Clinical Decision Making and Treatment Patterns in Canine Prolapsed Nictitans and Feline Herpetic Keratitis

Abstract

No evidence-based treatment guidelines exist for any ophthalmic conditions of dogs and there is limited published evidence supporting treatments of feline herpes viral keratitis (FHVK). The aim of this study was to document current treatment patterns of canine prolapsed nictitans (PN) and FHVK through the use of a vignette-based survey administered to general practitioner (GP) and ophthalmic specialist (SP) veterinarians.

The majority of veterinarians recommended surgical replacement of PN using a pocketing technique but GPs were more likely to trial medical therapy prior to surgery (26.8% GP, 10.4% SP, p=0.006). More GPs suggested excision as a first line therapy (12% GP, 0% SP, p=0.003) and GPs were more likely to suggest excision in case of surgical failure (27.0% GP, 3.0% SP, p<0.001). SPs rarely recommended excision and used periosteal anchoring more frequently in revision procedures.

The majority of veterinarians used topical antibiotics (77.8% GP, 72.7% SP) for FHVK with fusidic acid and chloramphenicol favored by both groups. GPs were less likely to use any antiviral therapy (52.1% GP,83.3% SP, p<0.0001) and more likely to use topical antiviral therapy (predominantly acyclovir). The majority of SPs used systemic famcyclovir (15.6% GP, 63.6% SP, p<0.001) and preferred trifluorothymidine when a topical was suggested. SPs were also more likely to suggest lysine supplementation (25.1% GP, 50.0% SP, p<0.001). The majority repeated their original treatment suggestions in the event of relapse.

Treatment variation was seen both within and between GP and SP groups for both of these conditions. In particular FHVK elicited a wider array of treatment suggestions, suggesting greater clinical uncertainty. Establishing current practice may add to knowledge of current collective opinion but also identify areas of priority for research in veterinary ophthalmology.