{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T18:12:11Z","timestamp":1782497531793,"version":"3.54.5"},"reference-count":38,"publisher":"American Veterinary Medical Association (AVMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["javma"],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"Abstract<\/jats:title>\n \n Objective<\/jats:title>\n To describe the demographics and treatment outcomes of horses definitively diagnosed with epithelial or stromal immune-mediated keratitis (IMMK) by use of in vivo confocal microscopy (IVCM) and\/or histopathology.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Medical records of horses presented to the Cornell University Equine Hospital definitively diagnosed with epithelial or stromal IMMK with IVCM and\/or histopathology between 2020 and 2024 were reviewed. Patient signalment, affected eye(s), diagnostics, treatments, and outcomes were assessed.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n 22 horses met the inclusion criteria. The mean age was 16.9 years (SD, \u00b1 7.3 years). There were significantly more geldings (n = 16) than mares (6). Nineteen horses were unilaterally affected (11 right eyes and 8 left eyes) and 3 bilaterally affected. Twenty horses underwent IVCM, of which 8 had histopathology following superficial keratectomy with agreement in diagnosis. Two horses had corneal histopathology without IVCM. All horses were initially managed medically. Seven horses subsequently underwent episcleral cyclosporine implantation, of which 2 were controlled at last follow-up (median, 532 days). Standing superficial keratectomy was performed in 10 horses, with IMMK controlled in 9 of 10 horses at last follow-up (median, 692 days). Recurrence was documented in 1 horse 12 months after keratectomy.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n IVCM allowed for a rapid noninvasive diagnosis of equine IMMK that correlated with histopathology. Standing superficial keratectomy was an effective diagnostic and therapeutic option for equine IMMK.<\/jats:p>\n <\/jats:sec>\n \n Clinical Relevance<\/jats:title>\n Standing superficial keratectomy was an effective diagnostic and treatment for equine IMMK that provided long-term control of disease and minimized the need for long-term daily medications.<\/jats:p>\n <\/jats:sec>","DOI":"10.2460\/javma.25.11.0754","type":"journal-article","created":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T17:26:20Z","timestamp":1771003580000},"page":"710-716","source":"Crossref","is-referenced-by-count":1,"title":["Standing superficial keratectomy provides long-term control of epithelial and stromal equine immune-mediated keratitis"],"prefix":"10.2460","volume":"264","author":[{"given":"Troy","family":"Toddy","sequence":"first","affiliation":[{"name":"Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1894-8839","authenticated-orcid":true,"given":"Eric C.","family":"Ledbetter","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8671-6661","authenticated-orcid":true,"given":"Kelly E.","family":"Knickelbein","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1272","reference":[{"issue":"4","key":"ref1","series-title":"Vet Ophthalmol","first-page":"233","article-title":"Immune-mediated keratitis in horses: 19 cases (1998-2004)","volume":"8","author":"Gilger BC","year":"2005","unstructured":"Gilger BC, Michau TM, Salmon JH. Immune-mediated keratitis in horses: 19 cases (1998-2004). Vet Ophthalmol. 2005;8(4):233-239. doi:10.1111\/j.1463-5224.2005.00393.x"},{"issue":"suppl 1","key":"ref2","series-title":"Vet Ophthalmol","first-page":"10","article-title":"Equine immune-mediated keratopathies","volume":"12","author":"Matthews A","year":"2009","unstructured":"Matthews A, Gilger BC. Equine immune-mediated keratopathies. Vet Ophthalmol. 2009;12(suppl 1):10-16. doi:10.1111\/j.1463-5224.2009.00740.x"},{"issue":"1","key":"ref3","series-title":"Vet Ophthalmol","first-page":"4","article-title":"Laser scanning in vivo confocal microscopic characterization of equine immune-mediated keratitis","volume":"23","author":"Ledbetter EC","year":"2020","unstructured":"Ledbetter EC, Irby NL. Laser scanning in vivo confocal microscopic characterization of equine immune-mediated keratitis. Vet Ophthalmol. 