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Ripa M, Panos GD, Rejdak R, Empeslidis T, Toro MD, Costagliola C, Ferrara A, Gotzaridis S, Frisina R, Motta L. Sympathetic Ophthalmia after Vitreoretinal Surgery without Antecedent History of Trauma: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:2316. [PMID: 36983316 PMCID: PMC10057773 DOI: 10.3390/jcm12062316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/12/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND To evaluate the morbidity frequency measures in terms of the cumulative incidence of sympathetic ophthalmia (SO) triggered by single or multiple vitreoretinal (VR) surgery procedures in eyes without an antecedent history of trauma and previous ocular surgery, except for previous or concomitant uneventful lens extraction, and to further investigate the relationship between VR surgery and SO. METHODS A literature search was conducted using PubMed, Embase, and Scopus from inception until 11 November 2022. The Joanna Briggs Institute (JBI) critical appraisal checklist for the case series and the Newcastle-Ottawa Scale were used to assess the risk of bias. The research was registered with the PROSPERO database (identifier, CRD42023397792). Meta-analyses were conducted using the measurement of risk and a 95% confidence interval (CI) for each study. RESULTS A random-effect meta-analysis demonstrated that the pooled cumulative incidence of SO triggered by single or multiple VR surgery procedures in eyes without an antecedent history of trauma and previous ocular surgery, except for previous or concomitant uneventful lens extraction among patients who developed SO regardless of the main trigger, was equal to 0.14 with a CI between 0.08 and 0.21 (I2 = 78.25, z: 7.24, p < 0.01). The pooled cumulative incidence of SO triggered by single or multiple VR surgery procedures in eyes without an antecedent history of trauma and previous ocular surgery, except for previous or concomitant uneventful lens extraction among patients who underwent VR surgery, was equal to 0.03 for every 100 people, with a confidence interval (CI) between 0.02% and 0.004% (I2 = 27.77, z: 9.11, p = 0.25). CONCLUSIONS Despite postsurgical SO being a rare entity, it is a sight-threatening disease. VR surgery should be viewed as a possible inciting event for SO and considered when counseling patients undergoing VR surgery.
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Affiliation(s)
- Matteo Ripa
- Department of Ophthalmology, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford TN24 0LZ, UK; (M.R.)
| | - Georgios D. Panos
- Department of Ophthalmology, Queen’s Medical Centre Campus, Nottingham University Hospitals, Nottingham NG7 2UH, UK
| | - Robert Rejdak
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, Ul. Chmielna 1, 20079 Lublin, Poland
| | | | - Mario Damiano Toro
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, Ul. Chmielna 1, 20079 Lublin, Poland
- Eye Clinic, Public Health Department, University of Naples Federico II, 80133 Naples, Italy
| | - Ciro Costagliola
- Eye Clinic, Department of Neurosciences, Reproductive and Dentistry Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Andrea Ferrara
- Department of Ophthalmology and Neuroscience, Medical School, University of Bari “Aldo Moro”, 70121 Bari, Italy
| | | | - Rino Frisina
- Ophthalmology Unit of Surgery, Department of Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
| | - Lorenzo Motta
- Department of Ophthalmology, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford TN24 0LZ, UK; (M.R.)
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Zhuang X, Gao F, Sun Z, Ding X, Xu G. Case report: Sympathetic ophthalmia after vitrectomies in a patient with Von Hippel-Lindau syndrome. Front Med (Lausanne) 2023; 10:1118913. [PMID: 36860339 PMCID: PMC9968801 DOI: 10.3389/fmed.2023.1118913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/16/2023] [Indexed: 02/17/2023] Open
Abstract
Background Sympathetic ophthalmia (SO) is a rare but sight-threatening uveitis, and most observations have been made after typical manifestations occur. This report focuses on the choroidal changes detected by multimodal imaging at the presymptomatic stage of SO, which is implicated in the early recognition of SO. Case presentation A 21-year-old woman suffered from decreased vision in the right eye and was diagnosed with retinal capillary hemangioblastomas associated with Von Hippel-Lindau syndrome. The patient underwent two 23-G pars plana vitrectomies (PPVs), soon after which typical signs of SO manifested. SO resolved quickly after the oral administration of prednisone and remained stable during the follow-up of more than 1 year. The retrospective analysis revealed preexisting bilaterally increased choroidal thickness, dots of flow void on the choroid, and choriocapillaris en-face slabs in optical coherence tomography angiography (OCTA) after the first PPV, which were all reversed by corticosteroid treatment. Conclusion The case report highlights the involvement of the choroid and choriocapillaris at the presymptomatic stage of SO after the first inciting event. Abnormally thickened choroid and flow void dots suggested that SO had started and an ensuing surgery would run the risk of exacerbating SO. OCTA scanning of both eyes should be ordered routinely for patients with a history of trauma or intraocular surgeries, especially before the next surgical intervention. The report also suggests that non-human leukocyte antigen gene variation may also regulate the progression of SO, which requires further laboratory investigations.
