Pannus And Edta Eye Ointment

[CharliesDad]

Hello Forum,

 

I searched our forum threads on pannus but did not find information about treating the condition with EDTA (Ethylene Diamene Tetraacetic Acid).

 

Strider (my 4 year old male) was diagnosed with pannus about 7 weeks ago. Since then I have been applying 0.1% dexamethesone ointment (Maxidex) to his eyes 3 x daily. At his follow-up 3+ weeks ago, our vet observed that the neo-vascularization (extra blood vessels) had diminished but that the opaque squiggly line (scarring and pigmentation at the edge of the film growing out from the the upper temporal (outer) region of the eye) was unchanged.

 

At his next follow-up, I am anticipating that our vet will propose treating the scarring with EDTA, (said to have lipid-calcium binding effects) on the advice of our local ophthalmologist. Does anyone on Greytalk have experience with EDTA in pannus treatment?

 

Also, I have read about treatment of pannus by cyclosprorine (an immunosuppressant?) in conjunction with a steroid like dexamethesone, and not just dexamethasone alone.

 

Do you have any feedback?

 

Thanks!

[krissy]

No personal experience with EDTA for pannus. Summit was initially on a dex/cyclosporine combo when I was in vet school. It was the win/win situation. The cyclosporine reduced the amount of dexamethasone (which has more side effects... Though honestly the absorb very little from the eye anyway) and the dex reduced the amount of cyclosporine (which is much more expensive). Now that I'm graduated and I get my drugs at cost I switched to 1% Cyclosporine only. Never noticed any difference between the two clinically. His eyes have been great ever since starting treatment.

 

Edited because auto correct doesn't know what dexamethasone is but apparently knows dex amethystine?

Edited September 7, 2013 by krissy

[cleptogrey]

i know someone whose grey is on the combo of cyclosprorine (an immunosuppressant?) in conjunction with a steroid like dexamethesone. the pannus seems to be under control. we saw excellent results after one month of 0.1% dexamethesone ointment to eyes 3 x daily, then 2xs daily for 2 weeks - then our recheck. annie is getting treated daily right now. from what i have experienced it's how your pup repsonds to the treatment that will determine the protocal.

[WHanson12]

Our senior girl, Molly, was diagnosed with pannus several years ago & was under the care of OSU's opthalmology dept. She is very sensitive to many eye meds & did not tolerate cyclosporine, tacrolymus using 3 different base oils (corn oil, mineral oil & one other) & even certain brands of Dex 0.1% (Bausch & Lomb). She has some lipid deposits forming, but for the most part her pannus is controlled on a generic brand of Dex 0.1% (Falcon manuf, their generic is Savon--cheaper to buy at human pharmacy)). She is also on an artifical tears 2-3 times a day. Her pannus flares up during the spring & summer months when the sun is stronger, even though I don't allow her to lay outside in the sun any more. Pannus LOVES ultraviolet light, so I was told to keep her out of the sun as much as possible (especially during the spring & summer) or be religious about having her wear doggles. At this point for Molly, the lipid deposits developing as a result of the long term Dex use are the least of her many problems...

[Guest greytkidsmom]

Haven't heard of the treatment you mention. Tiel's pannus has been well controlled for 5 years with methylprednisolone plus cyclosporine drops once daily. She was sensitive to the cyclosporine compounded in corn oil but we found that Wedgewood Pharmacy will compound it in sterile water. No problems. We ran out of the cyclosporine for about a month and noticed that the growth started coming back. Once we got the cyclosporine refilled the growth completely regressed. I think the pred costs about $15 and lasts several months. The cyclosporine is about $50 (including expedited shipping) and lasts about 3 months. As I recall the ointment was much less expensive but it freaked DH out. The drops are easier for him and for our pet sitter to use. Well worth the expense to know she is getting the meds she needs every day.

[Bill419]

I have one greyhound (Tucker) with Pannus. He gets 1 drop of Prednisolone Acetate every other day. I also have one greyhound (Dee) with dry eye who has undergone surgery rerouting her saliva to her tear ducts. She gets 2 drops per day of Tacrolimus and 1 drop per day of EDTA. She also gets 3 drops per day of over the counter eye gel. She also gets treats throughout the day to keep her eyes moist.

[CharliesDad]

Many thanks to all for your contributions to my query!

 

After recheck following 6 weeks 3 x daily dexamethasone, my greyt's neovascularization (new blood vessels) is pretty much gone! Yay! Plan is to continue 2 x daily going forward without EDTA and then recheck in 2 months. He is pretty resistant to wearing Doggles. They impede his vision a lot, I think, so I don't insist very much. I avoid mid-day direct sunlight except for 20-30mins walk.

 

FYI, below is an exchange between my vet and consulting vet ophthalmologist which occurred this week.

 

Thanks again!

 

CD

 

"Hi K,

The inflammation present in most cases of pannus include "red" changes - which is a vascular response, which responds well to use of anti-inflammatory drops +/- cyclosporine or tacrolimus. There is also "black" changes which is deposition of pigment secondary to the inflammatory response. The pigmentary changes do improve with ongoing treatment but this can take many months or longer. Then there are "white" changes - a mineral or fatty deposit which typically is located at the leading edge of the inflammatory wave so to speak. This typically does not get better, but by keeping the underlying inflammation at bay we can prevent this from getting worse. EDTA does not penetrate well through intact cornea, so typically I will use it in situations where mineralized deposit is being sloughed off as we see in very old dogs with corneal degeneration.

Hope this is helpful,

M Z

On Wed, Sep 11, 2013 at 9:55 AM, Dr. K H wrote:

Hi Dr Z..,

I have a question about atypical pannus in a greyhound ...the eye lesions are as follows: bilaterally symmetrical - extending from lateral sclera to lateral corneal surface, there is mild neovascularization that ends in a white squiggly line-like corneal opacity

I have been treating it with Maxidex (dexamethasone) ophthalmic TID (3xdaily) for the past 6 or so weeks and all the neovascularization has resolved, however the white squiggly line is still present – corneal deposit? Scar? It had been suggested to use EDTA ophthalmic, but it is on back order. Will cyclosporine help scarring, or will it only prevent it from getting worse? If this is in fact a corneal deposit, would this help?

Thank you so much,

Sincerely,

Dr K H"

[Charlies_Dad]

Don't have much advice but notice you are in Ottawa. For eye issues with our non-Grey's we always went to Dr. Tinsley at Alta Vista Animal hospital. He's very good and a nice vet in case you are seeking additional advice.