Immune-mediated Keratopathies

Over the last 15 years considerable interested has focused on nonulcerative corneal inflammatory disease. This has included the large and heterogenous group of primary, noninfectious and non- neoplastic inflammatory diseases, some of which are believed to be immune-mediated. These latter are referred to generically as immune-mediated keratopathies (IMMKs). This name has, somewhat unsatisfactorily, become a descriptive diagnosis per sein cases of nonulcerating corneal disease of unknown origin. However, much more, and difficult, research is required to categorise these diseases, and to determine a specific aetiogenesis.

The putative IMMKs

• IMMKs are largely unique to the horse.

• IMMKs are recognised worldwide. Geographic differences occur in their clinical presentation and, to some extent, response to treatment.

• These differences may relate to immunophenotype or the nature of the antigen challenge encountered.

• Clinically the IMMKs are defined by: neovascularsisation, cell infiltration and oedema, and critically NO UVEITIS. The pathology is usually limited to one level of corneal depth.

• IMMKs are classified according to the depth of the pathology e.g. chronic superficial keratitis, midstromal keratitis, endotheliitis.

• Typically the IMMKs respond to medical treatment using nonsteroidal anti-inflammatory drugs (NSAIDs) and/or immunosuppressive agents (cyclosporin [CsA], sirolimus, doxycycline).

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