Hannah L Smith, Kim R Love, Ariana Antezana, Erin M Barr, Brian C Gilger, Annie Oh
{"title":"马角膜炎的治疗,第 1 部分:根据临床表现和诊断检测选择适当的治疗方法可提高临床疗效。","authors":"Hannah L Smith, Kim R Love, Ariana Antezana, Erin M Barr, Brian C Gilger, Annie Oh","doi":"10.2460/javma.24.06.0431","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To determine clinical outcome, treatment costs, and hospitalization duration in horses treated for keratomycosis and identify ophthalmic examination and diagnostic results associated with these outcomes.</p><p><strong>Methods: </strong>This was a retrospective study of 126 equine keratomycosis cases between 2004 and 2020 with fungal infection confirmed on cytology, culture, and/or histopathology and a minimum of 1-month follow-up. Details of the ophthalmic examination, diagnostic test results, and treatment and cost outcomes were recorded. Outcomes of interest were analyzed by treatment type. The relationship of patient and diagnostic test variables to the outcomes of interest was determined via logistic and linear regression models.</p><p><strong>Results: </strong>Globe retention and positive visual outcome occurred in 82.5% and 78.9% of medically and 88.4% and 85.5% of surgically treated cases, respectively. While not statistically significant, there were more positive clinical outcomes with surgery; in recent years, the globe and vision were preserved in 94.7% of cases following penetrating keratoplasty. The choice to pursue surgery was related to lesion depth. Medical treatment was associated with statistically shorter hospitalization times and lower total and hospitalization invoices compared to all surgical treatments. Diagnosis of stromal abscess was associated with higher total invoice and longer hospitalization times compared to ulcerative keratomycosis, although clinical outcomes were similar.</p><p><strong>Conclusions: </strong>Overall positive clinical outcomes were achieved despite the severity of the disease in many cases, highlighting the need for appropriate treatment selection based on clinical presentation.</p><p><strong>Clinical relevance: </strong>Expanding knowledge of clinical decision-making, treatment options, and associated clinical and financial outcomes may further improve outcomes for equine keratomycosis patients.</p>","PeriodicalId":14658,"journal":{"name":"Javma-journal of The American Veterinary Medical Association","volume":null,"pages":null},"PeriodicalIF":1.6000,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Treatment of equine keratomycosis, part 1: selection of appropriate therapy based on clinical presentation and diagnostic testing improves clinical outcomes.\",\"authors\":\"Hannah L Smith, Kim R Love, Ariana Antezana, Erin M Barr, Brian C Gilger, Annie Oh\",\"doi\":\"10.2460/javma.24.06.0431\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To determine clinical outcome, treatment costs, and hospitalization duration in horses treated for keratomycosis and identify ophthalmic examination and diagnostic results associated with these outcomes.</p><p><strong>Methods: </strong>This was a retrospective study of 126 equine keratomycosis cases between 2004 and 2020 with fungal infection confirmed on cytology, culture, and/or histopathology and a minimum of 1-month follow-up. Details of the ophthalmic examination, diagnostic test results, and treatment and cost outcomes were recorded. Outcomes of interest were analyzed by treatment type. The relationship of patient and diagnostic test variables to the outcomes of interest was determined via logistic and linear regression models.</p><p><strong>Results: </strong>Globe retention and positive visual outcome occurred in 82.5% and 78.9% of medically and 88.4% and 85.5% of surgically treated cases, respectively. While not statistically significant, there were more positive clinical outcomes with surgery; in recent years, the globe and vision were preserved in 94.7% of cases following penetrating keratoplasty. The choice to pursue surgery was related to lesion depth. Medical treatment was associated with statistically shorter hospitalization times and lower total and hospitalization invoices compared to all surgical treatments. Diagnosis of stromal abscess was associated with higher total invoice and longer hospitalization times compared to ulcerative keratomycosis, although clinical outcomes were similar.</p><p><strong>Conclusions: </strong>Overall positive clinical outcomes were achieved despite the severity of the disease in many cases, highlighting the need for appropriate treatment selection based on clinical presentation.</p><p><strong>Clinical relevance: </strong>Expanding knowledge of clinical decision-making, treatment options, and associated clinical and financial outcomes may further improve outcomes for equine keratomycosis patients.</p>\",\"PeriodicalId\":14658,\"journal\":{\"name\":\"Javma-journal of The American Veterinary Medical Association\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2024-10-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Javma-journal of The American Veterinary Medical Association\",\"FirstCategoryId\":\"97\",\"ListUrlMain\":\"https://doi.org/10.2460/javma.24.06.0431\",\"RegionNum\":2,\"RegionCategory\":\"农林科学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"VETERINARY SCIENCES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Javma-journal of The American Veterinary Medical Association","FirstCategoryId":"97","ListUrlMain":"https://doi.org/10.2460/javma.24.06.0431","RegionNum":2,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"VETERINARY SCIENCES","Score":null,"Total":0}
Treatment of equine keratomycosis, part 1: selection of appropriate therapy based on clinical presentation and diagnostic testing improves clinical outcomes.
Objective: To determine clinical outcome, treatment costs, and hospitalization duration in horses treated for keratomycosis and identify ophthalmic examination and diagnostic results associated with these outcomes.
Methods: This was a retrospective study of 126 equine keratomycosis cases between 2004 and 2020 with fungal infection confirmed on cytology, culture, and/or histopathology and a minimum of 1-month follow-up. Details of the ophthalmic examination, diagnostic test results, and treatment and cost outcomes were recorded. Outcomes of interest were analyzed by treatment type. The relationship of patient and diagnostic test variables to the outcomes of interest was determined via logistic and linear regression models.
Results: Globe retention and positive visual outcome occurred in 82.5% and 78.9% of medically and 88.4% and 85.5% of surgically treated cases, respectively. While not statistically significant, there were more positive clinical outcomes with surgery; in recent years, the globe and vision were preserved in 94.7% of cases following penetrating keratoplasty. The choice to pursue surgery was related to lesion depth. Medical treatment was associated with statistically shorter hospitalization times and lower total and hospitalization invoices compared to all surgical treatments. Diagnosis of stromal abscess was associated with higher total invoice and longer hospitalization times compared to ulcerative keratomycosis, although clinical outcomes were similar.
Conclusions: Overall positive clinical outcomes were achieved despite the severity of the disease in many cases, highlighting the need for appropriate treatment selection based on clinical presentation.
Clinical relevance: Expanding knowledge of clinical decision-making, treatment options, and associated clinical and financial outcomes may further improve outcomes for equine keratomycosis patients.
期刊介绍:
Published twice monthly, this peer-reviewed, general scientific journal provides reports of clinical research, feature articles and regular columns of interest to veterinarians in private and public practice. The News and Classified Ad sections are posted online 10 days to two weeks before they are delivered in print.