2020;23(1):4-15. doi:10.1111\/vop.12677"},{"issue":"7","key":"ref4","series-title":"Am J Vet Res","first-page":"1067","article-title":"Immunohistochemical and immunopathologic characterization of superficial stromal immune-mediated keratitis in horses","volume":"73","author":"Pate DO","year":"2012","unstructured":"Pate DO, Clode AB, Olivry T, Cullen JM, Salmon JH, Gilger BC. Immunohistochemical and immunopathologic characterization of superficial stromal immune-mediated keratitis in horses. Am J Vet Res. 2012;73(7):1067-1073. doi:10.2460\/ajvr.73.7.1067"},{"issue":"2","key":"ref5","series-title":"Vet Ophthalmol","first-page":"168","article-title":"In vivo confocal microscopy characteristics of equine epithelial and subepithelial nonulcerative keratomycosis","volume":"22","author":"Ledbetter EC","year":"2019","unstructured":"Ledbetter EC, Irby NL, Teixeira LBC. In vivo confocal microscopy characteristics of equine epithelial and subepithelial nonulcerative keratomycosis. Vet Ophthalmol. 2019;22(2):168-176. doi:10.1111\/vop.12576"},{"issue":"1","key":"ref6","series-title":"Vet Ophthalmol","first-page":"1","article-title":"In vivo confocal microscopy of equine fungal keratitis","volume":"14","author":"Ledbetter EC","year":"2011","unstructured":"Ledbetter EC, Irby NL, Kim SG. In vivo confocal microscopy of equine fungal keratitis. Vet Ophthalmol. 2011;14(1):1-9. doi:10.1111\/j.1463-5224.2010.00822.x"},{"issue":"suppl 1","key":"ref7","series-title":"Vet Ophthalmol","first-page":"69","article-title":"In vivo confocal microscopy of corneal microscopic foreign bodies in horses","volume":"17","author":"Ledbetter EC","year":"2014","unstructured":"Ledbetter EC, Irby NL, Schaefer DMW. In vivo confocal microscopy of corneal microscopic foreign bodies in horses. Vet Ophthalmol. 2014;17(suppl 1):69-75. doi:10.1111\/vop.12139"},{"issue":"2","key":"ref8","series-title":"Vet Ophthalmol","first-page":"172","article-title":"Suspected malignant transformation of B lymphocytes in the equine cornea from immune-mediated keratitis","volume":"19","author":"Vallone LV","year":"2016","unstructured":"Vallone LV, Neaderland MH, Ledbetter EC, Dubielzig RR. Suspected malignant transformation of B lymphocytes in the equine cornea from immune-mediated keratitis. Vet Ophthalmol. 2016;19(2):172-179. doi:10.1111\/vop.12275"},{"issue":"4","key":"ref9","series-title":"Equine Vet J","first-page":"1028","article-title":"Clinical and morphological features of corneal lymphoma in 26 horses (27 eyes)","volume":"57","author":"Morris JM","year":"2025","unstructured":"Morris JM, Lassaline ME, Nunnery CM, Clinical and morphological features of corneal lymphoma in 26 horses (27 eyes). Equine Vet J. 2025;57(4):1028-1034. doi:10.1111\/evj.14446"},{"issue":"4","key":"ref10","series-title":"Equine Vet Educ","first-page":"e95","article-title":"The long-term outcomes of standing superficial keratectomy as the sole treatment of corneal B-cell lymphoma in five horses in the UK: clinical, histopathology, immunohistochemical and molecular findings","volume":"36","author":"De Oliveira F","year":"2024","unstructured":"De Oliveira F, Scurrell EJ, Dixon S, Lowe R. The long-term outcomes of standing superficial keratectomy as the sole treatment of corneal B-cell lymphoma in five horses in the UK: clinical, histopathology, immunohistochemical and molecular findings. Equine Vet Educ. 2024;36(4):e95-e103. doi:10.1111\/eve.13917"},{"key":"ref11","series-title":"Vet Immunol Immunopathol","first-page":"48","article-title":"Investigation of corneal autoantibodies in horses with immune mediated keratitis (IMMK)","volume":"187","author":"Braus BK","year":"2017","unstructured":"Braus BK, Miller I, Kummer S, Investigation of corneal autoantibodies in horses with immune mediated keratitis (IMMK). Vet Immunol Immunopathol. 2017;187:48-54. doi:10.1016\/j.vetimm.2017.04.002"},{"issue":"5","key":"ref12","series-title":"Vet Ophthalmol","first-page":"674","article-title":"Subconjunctival bone marrow-derived mesenchymal stem cell therapy as a novel treatment alternative for equine immune-mediated keratitis: a case series","volume":"22","author":"Davis AB","year":"2019","unstructured":"Davis AB, Schnabel LV, Gilger BC. Subconjunctival bone marrow-derived mesenchymal stem cell therapy as a novel treatment alternative for equine immune-mediated keratitis: a case series. Vet Ophthalmol. 