Table 1 : Clinical findings, cytology, histology and culture results, surgical interventions, and visual outcomes for 22 horses presenting to the University of Florida Veterinary Medical Center with the fungal plaque form of keratomycosis.


Case # Age, sex, breed Clinical Appearance Degree of Uveitis
at Presentation
Degree of Vascularization Cytology Culture Surgical Intervention Histology Results Outcome

1 20 y, F, T B-Y plaque, 40% of cornea (Figure 1) 1+flare Presentation-moderate,
reaching lesion Final-moderate
Neutrophilic keratitis
with fungal
infection-Aspergillus sp.
Staphylococcus,
gram+bacteria,
dematiaceous mold
SK Keratectomy-keratitis, focally extensive,
severe, with intra-lesional fungal hyphae;
appearance consistent with Aspergillus spp.
Visual, mild fibrosis

2 8 y, F, W W-Y plaque, 3x3mm 1+flare Presentation-moderate, 2 mm from lesion Final-infiltrating neovasc Fungal keratitis Scopulariopsis sp.,
Fusarium sp.
SK multiple times Keratectomy-large number of fungal hyphae Visual, mild fibrosis

3 12 y, F, Q W plaque, 0.5x0.5 mm 1+flare Presentation-mild
Final-infiltrating neovasc
Neutrophilic keratitis, single
encapsulated structure of
suspected fungal origin
No growth K-GA/Biosist/AMT Keratectomy-keratitis, neutrophilic, with neovascularization, chronic, diffuse,
moderate
Visual, mild fibrosis

4 2 y, F, T B-Y plaque, 30% of cornea Too much edema
to assess
Presentation-mild
Final-same
Bacterial and fungal sepsis Staphylococcus xylosus,
Streptococcus
spp.,
gram+bacteria
SK multiple times Keratectomy-large number of fungal
hyphae, suppurative inflammation
Visual

5 23 y, G, S W-Y plaque, B rim,
15x5 mm (Figure 3)
2+flare Presentation-none Prior to enuc.
-5-6 mm subepith 360 deg
neovasc, progressing slowly
Fungal keratitis Unknown fungus None-Recommended-K
and CF, declined for
financial reasons
  Enucleated-Melting
ulcer and groove;
financial

6 24 y, G, T W plaque, 1x0.7mm 2+flare Presentation-mild
Prior to enuc-mild
Fungal keratitis Pseudomonas,
Fusarium
sp
SK Enucleation-keratitis, ulcerative,
necrosuppurative, focal, mild to moderate,
with intralesional hyphae; anterior uveitis,
suppurative, multifocal, mild to moderate,
anterior chamber, iris, ciliary body, and
filtration angle
Iris prolapse,
Enucleated  

7 4 y, G, Q W-Y plaque, 6x6mm 2+flare Presentation-mild
Final-mild
Fungal keratitis α-hemolytic strep,
Dactylaria constricta
None   Visual

8 9 y, G, W W-Y plaque, 80%
of cornea (Figure 4)
Unknown Presentation-prolapsed iris Fungal keratitis Aspergillus,
Staphylococcus
  epidermis
SK Enucleation-keratitis, suppurative, multifocal,
subacute, severe with intralesional fungal
hyphae; corneal perforation; hyphema, acute,
marked, anterior chamber; iris prolapse and
anterior synechia, anterior chamber.
Iris prolapse,
Enucleated

9 9 y, G, Qx Y plaque, 40% of
cornea
Mild flare Presentation-moderate
Final-infiltrative
Fungal keratitis Non-hemolytic Staphylococcus,
unknown fungus
SK Keratectomy-large number of fungal hyphae,
suppurative inflammation
Visual

10 16 y, G, WP W plaque w/B rim,
80% of cornea
Severe (2+flare) Presentation-mild
Final-infiltrative
Fungal sepsis
w/neutrophilic inflammation
Pseudomonas
aeruginosa
SK Keratectomy-large number of fungal hyphae,
suppurative inflammation, subacute
Visual, mod fibrosis

11 6 y, F, T B plaque, 10x5mm 1+flare Presentation-mild
Final-infiltrative
Fungal keratitis Mold SK Keratectomy-suppurative, severe, acute to
subacute, diffuse, with numerous intralesional fungal hyphae
Visual

