Non-invasive diode laser, an effective and safe treatment of iris cysts in 46 eyes of 35 horses

BSummary Background: Iris cysts in horses are often asymptomatic and noticed incidentally. However, cysts can cause local corneal oedema and erratic behaviour like shying, decreased performance and headshaking. Objectives: To describe the use of diode laser as a non-invasive treatment option for iris cysts in the horse and to document factors influencing its efficacy, associated complications, long-term outcome and rate of recurrence. Study design: Retrospective case series. Methods: Case records of horses treated for iris cysts by diode laser at the Utrecht University Equine Clinic were reviewed between 2008 and 2020. Diagnosis was based on ophthalmic and ultrasonographic evaluation. Long-term follow-up was obtained in two phases, a telephone survey with the owner and a photographic re-evaluation of the treated eyes. Results: Thirty-five horses were included, with a total of 46 eyes treated. One day after diode laser treatment (short term), thirty-five (35/46) treated eyes had a good decrease in cyst size, 7/46 had a moderate effect, 1/46 minimal effect, 1/46 no effect, and in two cases the effect was unspecified. The decrease in size after diode laser treatment in polycystic eyes (Odds ratio 0.381, 95% CI 0.1530-0.724) p= 0.001), thick-walled cysts (OR = 0.139; CI = 0.023 – 0.726, p =0.02) and hyperplastic corpora nigra (OR = 0.081; CI = 0.004 – 0.528, p=0.03) was significantly less satisfactory, with odds ratis of 0.381, 0.139 and 0.081 respectively. Minor complications, such as a mild reactive uveitis, were reported in eight eyes (8/46, 17%). On long-term follow-up (median 19 months; IQR 25.5), clinical signs had diminished or disappeared in most cases (93%) and 83% of the owners would recommend the treatment. Based on long-term photographic re-evaluation (median 32.5 months; IQR 49.75), two cases (2/16) of recurrence were seen. Main limitations: Retrospective design, follow-up by telephone questionnaire and photographic re-evaluation. Loss to follow-up in the photographic re-evaluation. Conclusions: Both short- and long-term results indicate diode laser treatment is a useful and safe option for iris cyst size reduction, with a low risk of recurrence. Pre-surgical ultrasonography is recommended to assess the feasibility of treatment and to allow for better surgical planning.