2019;22(5):674-682. doi:10.1111\/vop.12641"},{"issue":"5","key":"ref13","series-title":"Vet Ophthalmol","first-page":"424","article-title":"Subconjunctival autologous muscle-derived mesenchymal stem cell therapy: a novel, minimally invasive approach for treating equine immune-mediated keratitis","volume":"27","author":"Narinx F","year":"2024","unstructured":"Narinx F, Sauvage A, Ceusters J, Grulke S, Serteyn D, Monclin S. Subconjunctival autologous muscle-derived mesenchymal stem cell therapy: a novel, minimally invasive approach for treating equine immune-mediated keratitis. Vet Ophthalmol. 2024;27(5):424-433. doi:10.1111\/vop.13175"},{"issue":"suppl 1","key":"ref14","series-title":"Vet Ophthalmol","first-page":"23","article-title":"Treatment of immune-mediated keratitis in horses with episcleral silicone matrix cyclosporine delivery devices","volume":"17","author":"Gilger BC","year":"2014","unstructured":"Gilger BC, Stoppini R, Wilkie DA, Treatment of immune-mediated keratitis in horses with episcleral silicone matrix cyclosporine delivery devices. Vet Ophthalmol. 2014;17(suppl 1):23-30. doi:10.1111\/vop.12087"},{"issue":"12","key":"ref15","series-title":"Am J Vet Res","first-page":"1","article-title":"Developing advanced therapeutics through the study of naturally occurring immune-mediated ocular disease in domestic animals","volume":"83","author":"Gilger BC","year":"2022","unstructured":"Gilger BC. Developing advanced therapeutics through the study of naturally occurring immune-mediated ocular disease in domestic animals. Am J Vet Res. 2022;83(12):1-6. doi:10.2460\/ajvr.22.08.0145"},{"issue":"1","key":"ref16","series-title":"Vet Ophthalmol","first-page":"e70027","article-title":"Infracyanine green-based photodynamic therapy for immune-mediated keratitis in horses","volume":"29","author":"Lam KP","year":"2026","unstructured":"Lam KP, Keys DA, McMullen RJ Jr. Infracyanine green-based photodynamic therapy for immune-mediated keratitis in horses. Vet Ophthalmol. 2026;29(1):e70027. doi:10.1111\/vop.70027"},{"issue":"2-3","key":"ref17","series-title":"Vet Ophthalmol","first-page":"153","article-title":"Inferomedial placement of a single-entry subpalpebral lavage tube for treatment of equine eye disease","volume":"3","author":"Giuliano EA","year":"2000","unstructured":"Giuliano EA, Maggs DJ, Moore CP, Boland LA, Champagne ES, Galle LE. Inferomedial placement of a single-entry subpalpebral lavage tube for treatment of equine eye disease. Vet Ophthalmol. 2000;3(2-3):153-156."},{"issue":"2","key":"ref18","series-title":"Am J Vet Res","first-page":"296","article-title":"Evaluation of concentration of voriconazole in aqueous humor after topical and oral administration in horses","volume":"67","author":"Clode AB","year":"2006","unstructured":"Clode AB, Davis JL, Salmon J, Michau TM, Gilger BC. Evaluation of concentration of voriconazole in aqueous humor after topical and oral administration in horses. Am J Vet Res. 2006;67(2):296-301. doi:10.2460\/ajvr.67.2.296"},{"key":"ref19","author":"Extralabel drug use in animals","unstructured":"Extralabel drug use in animals. 21 CFR \u00a7530."},{"issue":"4","key":"ref1","series-title":"Vet Ophthalmol","first-page":"233","article-title":"Immune-mediated keratitis in horses: 19 cases (1998-2004)","volume":"8","author":"Gilger BC","year":"2005","unstructured":"Gilger BC, Michau TM, Salmon JH. Immune-mediated keratitis in horses: 19 cases (1998-2004). Vet Ophthalmol. 2005;8(4):233-239. doi:10.1111\/j.1463-5224.2005.00393.x"},{"issue":"suppl 1","key":"ref2","series-title":"Vet Ophthalmol","first-page":"10","article-title":"Equine immune-mediated keratopathies","volume":"12","author":"Matthews A","year":"2009","unstructured":"Matthews A, Gilger BC. Equine immune-mediated keratopathies. Vet Ophthalmol. 2009;12(suppl 1):10-16. doi:10.1111\/j.1463-5224.2009.00740.x"},{"issue":"1","key":"ref3","series-title":"Vet Ophthalmol","first-page":"4","article-title":"Laser scanning in vivo confocal microscopic characterization of equine immune-mediated keratitis","volume":"23","author":"Ledbetter EC","year":"2020","unstructured":"Ledbetter EC, Irby NL. Laser scanning in vivo confocal microscopic characterization of equine immune-mediated keratitis. Vet Ophthalmol. 