12 17 y, F, Q B-Y plaque, 15% of cornea Mild Presentation-mild
Final-severe
Fungal keratitis Staphylococcus
epidermis
SK Keratectomy-large number of fungal hyphae,
neutrophilic, with neovascularization, chronic, diffuse, moderate
Visual, mild fibrosis

13 10, G, T Y plaque, 10% of
cornea
Mild Presentation-mild
Final-severe
Fungal keratitis Aspergillus SK Keratectomy-large number of fungal hyphae, neutrophilic, with neovascularization, chronic, diffuse, moderate Visual

14 4 y, G, W Y plaque, 15% of
cornea
None Presentation-mild
Final-severe
Fungal keratitis Staphylococcus
aeruginosa
,
Nocardia sp
GK-GA, CF Keratectomy-large number of fungal hyphae Visual

15 21 y, S, T Y-W plaque, 5% of cornea Mild Presentation-mild
Final-severe
Fungal keratitis None SK Keratectomy-large number of fungal hyphae;
neutrophilic, with neovascularization, chronic,
diffuse, moderate
Visual, mild fibrosis

16 7 y, G, W W plaque, 10x20 mm 2+flare Presentation-none Prior to enuc-moderate at site of AMT Fungal sepsis Ralstonia picketti K-GA, AMT-2 layers Keratectomy-large number of fungal hyphae Iris prolapse
Enucleated

17 17 y, F, Q W plaque, 20% of
cornea
3+flare Presentation-mild
Prior to enuc- moderate
Bacterial and fungal sepsis Stenotrophomonas maltophilia SK Enucleation-corneal ulcer, locally extensive,
severe, chronic with intralesional fungal hyphae
and with: panophthalmitis suppurative and
histiocytic, multifocal, mild to severe, chronic;
iris prolapse and anterior synechiae
Iris prolapse, Enucleated

18 10 y, G, T B-Y plaque, 40% of cornea None Presentation-mild
Final-moderate
Fungal keratitis None SK Keratectomy-large number of fungal hyphae
with many neutrophils
Visual, major fibrosis

19 10 y, F, Q B plaque,
20mmx5mm
Could not assess Presentation-moderate
Final-infiltrative  
Fungal keratitis α-hemolytic
streptococcus, mold
SK Keratectomy-large number of fungal hyphae
with many neutrophils
Visual, mild fibrosis  

20 6 y, F, P W w/B rim,
15mmx13mm
1+flare Presentation-mild
Final-infiltrative  
Neutrophilic keratitis
w/fungal sepsis
Aspergillus SK Keratectomy-large number of fungal hyphae
with many neutrophils
Visual,  mild fibrosis

21 6 y, F, C W, 60% of cornea None noted Presentation-none Prior to
enuc-mild, progressing slowly
Fungal keratitis Aspergillus K-GA, Biosist, AMT Keratectomy-keratitis, suppurative, severe,
acute to subacute, diffuse, with numerous
intralesional fungal hyphae, cornea.
Enucleation-ulcerative keratitis, with disruption
of Descemet's membrane and iris prolapse,
posterior synechia, scleritis, uveitis, suppurative,
acute, mutlifocal, moderate with intracorneal
fungi.
Iris prolapse, Enucleated

22 5 y, F, Ap W, 10% of cornea 2+flare Presentation-moderate
Final-infiltrative
Fungal keratitis Fusarium sp., Stenotrophomonas maltophilia DALK, K-GA,
voriconazole, Biosist,
AMT
Keratectomy-large number of fungal hyphae,
suppurative
Visual, major
fibrosis

Table 1 Abbreviations:
Sex: F: Mare; G: Gelding; S: Stallion; Plaque Colors: W: White; Y: Yellow; B:Brown; R: Red; Bl: Black; Degree of Vascularization: Neovasc: Neovascularization; Enuc: Enucleation; Surgical Interventions: SK: Standing keratectomy; K-GA: Keratectomy under General Anesthesia;
GK: Grid Keratotomy; AMT: Amniotic membrane transfer; CF: Conjunctival Flap; DALK: Deep anterior lamellar keratoplasty; Breed: T: Thoroughbred; Q: Quarter Horse; S: Saddlebred; W: Warmblood; P: Crossbreed pony; C: Crossbreed horse; Ap: Appaloosa

Brooks et al.Veterinary Medicine and Animal Sciences  2015 3:2DOI : 10.7243/2054-3425-3-2