Analysis of 1840 Equine Intraocular Fluid Samples for the Presence of Anti-Leptospira Antibodies and Leptospiral DNA and the Correlation to Ophthalmologic Findings in Terms of Equine Recurrent Uveitis (ERU)—A Retrospective Study

SIMPLE SUMMARY: In horses, the chronic intraocular leptospiral infection has been shown to cause equine recurrent uveitis (ERU). This inflammatory ophthalmic disease recurs for years and usually leads to blindness. Only recently it was found that biofilm formation of the leptospires in the vitreous cavity leads to uveitis recurrences and prevents effective elimination of the infection by antibiotics or by the immune system. The most effective treatment is vitrectomy (lavage of the vitreous cavity), which mechanically removes the biofilm infection. This surgery has been performed in horses for more than 30 years, and thousands of intraocular specimens have been analyzed for antibodies directed against leptospires and by PCR for leptospiral DNA. For the present study, medical records were retrospectively analyzed. Complete medical and laboratory records were available for 1800 intraocular specimens from horses treated from 2002 to 2017 (1387 specimens from ERU-eyes, 237 specimens from eyes affected with another type of uveitis, and 216 specimens from healthy eyes). In 83% of intraocular samples from ERU eyes, antibodies were detectable, and especially the detection of immunoglobulin A (IgA) seems to play an important role. In 72% of the intraocular specimens, leptospiral DNA was detectable by PCR. No antibodies were detectable in the samples from eyes with another type of uveitis or in the samples from healthy eyes. A PCR was positive in only one sample from a healthy eye. These results with a very high number of intraocular specimens demonstrate the great importance of an intraocular leptospiral infection for ERU. It can be concluded that for a reliable diagnosis of intraocular leptospiral infection or to reliably exclude an infection, multiple tests should be applied. ABSTRACT: In the equine clinic of the LMU in Munich, therapeutic vitrectomies have been routinely performed in horses for three decades. The vitreous samples obtained during vitrectomies were usually tested for anti-Leptospira antibodies and for more than 20 years also by PCR for leptospiral DNA. If the indication for surgery was ophthalmologically inconclusive, an aqueous humor was collected preoperatively and examined for evidence of leptospiral infection. In this study, medical records from 2002 to 2017 were analyzed. Records for 1387 eyes affected by equine recurrent uveitis (ERU) and 237 eyes affected by another type of uveitis met the inclusion criteria. A total of 216 samples from healthy eyes were used as controls. In 83% of intraocular samples from ERU eyes, antibody titers of 1:100 or higher were detectable by microscopic agglutination test (MAT). Similarly, 83% of intraocular samples had anti-Leptospira antibodies detected by ELISA. In 72% of the intraocular specimens, leptospiral DNA was detectable by PCR. No antibodies were detectable in the samples from eyes with another type of uveitis or in the samples from healthy eyes. A PCR was positive in only one sample from a healthy eye. These results with a very high number of intraocular specimens demonstrate the great importance of an intraocular leptospiral infection for ERU. It can be concluded that for a reliable diagnosis of intraocular leptospiral infection or to reliably exclude an infection multiple tests should be applied.