2020;23(1):4-15. doi:10.1111\/vop.12677"},{"issue":"7","key":"ref4","series-title":"Am J Vet Res","first-page":"1067","article-title":"Immunohistochemical and immunopathologic characterization of superficial stromal immune-mediated keratitis in horses","volume":"73","author":"Pate DO","year":"2012","unstructured":"Pate DO, Clode AB, Olivry T, Cullen JM, Salmon JH, Gilger BC. Immunohistochemical and immunopathologic characterization of superficial stromal immune-mediated keratitis in horses. Am J Vet Res. 2012;73(7):1067-1073. doi:10.2460\/ajvr.73.7.1067"},{"issue":"2","key":"ref5","series-title":"Vet Ophthalmol","first-page":"168","article-title":"In vivo confocal microscopy characteristics of equine epithelial and subepithelial nonulcerative keratomycosis","volume":"22","author":"Ledbetter EC","year":"2019","unstructured":"Ledbetter EC, Irby NL, Teixeira LBC. In vivo confocal microscopy characteristics of equine epithelial and subepithelial nonulcerative keratomycosis. Vet Ophthalmol. 2019;22(2):168-176. doi:10.1111\/vop.12576"},{"issue":"1","key":"ref6","series-title":"Vet Ophthalmol","first-page":"1","article-title":"In vivo confocal microscopy of equine fungal keratitis","volume":"14","author":"Ledbetter EC","year":"2011","unstructured":"Ledbetter EC, Irby NL, Kim SG. In vivo confocal microscopy of equine fungal keratitis. Vet Ophthalmol. 2011;14(1):1-9. doi:10.1111\/j.1463-5224.2010.00822.x"},{"issue":"suppl 1","key":"ref7","series-title":"Vet Ophthalmol","first-page":"69","article-title":"In vivo confocal microscopy of corneal microscopic foreign bodies in horses","volume":"17","author":"Ledbetter EC","year":"2014","unstructured":"Ledbetter EC, Irby NL, Schaefer DMW. In vivo confocal microscopy of corneal microscopic foreign bodies in horses. Vet Ophthalmol. 2014;17(suppl 1):69-75. doi:10.1111\/vop.12139"},{"issue":"2","key":"ref8","series-title":"Vet Ophthalmol","first-page":"172","article-title":"Suspected malignant transformation of B lymphocytes in the equine cornea from immune-mediated keratitis","volume":"19","author":"Vallone LV","year":"2016","unstructured":"Vallone LV, Neaderland MH, Ledbetter EC, Dubielzig RR. Suspected malignant transformation of B lymphocytes in the equine cornea from immune-mediated keratitis. Vet Ophthalmol. 2016;19(2):172-179. doi:10.1111\/vop.12275"},{"issue":"4","key":"ref9","series-title":"Equine Vet J","first-page":"1028","article-title":"Clinical and morphological features of corneal lymphoma in 26 horses (27 eyes)","volume":"57","author":"Morris JM","year":"2025","unstructured":"Morris JM, Lassaline ME, Nunnery CM, Clinical and morphological features of corneal lymphoma in 26 horses (27 eyes). Equine Vet J. 2025;57(4):1028-1034. doi:10.1111\/evj.14446"},{"issue":"4","key":"ref10","series-title":"Equine Vet Educ","first-page":"e95","article-title":"The long-term outcomes of standing superficial keratectomy as the sole treatment of corneal B-cell lymphoma in five horses in the UK: clinical, histopathology, immunohistochemical and molecular findings","volume":"36","author":"De Oliveira F","year":"2024","unstructured":"De Oliveira F, Scurrell EJ, Dixon S, Lowe R. The long-term outcomes of standing superficial keratectomy as the sole treatment of corneal B-cell lymphoma in five horses in the UK: clinical, histopathology, immunohistochemical and molecular findings. Equine Vet Educ. 2024;36(4):e95-e103. doi:10.1111\/eve.13917"},{"key":"ref11","series-title":"Vet Immunol Immunopathol","first-page":"48","article-title":"Investigation of corneal autoantibodies in horses with immune mediated keratitis (IMMK)","volume":"187","author":"Braus BK","year":"2017","unstructured":"Braus BK, Miller I, Kummer S, Investigation of corneal autoantibodies in horses with immune mediated keratitis (IMMK). Vet Immunol Immunopathol. 2017;187:48-54. doi:10.1016\/j.vetimm.2017.04.002"},{"issue":"5","key":"ref12","series-title":"Vet Ophthalmol","first-page":"674","article-title":"Subconjunctival bone marrow-derived mesenchymal stem cell therapy as a novel treatment alternative for equine immune-mediated keratitis: a case series","volume":"22","author":"Davis AB","year":"2019","unstructured":"Davis AB, Schnabel LV, Gilger BC. Subconjunctival bone marrow-derived mesenchymal stem cell therapy as a novel treatment alternative for equine immune-mediated keratitis: a case series. Vet Ophthalmol. 