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Hi, my GSD was diagnosed with pannus at 7 yrs old. After starting dexamethasone (steroid) drops it got better. Then the vet started her on tacrolimus to give her a break from steroid eye drops and it has come back. How long and how often a day have you given the steroid drops? Has anyone experienced the negative side effects of prolonged steroid use? How did you figure out how to adjust the dexamethasone regimen? For how long can a gsd tolerate dexamethasone? Thanks.
 

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Ziva was diagnosed with plasmona (pannus of the third eye lids) and pannus about 2.5 years ago. She has been on Pred Acetate 1.25% and Tacrolimus 0.03% ever since. The number of times a day she gets her drops varies. She started out getting the pred 3 times a day and the tacrolimus twice a day. Once the inflammation was under control she was tapered to less pred. We tried just tacrolimus for 3 months and there was relapse. Her ophthalmologist said she would always need to have the pred acetate and tacrolimus for the rest of her life. She doesn't seem to have any ill effects from it. It's a pretty low dose of steroid. The amount of steroid she gets seems to increase for a short time every year at the end of summer (like now). She won't wear her doggles and uv rays aggravate pannus.
Currently Ziva is getting pred acetate twice a day for another week then we will go to her normal dose of once a day. She gets tacrolimus once a day. Her maintenance dose is one drop a day of both the pred and tacrolimus for life.
The pros of the steroid outweigh the cons in the long term.
Ziva is 6.5 now and just had her eye check. Ophthalmologist was happy that although she has some minor up tic in inflammation of the third eyelid (thus the steroid increase for a few weeks) her corneas have had no increase in disease.
Tacrolimus is the gold standard drug for immune mediation and life long control. The steroid is to get inflammation under control. However, some dogs need both for life.
The goal is the lowest amount of steroid with tacrolimus to keep the disease in control.

I hope this was helpful.

ETA: Is she seeing a regular vet for this or an Ophthalmologist? I would recommend an Ophthalmologist.
 

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How long and how often a day have you given the steroid drops?
Once a day, first cyclosporine, then after 10 minutes, dexamethasone. One drop in each eye.

Has anyone experienced the negative side effects of prolonged steroid use?
Not yet. It has been almost 2 years. The only effect has been positive, in that his Pannus, which is atypical, meaning that only the membranes get inflamed and granulated, has been kept in check.

How did you figure out how to adjust the dexamethasone regimen?
First we did it twice a day, and the doctor said that if he responds well to once a day, to drop it to that. He tried to get me to do it every other day, and it wasn’t good. We had to go back to once a day. So, trial and error.

For how long can a GSD tolerate dexamethasone?

I have no idea. Hans will be 8 in January. If I stop it, the inflammation goes crazy, so we are managing it and whatever happens, happens. He’s old enough right now to where if he’s on it for the rest of his life, I doubt that there will be any problems.

By the way, I hate steroids, too, but in some cases they are a necessary evil and the only thing that works.
 

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My Ellie has had Pannus for the last 4 years. It will clear up some with steroid drops but the vision loss is permanent. She's on Maxitrol (steroid and antibiotic) eye drops and a tear substitute. I understand you can buy sunglasses for them, as sunlight can make everything worse, but I just keep her in most of the summer, she hates the heat anyway. It sucks, but it's manageable, though her life as a service dog is done. I take her off Maxitrol when the eyes clear up for a few months, then start again.
 

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My Ellie has had Pannus for the last 4 years. It will clear up some with steroid drops but the vision loss is permanent. She's on Maxitrol (steroid and antibiotic) eye drops and a tear substitute. I understand you can buy sunglasses for them, as sunlight can make everything worse, but I just keep her in most of the summer, she hates the heat anyway. It sucks, but it's manageable, though her life as a service dog is done. I take her off Maxitrol when the eyes clear up for a few months, then start again.
I'm not familiar with Maxitrol but curious why you stop treatment? Pannus is an auto immune disease thus it doesn't go away. Our Optho and my research is pretty clear that to save eye sight treatment is life long and continuous. It's my understanding that even if we don't see to the naked eye active inflammation the disease will progress without treatment. Not judging, just curious why you stop treatment?
 

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The steroid is very drying to her eyes, hence the eye lube, but it's still irritating. She's already lost a fair amount of her sight. If I give her a bit of a break (I said months but I mistyped, I meant weeks) it just gives her mentally a break, too, because this is a lifelong disease, but it isn't like Diabetes where missing a dose of insulin can kill you. We know she'll continue to lose sight.

Needing to have eye drops applied 4X a day is hard on a person--I am intimately acquainted with them as I had a BAD detached retina requiring a Scleral buckle and Cryotherapy, and then developed glaucoma due to the high pressure within the eye. When I was able to go down to 2X a day on myself, it was a huge relief.

With the Maxitrol (Dex and Neomycin) you have to give it, then wait 5-10 mins to put the lube in--which basically equates to giving drops 8 X a day. It's not manageable either to me or Ellie, so for a couple weeks she just gets lube. Vet sees her quarterly to check her eyes and renew prescriptions, they know I take a break with the Maxitrol.


I'll note--she's 8, not a young dog, so the key is managing a chronic disease while not having a dog who runs and hides when the drops come out. That's not fun, she doesn't know it's for her own good.
 

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Once a day on the first dog that had this until we moved to significantly lower altitude -- then once every couple of days for the life of the dog.


Current dog - once a day - it's been about 4 years. We should probably go to a doggy othamologist but our regular vet seems to do a good job. The treatment has gotten "spread" to general vet practices I think...


So far as effects of long term use - the first dog only lived to something like 14.
 
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