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CE Article 2
Author Shelby L. Reinstein,
DVM, MS, with Beasley at The
University of Pennsylvania.
Canine Glaucoma:
Medical and Surgical
Treatment Options*
S
helby L. Reinstein,
DVM, MS
A
my J. Rankin, DVM,
MS, DACVO
Rachel Allbaugh, DVM,
MS, DACVO
Kansas State University
Abstract: Canine glaucoma can be treated medically or surgically, depending on the underlying
cause, disease stage, desired outcome, available equipment, and owners financial limitations.
Common medications for glaucoma include hyperosmotics, -blockers, carbonic anhydrase inhibitors, cholinergics, and prostaglandin analogues. Surgical options include aqueous humor
shunts, cyclodestructive procedures, enucleation, intrascleral prostheses, and chemical ablation.
Each patient requires a customized treatment plan that generally includes a combination of medications and, potentially, surgical intervention.
T
At a Glance
Antiglaucoma Medications
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Antiglaucoma Medications1,8,a,b
Drug
Recommended
Dose or Timing
Available Preparations
Contraindications
Blockers
Betaxolol
Timolol maleate
q12h
2.55 mg/kg
q812h PO
Brinzolamide
1% solution
Dorzolamide
2% solution
Dorzolamidetimolol maleate
q12h
Pilocarpine
1% solution
q812h
Demecarium bromidec
q1224h
q8h
Cholinergics
Anterior lens luxation, uveitis
Prostaglandin analogues
Latanoprost
0.005% solution
Travoprost
0.004% solution
Bimatoprost
0.03% solution
q1224h
Hyperosmotic agents
Mannitol
20% solution
11.5 g/kg IV
slowly over 20 min
Glycerin
12 g/kg PO
a
b
c
Willis AM, Diehl KA, Robbin TE. Advances in topical glaucoma therapy. Vet Ophthalmol 2002;5(1):9-17.
Medications are topical ophthalmic preparations unless otherwise noted.
Must be compounded.
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Other Medications
2 Agonists and epinephrine have historically
been used to treat glaucoma, but with recent
advances in glaucoma therapy, other drugs
with increased efficacy and fewer potential
adverse effects ( blockers, CAIs) may be
more appropriate.8,10,11
QuickNotes
Many patients
with glaucoma
require multiple
medications.
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Cyclodestruction, or destruction of the ciliary body, decreases the production of aqueous humor and can be performed using
cryotherapy, transscleral lasers, or endoscopic
cyclophotocoagulation.
Cyclocryotherapy uses either liquid nitrogen or nitrous oxide applied to the sclera by a
probe to cause cryonecrosis of the ciliary body.
Cryotherapy can cause severe uveitis, cataracts,
and retinal detachment and is therefore not
generally recommended in visual eyes.1
Transscleral cyclophotocoagulation (TSCP) Salvage Procedures
uses a diode or Nd:YAG laser to irradiate the Chronic end-stage glaucoma may be painful,
ciliary body. Studies have shown this proce- and buphthalmic globes are predisposed to
dure to be effective in controlling IOP.17,18 The exposure keratitis. Surgical options for chronimost common complications of TSCP are cally glaucomatous globes include enucleation,
recurrence of glaucoma requiring a second evisceration with intrascleral prosthesis, and
procedure, secondary cataract formation, and chemical ablation.
ulcerative keratitis.19 This procedure may be
combined with implantation of an anterior Enucleation
chamber shunt (gonioimplant) for better con- Enucleation is relatively inexpensive and has
trol of postoperative IOP spikes. Two studies few complications. An orbital prosthesis may be
have shown the combination procedure to be placed to improve the cosmetic appearance. The
successful, with up to 58% of dogs retaining main disadvantage of enucleation is the postoperative appearance of the patient. The benefits
vision after 1 year.18,20
One of the main disadvantages of the non- include the potential for histopathologic examiinvasive cyclodestructive techniques is the nation of the globe and immediate pain control.1
inability to see the extent of destruction of the
ciliary body. Endoscopic cyclophotocoagu- Intrascleral Prosthesis
lation (ECPC; endolaser) uses a diode endo- Evisceration and intraocular placement of a
scopic laser to deliver energy to the ciliary silicone ball has a 95% success rate and, often,
body. Most patients require phacoemulsifica- very good cosmetic results. Postoperative comtion and intraocular lens implantation before plications are minimal but may include corneal
the procedure to prevent cataract formation. ulcers and persistent corneal edema.1,23
Other reported complications include uncontrolled IOP, corneal ulceration, retinal detach- Chemical Ablation
ment, and hyphema secondary to postoperative Pharmacologic destruction of the ciliary body
hypotony. This procedure offers a high success is accomplished by injecting gentamicin and
rate of IOP control and vision preservation and dexamethasone into the vitreous cavity. Com
may allow a decrease in antiglaucoma medica- plications include inadequate control of IOP,
tions. In a study of 106 dogs with primary and aPersonal communication, D. Bras, DVM, MS, DACVO,
secondary glaucoma, 93% of dogs treated with MedVet, Worthington, OH, February 5, 2008.
QuickNotes
As with medical therapy, surgical procedures to address
glaucoma either
reduce aqueous
humor production
or improve aqueous
humor outflow.
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CE Canine Glaucoma: Treatment Options
Conclusion
Canine glaucoma is difficult to manage, but there are
many therapeutic options. Owner expectations, visual status, and cause of the disease help dictate the appropriate
treatment course.
References
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13. Richter M, Krauss AH-P, Woodward D, Lutjen-Drecoll E. Morphological changes in the
anterior eye segment after long-term treatment with different receptor selective prostaglandin agonists and a prostamide. Invest Ophthalmol Vis Sci 2003;44(10):4419-4426.
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Proc 36th Annu Meet Am Coll Vet Ophthalmologists 2005:15.
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16. 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.
17. Nasisse MP, Davidson MG, English RV, et al. Treatment of glaucoma by use of
transscleral neodymium:yttrium aluminum garnet laser cyclocoagulation in dogs.
JAVMA 1990;197(3):350-354.
18. Sapienza JS, van der Woerdt A. Combined transscleral diode laser cyclophotocoagulation and Ahmed gonioimplantation in dogs with primary glaucoma: 51 cases
(1996-2004). Vet Ophthalmol 2005;8(2):121-127.
19. Hardman C, Stanley RG. Diode laser transscleral cyclophotocoagulation for the
treatment of primary glaucoma in 18 dogs: a retrospective study. Vet Ophthalmol
2001;4(3):209-215.
20. Bentley E, Miller PE, Murphy CJ, Schoster JV. Combined cycloablation and gonioimplantation for treatment of glaucoma in dogs: 18 cases (1992-1998). JAVMA
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21. Cullen CL, Allen AL, Grahn BH. Anterior chamber to frontal sinus shunt for the
diversion of aqueous humor: a pilot study in four normal dogs. Vet Ophthalmol
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23. Cook CS. Surgery for glaucoma. Vet Clin North Am Small Anim Pract 1997;
27(5):1109-1129.
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3 CE
CREDITS
CE Test 2 This article qualifies for 3 contact hours of continuing education credit from the Auburn University College of Veterinary
Medicine. Subscribers may take individual CE tests online and get real-time scores at CompendiumVet.com. Those who wish to apply this
credit to fulfill state relicensure requirements should consult their respective state authorities regarding the applicability of this program.