2019;22(5):674-682. doi:10.1111\/vop.12641"},{"issue":"5","key":"ref13","series-title":"Vet Ophthalmol","first-page":"424","article-title":"Subconjunctival autologous muscle-derived mesenchymal stem cell therapy: a novel, minimally invasive approach for treating equine immune-mediated keratitis","volume":"27","author":"Narinx F","year":"2024","unstructured":"Narinx F, Sauvage A, Ceusters J, Grulke S, Serteyn D, Monclin S. Subconjunctival autologous muscle-derived mesenchymal stem cell therapy: a novel, minimally invasive approach for treating equine immune-mediated keratitis. Vet Ophthalmol. 2024;27(5):424-433. doi:10.1111\/vop.13175"},{"issue":"suppl 1","key":"ref14","series-title":"Vet Ophthalmol","first-page":"23","article-title":"Treatment of immune-mediated keratitis in horses with episcleral silicone matrix cyclosporine delivery devices","volume":"17","author":"Gilger BC","year":"2014","unstructured":"Gilger BC, Stoppini R, Wilkie DA, Treatment of immune-mediated keratitis in horses with episcleral silicone matrix cyclosporine delivery devices. Vet Ophthalmol. 2014;17(suppl 1):23-30. doi:10.1111\/vop.12087"},{"issue":"12","key":"ref15","series-title":"Am J Vet Res","first-page":"1","article-title":"Developing advanced therapeutics through the study of naturally occurring immune-mediated ocular disease in domestic animals","volume":"83","author":"Gilger BC","year":"2022","unstructured":"Gilger BC. Developing advanced therapeutics through the study of naturally occurring immune-mediated ocular disease in domestic animals. Am J Vet Res. 2022;83(12):1-6. doi:10.2460\/ajvr.22.08.0145"},{"issue":"1","key":"ref16","series-title":"Vet Ophthalmol","first-page":"e70027","article-title":"Infracyanine green-based photodynamic therapy for immune-mediated keratitis in horses","volume":"29","author":"Lam KP","year":"2026","unstructured":"Lam KP, Keys DA, McMullen RJ Jr. Infracyanine green-based photodynamic therapy for immune-mediated keratitis in horses. Vet Ophthalmol. 2026;29(1):e70027. doi:10.1111\/vop.70027"},{"issue":"2-3","key":"ref17","series-title":"Vet Ophthalmol","first-page":"153","article-title":"Inferomedial placement of a single-entry subpalpebral lavage tube for treatment of equine eye disease","volume":"3","author":"Giuliano EA","year":"2000","unstructured":"Giuliano EA, Maggs DJ, Moore CP, Boland LA, Champagne ES, Galle LE. Inferomedial placement of a single-entry subpalpebral lavage tube for treatment of equine eye disease. Vet Ophthalmol. 2000;3(2-3):153-156."},{"issue":"2","key":"ref18","series-title":"Am J Vet Res","first-page":"296","article-title":"Evaluation of concentration of voriconazole in aqueous humor after topical and oral administration in horses","volume":"67","author":"Clode AB","year":"2006","unstructured":"Clode AB, Davis JL, Salmon J, Michau TM, Gilger BC. Evaluation of concentration of voriconazole in aqueous humor after topical and oral administration in horses. Am J Vet Res. 2006;67(2):296-301. doi:10.2460\/ajvr.67.2.296"},{"key":"ref19","author":"Extralabel drug use in animals","unstructured":"Extralabel drug use in animals. 21 CFR \u00a7530."}],"container-title":["Journal of the American Veterinary Medical Association"],"original-title":[],"link":[{"URL":"https:\/\/avmajournals.avma.org\/view\/journals\/javma\/264\/6\/javma.25.11.0754.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/avmajournals.avma.org\/downloadpdf\/journals\/javma\/264\/6\/javma.25.11.0754.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/avmajournals.avma.org\/downloadpdf\/journals\/javma\/264\/6\/javma.25.11.0754.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T13:52:22Z","timestamp":1779112342000},"score":1,"resource":{"primary":{"URL":"https:\/\/avmajournals.avma.org\/view\/journals\/javma\/264\/6\/javma.25.11.0754.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,1]]},"references-count":38,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.2460\/javma.25.11.0754","relation":{},"ISSN":["0003-1488"],"issn-type":[{"value":"0003-1488","type":"print"}],"subject":[],"published":{"date-parts":[[2026,6,1]]}}}