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Affiliation(s)
- Xiaonan Zhuang
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
| | - Fengjuan Gao
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
| | - Zhongcui Sun
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
| | - Xinyi Ding
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
| | - Gezhi Xu
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China,*Correspondence: Gezhi Xu,
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3
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Chen SC, Sheu SJ, Wu TT. Changing etiology of sympathetic ophthalmia: A 10-year study from a tertiary referral center in Taiwan. Taiwan J Ophthalmol 2023. [DOI: 10.4103/tjo.tjo-d-22-00094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Agarwal M, Radosavljevic A, Tyagi M, Pichi F, Al Dhanhani AA, Agarwal A, Cunningham ET. Sympathetic Ophthalmia - An Overview. Ocul Immunol Inflamm 2022; 31:793-809. [PMID: 35579612 DOI: 10.1080/09273948.2022.2058554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Sympathetic ophthalmia (SO) is rare, bilateral granulomatous panuveitis that typically occurs following penetrating or perforating ocular trauma or surgery. This review aims to provide an update on the etiopathogenesis, clinical presentations, diagnosis and treatment of SO. METHODS Reports cited in MEDLINE database, that analyzed SO in at least 5 patients, published prior to December 1st, 2021 were included. RESULTS Initially, SO was associated with penetrating ocular trauma, however, various studies reported an increased incidence of SO after surgical procedures including vitreoretinal surgeries. Multimodal imaging including fluorescein and indocyanine green angiography, optical coherence tomography (OCT) and OCT angiography have added further insights into the understanding of SO. While pulse dose corticosteroids & immunosuppressive drugs are still the treatment of choice, TNF-α blockers & other biologic drugs represent new promising agents. CONCLUSION There is a growing pool of evidence in understanding the pathogenesis of SO. Novel treatment options have provided better prognosis for this potentially blinding condition.
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Affiliation(s)
- Mamta Agarwal
- Medical Research Foundation, Sankara Nethralaya, Uveitis & Cornea Services, Chennai, India
| | | | | | - Francesco Pichi
- Eye Institute, Cleveland Clinic, Abu Dhabi, UAE.,Cleveland Clinic Lerner College of Medicine, Case Western Reserve University Cleveland, Cleveland, Ohio, USA
| | | | - Aditi Agarwal
- Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Emmett T Cunningham
- The Department of Ophthalmology, California Pacific Medical Center, San Francisco, California, USA.,West Coast Retina Medical Group, San Francisco, California, USA.,The Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA.,Proctor Foundation, UCSF School of MedicineThe Francis I., San Francisco, California, USA
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5
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Shah M, Pradhan A, Dutta Majumder P. Leopard retinopathy: An unusual presentation of sympathetic ophthalmia. Eur J Ophthalmol 2022; 33:NP131-NP135. [PMID: 35266403 DOI: 10.1177/11206721221085851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report an unusual case of sympathetic ophthalmia (SO) in an elderly gentleman following multiple eye surgeries. He presented with diffuse granulomatous panuveitis resembling leopard retinopathy in the left eye. There was a delay in the initiation of effective treatment of his intraocular inflammation, but he responded to corticosteroid and azathioprine. The pigmentary changes in his fundus were highly unusual, and he was investigated extensively to rule out other possible causes including a search for occult malignancy. The delay in initiation of effective treatment or suboptimal therapy in SO, can lead to variable clinical picture in elderly patients. A proper screening to exclude any malignancy along with aggressive immunosuppressive therapy can achieve optimum results.
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Affiliation(s)
- Mauli Shah
- Medical and Vision Research Foundations, 29853Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Arkaprava Pradhan
- Medical and Vision Research Foundations, 29853Sankara Nethralaya, Chennai, Tamil Nadu, India
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Zhuang H, Zhang R, Zhang T, Chang Q, Xu G. Clinical classification, visual outcomes, and optical coherence tomographic features of 48 patients with posterior sympathetic ophthalmia. Orphanet J Rare Dis 2022; 17:103. [PMID: 35246199 PMCID: PMC8895912 DOI: 10.1186/s13023-022-02258-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 02/20/2022] [Indexed: 12/04/2022] Open
Abstract
Background To investigate the clinical manifestations, visual outcomes and optical coherence tomographic (OCT) features of patients with posterior sympathetic ophthalmia (PSO). Methods We performed a retrospective review of 48 patients diagnosed with PSO between January 2013 and December 2019. We compared the clinical and OCT features among different clinical types of PSO. Results PSO could be classified into two types according to whether the fundus exhibited serous retinal detachment (SRD) or multifocal choroiditis (MFC). There were 41 patients (85.4%) with SRD and 7 patients (14.6%) with MFC. The latent period of patients with MFC was significantly longer than that of patients with SRD (P = 0.002). The final visual acuity of patients with MFC was significantly worse than that of patients with SRD (P = 0.0001). In patients with acute SRD, OCT revealed that the mean height of retinal detachment in the fovea was 528.8 ± 437.5 μm. After treatment, the retina reattached in all patients and the band structures of the outer retina were restored in most patients (92.7%). In patients with acute MFC, the OCT images revealed inflammatory lesions on the retinal pigment epithelium layer. After treatment, the OCT images showed hyperreflective fibrosis of the lesions and loss of the outer retinal band structures in all patients. Conclusions We found that PSO could be classified according to the presence of SRD or MFC. The visual prognosis differed significantly between these types of PSO. OCT imaging is useful for clinical classification and monitoring of retinal changes after treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02258-0.
