Treatment of immune-mediated keratitis in horses with episcleral silicone matrix cyclosporine delivery devices

Purpose To describe the use of episcleral silicone matrix cyclosporine (ESMC) drug delivery devices in horses with immune-mediated keratitis (IMMK) with evaluation of tolerability and efficacy in long-term control of inflammation. Methods Retrospective study. ESMC implants (1.2 cm length, 30% wt/wt cyclosporine (CsA) in silicone; with approximately 2 mu g/day steady-state release for at least 400 days) were used. Results Nineteen horses (20 eyes) received two or more ESMC implants for superficial stromal (n = 9), midstromal (n = 3), or endothelial (n = 5) IMMK. Three additional horses received two or more ESMC implants for pigmentary keratouveitis (PK). Nine eyes of eight horses with superficial and five eyes of five horses with endothelial IMMK were well controlled after placement of ESMC implants (mean follow-up 176.8 and 207.2 days, respectively). Horses with midstromal IMMK and PK were not controlled with ESMC implants alone, but instead required frequent use of other medications or surgery to control the disease. The mean duration of disease prior to ESMC implantation of horses with midstromal IMMK was 495 +/- 203.9 days, compared with 121.6 +/- 92.7 days with superficial IMMK. ESMC implants were well tolerated by all horses without documented loss of the device. Conclusions Results from this preliminary retrospective study suggest that the ESMC implants were well tolerated and associated with treatment success with superficial and endothelial IMMK, especially if placed early in the disease process. Further study is needed to determine the duration of efficacy, number of implants required, and better therapies for chronic midstromal IMMK and pigmentary keratouveitis.