title: Corneal edema in four horses treated with a superficial keratectomy and Gundersen inlay flap.
abstract: OBJECTIVE
  To describe the clinical presentation, treatment, and outcome of four horses with severe corneal edema caused by suspected endothelial disease treated with a superficial keratectomy and Gundersen inlay flap and to determine whether this procedure (i) reduces corneal edema, (ii) reduces ocular pain, (iii) eliminates recurrent corneal ulceration, and (iv) improves vision in these horses.
  
  
  METHODS
  Four horses met inclusion criterion of (i) diagnosis with endothelial disease by a board-certified veterinary ophthalmologist and (ii) surgical treatment with a superficial keratectomy and Gundersen inlay flap.
  
  
  METHODS
  Retrospective medical record review of included horses was used to determine breed, age and sex of included horses, as well as details of medical and surgical therapy, and visual outcome.
  
  
  RESULTS
  Four horses were presented with a complaint of focal corneal edema that progressed to diffuse corneal edema. Epithelial bullae and ulceration were present in all cases. The disease process was unresponsive to standard medical treatment with a hyperosmotic agent and topical and systemic anti-inflammatories. However, treatment with a superficial keratectomy and Gundersen inlay flap performed under general anesthesia was associated with (i) a significant decrease in corneal edema, (ii) increased comfort, (iii) elimination of corneal ulceration, and (iv) retention of vision postoperatively with little to no need for medical therapy. Follow-up time was 15, 12, 6, and 3 months.
  
  
  CONCLUSIONS
  The superficial keratectomy and Gundersen inlay flap may provide a surgical alternative to chronic medical treatment of severe corneal edema in horses.
authors.affiliation: New Bolton Center, University of Pennsylvania School of Veterinary Medicine, 382 West Street Rd, Kennett Square, PA, 19348, USA.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Scherrer
authors.affiliation: Department of Radiological and Surgical Sciences, University of California, 1 Shields Ave, Davis, CA, 95616, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Lassaline
authors.affiliation: Memphis Veterinary Specialists, 555 Trinity Creek Cove, Cordova, TN, 38018, USA.
authors.forename: William W
authors.initials: WW
authors.lastname: Miller
mesh_terms: D000818:Animals; D003315:Cornea / Q000601:surgery; D015715:Corneal Edema / Q000601:surgery / Q000662:veterinary*; D005260:Female; D006734:Horse Diseases / Q000601:surgery*; D006736:Horses; D000074431:Keratectomy / Q000379:methods / Q000662:veterinary*; D008297:Male; D013524:Surgical Flaps / Q000601:surgery / Q000662:veterinary
keywords: Gundersen inlay flap; conjunctival graft; corneal edema; horse; superficial keratectomy