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Affiliation(s)
- Hong Zhuang
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, and NHC Key Laboratory of Myopia (Fudan University), Shanghai, 200031, China
| | - Rui Zhang
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Ting Zhang
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, and NHC Key Laboratory of Myopia (Fudan University), Shanghai, 200031, China
| | - Qing Chang
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, and NHC Key Laboratory of Myopia (Fudan University), Shanghai, 200031, China
| | - Gezhi Xu
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China. .,Shanghai Key Laboratory of Visual Impairment and Restoration, and NHC Key Laboratory of Myopia (Fudan University), Shanghai, 200031, China.
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7
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Anikina E, Wagner S, Liyanage S, Sullivan P, Pavesio C, Okhravi N. The Risk of Sympathetic Ophthalmia Following Vitreoretinal Surgery. Ophthalmol Retina 2022; 6:347-360. [PMID: 35093583 DOI: 10.1016/j.oret.2022.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE To investigate the clinical course and the outcomes of sympathetic ophthalmia and correlate these with the nature of the inciting event and the number of vitreoretinal procedures undergone by patients. DESIGN A retrospective case review. SUBJECTS All patients diagnosed with sympathetic ophthalmia who have been treated or monitored at a single centre over a 15 year period. METHODS A search of the electronic patient record system at Moorfields Eye Hospital, Londo over a 15 year period (between January 2000 and December 2015) was carried out, using the search terms "sympathetic", "ophthalmia" and "ophthalmitis". 61 patients with available records were identified and data collected from their complete electronic and paper records. MAIN OUTCOME MEASURES The main outcome measures looked at were the best-corrected visual acuity (BCVA) at 1 year and at the end of follow up and the number of vitreoretinal surgical procedures preceding the diagnosis. Data was also collected to report on patient age, gender, disease duration, ocular and systemic manifestations, ocular complications, retinal angiography and treatment. RESULTS There was a wide age range at presentation (2-84) and the length of follow up ranged 1-75 years. The first ocular event was trauma in 40 patients and surgery in 21. Vitreoretinal (VR) surgery accounted for 13 of the 21 surgical first event triggers (62%). 23/61 patients (38%) underwent VR surgery (1-7 operations) at some point prior to diagnosis. Surgical details were available for 15 patients, who had a total of 25 VR procedures carried out. Based on the surgical activity of the unit, the risk of developing SO following a single VR procedure is estimated at 0.008%, rising to 6.67% with 7 procedures. A total of 23 patients (38%) experienced a decrease in acuity at the end of the follow up period, versus 9 patients (15%) experiencing an improvement and 18 (30%) remaining unchanged. CONCLUSIONS We feel that the most significant finding in this study is the calculated risk of SO development following a single VR procedure, which is significantly lower in our cohort than previously reported in the literature. This is seen to rise exponentially with additional procedures.
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Affiliation(s)
- Evgenia Anikina
- Vitreoretinal Service, Moorfields Eye Hospital NHSFT, London, EC1V 2PD United Kingdom; NIHR Biomedical Research Centre at Moorfields Eye Hospital NHSFT,; UCL Institute of Ophthalmology, London, EC1V 2PD United Kingdom
| | - Siegfried Wagner
- Vitreoretinal Service, Moorfields Eye Hospital NHSFT, London, EC1V 2PD United Kingdom; NIHR Biomedical Research Centre at Moorfields Eye Hospital NHSFT,; UCL Institute of Ophthalmology, London, EC1V 2PD United Kingdom
| | - Sidath Liyanage
- Vitreoretinal Service, Moorfields Eye Hospital NHSFT, London, EC1V 2PD United Kingdom; NIHR Biomedical Research Centre at Moorfields Eye Hospital NHSFT,; UCL Institute of Ophthalmology, London, EC1V 2PD United Kingdom
| | - Paul Sullivan
- Vitreoretinal Service, Moorfields Eye Hospital NHSFT, London, EC1V 2PD United Kingdom
| | - Carlos Pavesio
- Uveitis Service, Moorfields Eye Hospital NHSFT, London, EC1V 2PD United Kingdom; NIHR Biomedical Research Centre at Moorfields Eye Hospital NHSFT,; UCL Institute of Ophthalmology, London, EC1V 2PD United Kingdom
| | - Narciss Okhravi
- Uveitis Service, Moorfields Eye Hospital NHSFT, London, EC1V 2PD United Kingdom; NIHR Biomedical Research Centre at Moorfields Eye Hospital NHSFT,; UCL Institute of Ophthalmology, London, EC1V 2PD United Kingdom.
