley EM, Allbaugh RA, et al. Comparison of two- and three-times-daily topical ophthalmic application of 0.005% latanoprost solution in clinically normal dogs. Am J Vet Res 2015;76(7):625-631. 9. Cawrse MA, Ward DA, Hendrix DV. Effects of topical application of a 2% solution of dorzolamide on intraocular pressure and aqueous humor flow rate in clinically normal dogs. Am J Vet Res 2001;62(6):859-863. 10. Gelatt KN, MacKay EO. Changes in intraocular pressure associated with topical dorzolamide and oral methazolamide in glaucomatous dogs. Vet Ophthalmol 2001;4(1):61-67. 11. Plummer CE, MacKay EO, Gelatt KN. Comparison of the effects of topical administration of a fixed combination of dorzolamide-timolol to monotherapy with timolol or dorzolamide on IOP, pupil size, and heart rate in glaucomatous dogs. Vet Ophthalmol 2006;9(4):245-249. 12. Wilkie DA, Latimer CA. Effects of topical administration of timolol maleate on intraocular pressure and pupil size in dogs. Am J Vet Res 1991;52(3):432-435. 13. Miller PE, Schmidt GM, Vainisi SJ, et al. The efficacy of topical prophylactic antiglaucoma therapy in primary closed angle glaucoma in dogs: a multicenter clinical trial. JAAHA 2000;36(5):431-438. 14. Dees DD, Fritz KJ, Maclaren NE, et al. Efficacy of prophylactic antiglaucoma and anti-inflammatory medications in canine primary angle-closure glaucoma: a multicenter retrospective study (2004- 2012). Vet Ophthalmol 2014;17(3):195-200. 15. Pirie CG, Maranda LS, Pizzirani S. Effect of topical 0.03% flurbiprofen and 0.005% latanoprost, alone and in combination, on normal canine eyes. Vet Ophthalmol 2011;14(2):71-79. Shelby Reinstein Shelby Reinstein, DVM, MS, DACVO, is the chief of ophthalmology at the Veterinary Specialty and Emergency Center in Levittown, Pennsylvania. Dr. Reinstein graduated from Kansas State University College of Veterinary Medicine and completed a 1-year internship in small animal medicine and surgery at Michigan State University College of Veterinary Medicine. She then joined the ophthalmology team at the University of Pennsylvania and completed a fellowship and residency in ophthalmology. Dr. Reinstein has a passion for lecturing and continuing education. She has been published in numerous journals and textbooks, lectures at national and local veterinary medical associations, and is the ophthalmology consultant for the web-based continuing education company, VETgirl.

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