Advice re feline uveitis

Keit

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We started to research the eye drops, the metacam, and the eye dye he was given again this time. It turns out that in the US, the FDA does not approve the repeated use of metacam in cats. Oral suspension has not been shown to be safe under any circumstances, and the injection is only to ever be given once before operations. The drug has been shown to cause renal failure and death in cats.

Several things come to mind. It's strange what you say about meloxicam, because it would usually cause a different type of side effects. Have you asked the vet about it?

Low doses of meloxicam can be safely used in cats for longer times. But my personal choice is Onsior (robenacoxib). Based on the research, it has the least side effects in cats. But unfortunately there are no NSAIDs with zero side effects, so do your reaearch anyway.

Also perhaps worth asking if they used atropine drops, since atropine causes mydriasis and could be part of uveitis treatment. This would explain the dilated pupils.

And I would also ask if they ever measured your kittie's blood pressure. Because unfortunately chronic high blood pressure can lead to progressing blindness. And one of the symptoms is mydriasis (and/or uveitis).

Also, here's a comprehensive information about uveitis. Unless you already found this page:Managing Uveitis in Dogs and Cats
 
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T.C.

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Several things come to mind. It's strange what you say about meloxicam, because it would usually cause a different type of side effects. Have you asked the vet about it?

It’s a tricky one really, because the only thing we know for sure about his blindness is that it has happened after a meloxicam injection and eye treatments administered by the vets. We don’t know exactly what caused it.

We told the vets what happened and that since they had already mentioned trying oral steroids to treat the pain, inflammation and high temperature the last time we went, that we will switch to that tomorrow, having read about the side-effects of meloxicam, the FDA warning, and the side effects of the eye drops.

We’ll see how he gets on with the oral steroids, and I will ask about the atropine drops. If the steroids don’t agree with him, and we have to try something else, I’ll ask them about Onsior.

Thanks again for your input!
 

Keit

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It’s a tricky one really, because the only thing we know for sure about his blindness is that it has happened after a meloxicam injection and eye treatments administered by the vets. We don’t know exactly what caused it.

I totally understand how upsetting it can be. :hug2: To my knowledge, these two drugs are not supposed to lead to such a problem. At the same time uveitis is often the reason for blindness in cats.

Here's an article that provides a good explanation of the possible causes. Perhaps it is something additional to look into:
 
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T.C.

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On Sunday afternoon, the day I wrote my last post where Del had regained his vision, he went outside for a few hours, and when he came back, his vision had worsened again and his pupils were dilated. Another confusing thing for us. Now, we questioned just how much the visits to the vets, and what was administered there, had caused the sudden blindness.

We took him back to the vet yesterday morning, having not given him any metacam or pred eye drops since Friday, because we were thinking we would change onto oral steroids instead. The vet said she was a bit surprised that he seemed so pain-free, having not had anything for pain relief. We talked about the blindness, discussed the various risks associated with the different treatments. I shared my concerns about metacam, the FDA warning, and the potential side-effects of the pred eye drops.

The vet said the same thing as you, @Keit. That in her opinion, even though there are risks with any treatment, low doses of metacam in cats is relatively safe, and that she gives it to her own cats. Also, during the consultation, it did occur to me and my wife that the two occasions when he was really sick and we took him to the vets, and he came home blind... well, before we took him in, he basically hadn't moved for two days, and so if he had lost his eyesight, we wouldn't really have been able to tell. When he's at his worse, lethargic and not eating, he's not roaming around the house, and also, he keeps his eyelids half-closed. What we can say for sure in those times is that his eyes are very cloudy.

The vet explained, if I understand this correctly, that the cloudiness is antibodies produced by his immune system. And that the dilation of the pupils may just be his eyes trying to get more light, due to the fact that he can't see anything.

We talked more about toxo itself. The vet said that most of the times where she's diagnosed and treated it, it's actually been in dogs. This is due to the fact that dogs are not the main, end-host the toxo is designed for, and when it gets into them, it causes them a lot more symptomatic issues. She said it usually doesn't cause serious symptomatic issues in cats because biologically speaking, the toxo would want the host to be as well as possible so that it can carry on it's own life cycle. The vet was sharing this with us because the subject of treament plans and what is the long-term prognosis is something that she is inexperienced with and that she is also learning more as we go. I thought it showed strength on her part that rather than try to appear to be all-knowing, or reassure us without foundation, she admitted that she hadn't had much experience with the condition in cats.

Based on your feedback, Keit, and the discussion we had with the vet, we've decided to keep him on the metacam, and switched the eyedrops from the prednisolone to Acular, an NSAID. We're going to give the metacam once every two days, preventatively, and use the Acular when required. His vision seems pretty good yesterday and today. The cloudiness in his eyes is mostly gone again.

The vet is going to contact the lab to ask about what we need to do when he's finished the clindamycin, whether we should test for the toxo again. She says he may never get it out of his system, and has been forward enough with us in the last two consultations to bring up the subject of "quality of life"; as in, if he has the toxo forever, and his immune system continues to react to it forever, then that's going to be horrible for him. I asked about whether the idea of long-term immunosuppression is a viable treatment option, and she said obviously that would be something we could try with the oral steroids, but that in itself obviously comes with it's own potential problems.
 

T.C.

The Living Force
FOTCM Member
I’m looking for information regarding toxo and iodine. I found a study showing a correlation between prevalence of toxoplasmosis in a small sample of humans, and iodine deficiency. So then I searched for evidence that iodine kills toxo, and found this paper where it’s stated:


“Frenkel et al. found that a strong concentration of ammonia (28%) killed all oocysts of T. gondii within 10 min and a strong tincture of iodine did so within 30 min.”

Iodine eye drops are used to prevent infection before operations, so I’m wondering if we finish the clindamycin and he still tests positive for toxo, whether it would be worth a shot. Apparently povidone iodine 5% is what’s usually used in the eyes. But how long it could be used for would be the main issue. Further research shows that long term use of povidone iodine drops is mainly contraindicated in patients receiving regular intravitreal injections.

I’m struggling to find out exactly where the toxo would be located in the eye, and whether the iodine would actually reach it, since povidone iodine drops mostly run out of the eye and are only used to disinfect the surface.

Well, if it comes to a decision of either putting him to sleep, or trying iodine eye drops first, it’s a no-brainier, anyway.
 

T.C.

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Del’s now finished his course of antibiotics. For the first four days after my last post, we gave the metacam once every two days preventatively, but he was obviously still in pain, so we just went the whole hog and gave it him every day, and he responded really well.

For about a week, he had good days and bad days, mainly his eyes getting cloudy or bloodshot, and then clearing, but by the second week, his natural personality began to return, and for the last week, he’s really come back to himself - playing, exploring, being affectionate, and having a massively improved appetite. I’d say since the last post, he’s probably gained at least 40 grams in weight, going from 3.6kg, back up to his usual 4kg.

He finished the antibiotic and the metacam last Thursday, and seems fine now. We’d like to know whether the toxo is gone, or just deactivated. So we’ll be contacting the vets this week to see about having him retested.

Thanks again for everyone’s input and kind messages.
 
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