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Fromal OV, Swaminathan V, Soares RR, Ho AC. Recent advances in diagnosis and management of sympathetic ophthalmia. Curr Opin Ophthalmol 2021; 32:555-560. [PMID: 34494974 DOI: 10.1097/icu.0000000000000803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Sympathetic ophthalmia is a bilateral granulomatous uveitis that occurs following unilateral trauma or surgery and is sight-threatening in the contralateral eye. Despite significant potential morbidity, disease remains poorly understood. Variable presentations and clinical courses, as well as a lack of definitive diagnostic laboratory tests can complicate the diagnosis and result in delayed treatment, which can beget permanent vision loss. This review focuses on recent advances in areas of pathophysiology, classification, diagnosis and treatment. RECENT FINDINGS Sympathetic ophthalmia is thought to involve a cell-mediated immune response to retinal and uveal antigens exposed through trauma or surgery. Multiple mechanisms have been implicated, including activation of the interleukin-23/IL-17 pathway. Ongoing emphasis is placed on early disease recognition and prompt treatment with multimodal imaging. Multiple authors advocate for the routine use of optical coherence tomography (OCT) for screening and disease monitoring. Systemic steroids and steroids sparing-immunosuppressive agents remain the mainstay of treatment. SUMMARY Understanding pathophysiology may provide useful targets for drug development, as well as allow for identification of patients at risk. OCT is a useful tool in early diagnosis and management of sympathetic ophthalmia, as OCT changes may precede clinical symptoms and signs, allowing for early disease detection and better visual outcomes.
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Affiliation(s)
- Ollya V Fromal
- Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Abstract
PURPOSE Prophylactic enucleation of a ruptured globe with no light perception within 14 days of injury to prevent sympathetic ophthalmia (SO) has been an established dictum in academic teaching for more than 100 years. This treatment strategy was originally based on observation, speculation, and careful thought, but there was never any scientific proof. This review summarizes and updates the current state of our knowledge about globe rupture and SO, examines the origin and validity of the 14-day rule, and emphasizes the importance of trying to save the traumatized eye whenever possible. METHODS A comprehensive literature review of SO and globe rupture was performed. RESULTS SO is a rare disorder that may potentially occur following traumatic globe rupture as well as following a variety of other intraocular surgeries. Vitreoretinal surgery may be a more common cause than trauma according to some studies. SO may still occur despite having the eye removed within 14 days of the trauma. A variety of new medications including biologic agents are now available to treat SO with improved efficacy in suppressing the associated ocular inflammation and allowing retention of some useful vision. Removing the traumatized, blind eye may have other important psychological consequences associated with it that require consideration before eye removal is carried out. Retaining the blind, phthisical, disfigured eye avoids phantom vision and phantom pain associated with enucleation as well as providing a good platform to support and move an overlying prosthetic eye. Data on the occurrence of SO following evisceration and enucleation with and without predisposing factors confirms the exceedingly low risk. CONCLUSION Most civilian open globe injuries can be successfully repaired with modern, advanced microsurgical techniques currently available. Because of the exceedingly low risk of SO, even with the severity of open globe trauma during military conflicts being more devastating as a result of the blast and explosive injuries, today every attempt is made to primarily close the eye rather than primarily enucleate it, providing there is enough viable tissue to repair. The 14-day rule for eye removal after severe globe ruptures is not scientifically supported and does not always protect against SO, but the safe time period for prophylactic eye removal is not definitively known. In the exceptional cases where SO does occur, several new medications are now available that may help treat SO. We advocate saving the ruptured globe whenever possible and avoiding prophylactic enucleation to prevent the rare occurrence of SO. When an eye requires removal, evisceration is an acceptable alternative to enucleation in cases that do not harbor intraocular malignancy.
