Standing superficial keratectomy provides long-term control of epithelial and stromal equine immune-mediated keratitis.

Standing superficial keratectomy effectively controls equine IMMK with 90% long-term success.

This retrospective study evaluated treatment outcomes for equine immune-mediated keratitis (IMMK) in 22 horses diagnosed using in vivo confocal microscopy (IVCM) and/or histopathology between 2020-2024 at Cornell University Equine Hospital. The cohort had a mean age of 16.9 years with predominantly geldings affected (16 geldings vs. 6 mares). Nineteen horses were unilaterally affected while three were bilateral. All horses received initial medical management; seven subsequently underwent episcleral cyclosporine implantation with only 2 achieving control at final follow-up (median 532 days). Ten horses underwent standing superficial keratectomy, resulting in disease control in 9 of 10 horses at last follow-up (median 692 days), with one recurrence documented 12 months post-procedure. IVCM proved valuable as a rapid, noninvasive diagnostic tool that correlated well with histopathologic findings. The study demonstrates that standing superficial keratectomy is both an effective diagnostic and therapeutic intervention for equine IMMK, providing sustained long-term disease control while reducing dependence on chronic daily topical medications.

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