Discussion

Kemp-Symonds, J.G.
To assess the efficacy, complications and longer-term outcome of carbon dioxide (CO2) laser surgery with adjunctive photodynamic therapy (PDT) as a treatment for equine, peri- ocular sarcoid. Methods: Between April 2009 and December 2011, 21 horses and ponies of various breeds and ages which had been diagnosed with one or more fibroblastic, nodular, verrucous, occult and/or mixed peri-ocular sarcoids were treated with a combination of either excisional surgery or ablation utilising a CO2 laser with subsequent, adjunctive PDT using methyl aminolevulinate (MAL). The initial surgery and first PDT treatment were conducted on the same day; this was achieved under standing chemical restraint alone in all but 4 of the patients (81%). The second MAL PDT treatment was conducted on all 21 patients under standing chemical restraint one week later. Patients were discharged with short courses of both oral potentiated sulphonamides and an oral nonsteroidal anti-inflammatory (suxibuzone). Results, complications and disease-free outcomes were assessed either by re-visiting the patient and/or by contacting the animal's owner. Results: Currently, the disease- free rate after one year can be assessed in 16 of these cases and is 93% (15/16). Complications were minimal in all 21 cases, including a single case of keratitis (5%) and 5 cases of moderate to severe, but transient, peri-ocular oedema (24%). Discussion and practical significance: Peri-ocular sarcoids present a significant challenge in terms of both clinical approach and the patient's welfare. The techniques described in this study compare very favourably with other currently utilised treatments in respect of the high remission rate, relatively low cost and lack of significant complications. Acknowledgements: Sigmacon (UK) Ltd and Galderma (UK) Ltd generously supported this study with the provision of a CO2 laser and an Aktilite lamp, respectively.