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Hashimoto Y, Matsui H, Michihata N, Ishimaru M, Yasunaga H, Aihara M, Kaburaki T. Incidence of Sympathetic Ophthalmia after Inciting Events: A National Database Study in Japan. Ophthalmology 2021; 129:344-352. [PMID: 34560127 DOI: 10.1016/j.ophtha.2021.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/31/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To analyze the incidence of sympathetic ophthalmia (SO) after inciting events (eye trauma or intraocular surgery). DESIGN Retrospective cohort study. PARTICIPANTS Patients experiencing inciting events between 2012 and 2019. Onset of SO was defined as the first date of SO diagnosis. METHODS Using a nationwide administrative claims database in Japan, we calculated the cumulative incidence of SO after inciting events stratified by sex, 10-year age groups, and a categorical variable of primary or repeated, reflecting the history of inciting events in the past year (no inciting events, inciting events without trauma, or inciting events with trauma) using the Kaplan-Meier approach. We also estimated the adjusted hazard ratio (aHR) by Cox regression. We then restricted the population to those with only 1 inciting event during the observation period to investigate the pure effect of each inciting event. MAIN OUTCOME MEASURES Cumulative incidence of SO over 60 months. RESULTS A total of 888 041 inciting events (704 717 patients) were eligible. The total number of SO cases was 263, and the cumulative incidence of SO was 0.044% over 60 months. Female sex was not associated with onset of SO (aHR, 1.01; 95% confidence interval [CI], 0.79-1.29; P = 0.95). The group 40 to 49 years of age showed the highest incidence of 0.104% among the age groups (aHR vs. ≥80 years of age group [0.041%], 2.44 [95% CI, 1.56-3.80]; P < 0.001). Repeated inciting events with and without trauma showed higher incidences of SO (0.469% and 0.072%, respectively) than primary inciting events (0.036%) (aHR 11.68 [7.74-17.64] and 2.21 [95% CI, 1.59-3.07], respectively); P < 0.001 and P < 0.001, respectively). The incidence of SO after vitrectomy was much lower than after trauma (0.016% vs. 0.073%), and the incidence after scleral buckling was even lower. CONCLUSIONS The cumulative incidence of SO over 60 months was estimated to be 0.044% at minimum. Repeated inciting events, especially those with trauma, increased the risk of SO developing. Trauma was 4 to 5 times as likely to induce SO than vitrectomy. The present findings will be valuable for counseling patients about the risks of SO after trauma and before performing intraocular surgeries.
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Affiliation(s)
- Yohei Hashimoto
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Miho Ishimaru
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Makoto Aihara
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshikatsu Kaburaki
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Shen J, Zhang Z, Ye D, Wen Z, Shu X, Chen Z. Sympathetic ophthalmia after vitreoretinal surgery: a report of two cases. J Int Med Res 2021; 49:3000605211032782. [PMID: 34382463 PMCID: PMC8366150 DOI: 10.1177/03000605211032782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Sympathetic ophthalmia (SO) is a panuveitis that usually occurs after trauma to one eye. We describe two cases of SO occurring after 23-gauge vitrectomy. Case 1 involved a 66-year-old woman who underwent pars plana vitrectomy (PPV) for a rhegmatogenous retinal detachment. Two months later, she presented with decreased visual acuity (VA) and bilateral uveitis. Case 2 involved a 43-year-old woman who underwent a second PPV for recurrent retinal detachment. Two months later, she presented with bilateral panuveitis. Both patients were diagnosed with SO and were treated with methylprednisolone and cyclosporine. The first patient was further treated with a dexamethasone intravitreal implant (Ozurdex®) owing to the side effects of methylprednisolone. The VA and symptoms improved significantly after treatment in both patients. Bilateral granulomatous panuveitis following PPV should alert surgeons to consider SO. Appropriate interventions for SO can produce positive outcomes.
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Affiliation(s)
- Junhui Shen
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Ophthalmology of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Zheng Zhang
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Ophthalmology of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Dian Ye
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Ophthalmology of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Zuohui Wen
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Ophthalmology of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Xupeng Shu
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Ophthalmology of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Zhiqing Chen
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Ophthalmology of Zhejiang Province, Hangzhou, Zhejiang, China
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12
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Patil VS, Surve A, Banerjee M, Kumar V. Sympathetic ophthalmia following blunt injury to phthisical eye. BMJ Case Rep 2021; 14:14/7/e242516. [PMID: 34210701 DOI: 10.1136/bcr-2021-242516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Sympathetic ophthalmia is a severe sight-threatening disorder that can lead to blindness if not diagnosed and managed appropriately. It occurs most commonly following penetrating ocular injury and less commonly following surgery. Herein, we report a case of sympathetic ophthalmia following blunt trauma to the phthisical eye along with the pathophysiology and management of such cases.
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Affiliation(s)
- Vinay S Patil
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Abhidnya Surve
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Mousumi Banerjee
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Kumar
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Yang J, Li Y, Xie R, Li X, Zhang X. Sympathetic ophthalmia: Report of a case series and comprehensive review of the literature. Eur J Ophthalmol 2020; 31:3099-3109. [PMID: 33256432 DOI: 10.1177/1120672120977359] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate the factors related to sympathetic ophthalmia (SO) in a series of patients in our ophthalmology center and previously published cases. METHODS A retrospective and noncomparative review was performed on 16 patients with SO attending our ophthalmology center from 2013 to 2019. A total of 87 previously published cases of SO were identified by searching the Medline database from 2009 to 2019. RESULTS Sixteen patients were included in the analysis, and six cases were induced by transscleral cyclophotocoagulation (TCP). All patients had achieved controlled inflammation at their last follow-up visit. Thirteen patients (81.3%) had improved best-corrected visual acuity (BCVA). A review of the literature revealed 87 previously reported cases of SO. Shared clinical features and treatment outcomes were summarized. CONCLUSION Ocular therapies, including both penetrating ocular therapy and non-penetrating ocular intervention, have become increasingly prevalent risk factors for SO, and the latent period has increased compared to past reports. Visual prognosis with appropriate medical management is relatively good.
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Affiliation(s)
- Jing Yang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Yan Li
- Binhai Hospital of Tianjin Medical University General Hospital, Tianjin, China
| | - Ruotian Xie
- Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaorong Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Xiaomin Zhang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
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Rua D, Pohlmann D, Pleyer U. Sympathetic Ophthalmia - a Contribution to Immunology, Clinic and Current Imaging. Klin Monbl Augenheilkd 2020; 237:1060-1069. [PMID: 32967030 DOI: 10.1055/a-1245-4373] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Sympathetic ophthalmia (SO) is a rare inflammation of an operated or injured eye that spreads to the fellow eye. It is typically a bilateral granulomatous panuveitis. The traumatized eye is referred to as inciting eye and the fellow eye as sympathizing eye. The pathophysiology of the disease is not entirely understood, but there is strong evidence of an autoimmune genesis. PATIENTS/MATERIAL AND METHODS A selective literature search on epidemiology, immunology, clinical features and risk factors of SO was carried out. In addition, our own experience using multimodal imaging for this clinical entity was introduced. RESULTS In the literature, the incidence after traumatic eye injuries is 0.1 - 3% and approximately 0.01% after intraocular surgery. Among the iatrogenic causes, vitreoretinal surgery has the highest rate of SO, presumably due to disruption of the blood-retinal barrier and involvement of retinal and choroidal tissue, which are susceptible to anterior traction, phthisis and chronic inflammation. In 90% of patients, the disease develops within a year following the eliciting event and is associated with a potentially bilateral risk of blindness. Typical symptoms include bilateral visual impairment with photophobia, dull pain and photopsia. The spectrum of clinical manifestations ranges from granulomatous anterior uveitis and vitritis, to choroiditis, serous retinal detachment and Dalen-Fuchs nodules in the context of posterior involvement. The diagnosis of SO is generally based on clinical presentation and is supported by imaging methods. These primarily comprise fluorescein and indocyanine green angiography, which are increasingly being supplemented by non-invasive methods such as optical coherence tomography. They can provide important information for assessment of severity, differential diagnosis as well as for disease monitoring. The differential diagnosis includes i. a. Vogt-Koyanagi-Harada syndrome, ocular sarcoidosis and the rare phacoanaphylactic endophthalmitis. Immediate systemic high-dose steroid therapy is used as initial treatment. The course of the disease is often relapsing to chronic progressive. Immunomodulators such as ciclosporine A, azathioprine, cyclophosphamide, mycophenolate mofetil, and biologics are increasingly being used and contribute to the significantly better prognosis of the disease. Generally, SO can be triggered by any kind of intraocular intervention. CONCLUSION SO remains a threatening clinical diagnosis that poses diagnostic and therapeutic challenges. It can be triggered post-traumatic, but also any intraocular surgery. This should be taken into account when assessing the indication for intraocular eye surgery, especially in eyes with reduced visual outcome.
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Affiliation(s)
- David Rua
- Universitäts-Augenklinik, Charité Campus Virchow-Klinik, Berlin
| | | | - Uwe Pleyer
- Universitäts-Augenklinik, Charité Campus Virchow-Klinik, Berlin
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Dutta Majumder P, Mistry S, Sridharan S, George AE, Rao V, Ganesh SK, Biswas J. Pediatric Sympathetic Ophthalmia: 20 Years of Data From a Tertiary Eye Center in India. J Pediatr Ophthalmol Strabismus 2020; 57:154-158. [PMID: 32453848 DOI: 10.3928/01913913-20200219-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 02/10/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To examine the clinical profile of sympathetic ophthalmia among the pediatric age group. METHODS Retrospective review of patients 18 years and younger with sympathetic ophthalmia seen in a tertiary eye care center between 1997 and 2017. RESULTS Of 20 patients included in the study, 70% were male. The most common inciting event for sympathetic ophthalmia was trauma (85%), followed by vitreoretinal surgery (15%). All patients were treated with systemic steroids. Seventeen patients received additional corticosteroid-sparing immunosuppressive agents, and 4 patients (20%) required more than one immunosuppressive agent. Azathioprine was the most commonly used corticosteroid-sparing immunosuppressive agent. The most common complications were cataract (50%) and ocular hypertension (30%). The mean presenting best corrected visual acuity in the sympathizing eye was 1.15 ± 0.99 logarithm of the minimum angle of resolution (logMAR), which improved to 0.54 ± 1.00 logMAR following treatment. Visual outcome was good (6/12 or better) in 70% of the sympathizing eyes, and 3 of the exciting eyes in the current study had good visual outcomes after the treatment. CONCLUSIONS Prompt and effective management with corticosteroid-sparing immunosuppressive therapy in children with sympathetic ophthalmia allows favorable control of the disease and retention of good visual acuity. [J Pediatr Ophthalmol Strabismus. 2020;57(3):154-158.].
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Tyagi M, Agarwal K, Reddy Pappuru RR, Dedhia C, Agarwal H, Nayak S, Panchal B, Kaza H, Basu S, Pathengay A, Murthy S, Sangwan VS. Sympathetic Ophthalmia after Vitreoretinal Surgeries: Incidence, Clinical Presentations and Outcomes of a Rare Disease. Semin Ophthalmol 2019; 34:157-162. [PMID: 31055985 DOI: 10.1080/08820538.2019.1610464] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aim: To evaluate clinical presentation, course and outcomes in patients without a history of penetrating ocular trauma who developed Sympathetic Ophthalmia (SO) following vitreoretinal surgeries Methods: Retrospective review of clinical records of all patients diagnosed and treated as S.O was done . All cases without a previous history of trauma were included and were analyzed with respect to clinical presentations, anatomic and visual outcomes. Results: 175 cases of sympathetic ophthalmia were diagnosed and treated till June 2017. 16 of these cases had undergone a pars plana vitrecomy (PPV) in the past and had no history of prior ocular trauma. SO after vitreoetinal surgeries accounted for 9.14 percent of all cases of SO .In the same duration, till 2017,a total 41365 PPV were done. Thus 0.038 percent of PPV cases developed a SO . 10 patients were males and 6 were females. The median age at presentation was 45.7 years. The time interval from surgery to diagnosis of sympathetic ophthalmia ranged from 22 days to 4 years after undergoing a surgery. The mean visual acuity in the sympathizing eye was 1.26 logMAR (snellens equivalent of 20/320) which improved to 0.62 logMAR(snellens equivalent of 20/80) after treatment. The most common anterior segment finding was non granulomatous anterior uveitis, seen in 8 cases (50%) while neurosensory detachments were the most common posterior segment presentation (10 cases, 62.5%).12 patients had undergone more than 1 surgery (mean number of surgeries was 1.88). 10 patients had undergone a sutureless PPV (6 cases of 23 gauge and 4 cases of 25 gauge vitrectomy) while 4 patients had undergone a 20 gauge vitrectomy where all sclerotomies were sutured after surgery All patients were treated with systemic steroids and immunosuppresants and 15 out of 16 patients showed significant improvement in the final visual acuity in the sympathizing eye Conclusions: Sympathetic ophthalmia after vitreoretinal surgeries is a rare but potentially sight threatening disease occurring in 0.038 percent of all cases of Pars Plana Vitrectomy. Presence of inflammation in the fellow eye after a vitreoretinal surgery in the other eye should alert the surgeon to possibility of sympathetic ophthalmia.
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Affiliation(s)
- Mudit Tyagi
- a Uveitis and Ocular Immunology Services , Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L. V. Prasad Eye Institute , Hyderabad , India
| | - Komal Agarwal
- a Uveitis and Ocular Immunology Services , Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L. V. Prasad Eye Institute , Hyderabad , India
| | - Rajeev R Reddy Pappuru
- a Uveitis and Ocular Immunology Services , Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L. V. Prasad Eye Institute , Hyderabad , India
| | - Chintan Dedhia
- a Uveitis and Ocular Immunology Services , Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L. V. Prasad Eye Institute , Hyderabad , India
| | - Hitesh Agarwal
- a Uveitis and Ocular Immunology Services , Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L. V. Prasad Eye Institute , Hyderabad , India
| | - Sameera Nayak
- b Uveitis and Retina services, KVC Campus , L.V. Prasad Eye Institute , Vijayawada , India
| | - Bhavik Panchal
- c Uveitis and Retina Services, GMRV Campus , L.V .Prasad Eye Institute , Visakhapatnam , India
| | - Hrishikesh Kaza
- d Uveitis and Retina Services, MTC Campus , L. V. Prasad Eye Institute , Bhubaneshwar , India
| | - Soumyava Basu
- d Uveitis and Retina Services, MTC Campus , L. V. Prasad Eye Institute , Bhubaneshwar , India
| | - Avinash Pathengay
- c Uveitis and Retina Services, GMRV Campus , L.V .Prasad Eye Institute , Visakhapatnam , India
| | - Somasheila Murthy
- e Uveitis and Ocular Immunology Services , Tej Kohli Cornea Institute, L. V. Prasad Eye Institute , Hyderabad , India
| | - Virender S Sangwan
- e Uveitis and Ocular Immunology Services , Tej Kohli Cornea Institute, L. V. Prasad Eye Institute , Hyderabad , India
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Tan XL, Seen S, Dutta Majumder P, Ganesh SK, Agarwal M, Soni A, Biswas J, Aggarwal K, Mahendradas P, Gupta V, Ling HS, Teoh S, Pavesio C, Agrawal R. Analysis of 130 Cases of Sympathetic Ophthalmia - A Retrospective Multicenter Case Series. Ocul Immunol Inflamm 2018; 27:1259-1266. [PMID: 30207811 DOI: 10.1080/09273948.2018.1517894] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective: To analyze the demographic profile, treatment, and visual outcome of the patients with sympathetic ophthalmia (SO) in a multicenter collaborative retrospective cohort study.Methods: Medical records of the patients with SO from UK, Singapore, India were reviewed for history of ocular trauma or surgery and subsequent development of uveitis consistent with SO, presenting symptoms, treatment, and visual outcomes.Results: A total of 130 patients were diagnosed with SO during the study period. Eighty-one (62.3%) patients were men. The mean age was 48.4 ± 15.5 years. The most common presenting symptom was blurring of vision (89.2%), followed by pain (29.2%) and floaters (23.8%). Ninety-two (70.7%) required additional immunosuppressive therapy. Thirty-six (27.9%) patients underwent enucleation of the inciting eye.Conclusions: SO is a potentially sight-threatening disease with high rates of visual loss. It warrants prompt evaluation and treatment. With the advances and availability in immunotherapy, the visual prognosis is relatively good.
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Affiliation(s)
- Xiu Ling Tan
- Department of Ophthalmology, National Healthcare Group Eye Institute, Singapore
| | - Sophia Seen
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Sudha K Ganesh
- Medical Research Foundation, Sankara Netralaya, Chennai, Tamil Nadu, India
| | - Mamta Agarwal
- Medical Research Foundation, Sankara Netralaya, Chennai, Tamil Nadu, India
| | - Aniruddh Soni
- Medical Research Foundation, Sankara Netralaya, Chennai, Tamil Nadu, India
| | - Jyotirmay Biswas
- Medical Research Foundation, Sankara Netralaya, Chennai, Tamil Nadu, India
| | - Kanika Aggarwal
- Uveitis Department, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Vishali Gupta
- Uveitis Department, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ho Su Ling
- Department of Ophthalmology, National Healthcare Group Eye Institute, Singapore
| | - Stephen Teoh
- Department of Ophthalmology, National Healthcare Group Eye Institute, Singapore
| | - Carlos Pavesio
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Rupesh Agrawal
- Department of Ophthalmology, National Healthcare Group Eye Institute, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Moorfields Eye Hospital, NHS Foundation Trust, London, UK
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Mansour AM. Dexamethasone Implant as Sole Therapy in Sympathetic Ophthalmia. Case Rep Ophthalmol 2018; 9:257-263. [PMID: 29928220 PMCID: PMC6006629 DOI: 10.1159/000488850] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 03/26/2018] [Indexed: 11/19/2022] Open
Abstract
We present the case of a 46-year-old woman with sympathetic ophthalmia occurring 27 years after complicated juvenile cataract surgeries. The patient declined systemic immunosuppressive therapy. Dexamethasone implant in the sympathizing eye allowed good visual recovery up to 18 months of follow-up with a total of 6 implants. Intraocular pressure rise was controlled medically. This is a unique report of sympathetic ophthalmia treated solely with slow-release dexamethasone implant without systemic therapies.
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Affiliation(s)
- Ahmad M Mansour
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon.,Department of Ophthalmology, Rafic Hariri University Hospital, Beirut, Lebanon
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19
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Dutta Majumder P, Anthony E, George AE, Ganesh SK, Biswas J. Postsurgical sympathetic ophthalmia: retrospective analysis of a rare entity. Int Ophthalmol 2017; 38:2487-2493. [PMID: 29164454 DOI: 10.1007/s10792-017-0759-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 10/19/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe clinical manifestations, management and visual outcome in postsurgical sympathetic ophthalmia (SO). METHODS Retrospective study. RESULTS Mean age of the patients was 41.1 years, and males were affected 1.8 times than the female. Vitrectomy and scleral buckling were the most common inciting surgeries followed by cataract surgery. Among 10 eyes with anterior uveitis, mutton-fat keratic precipitate was seen in only two eyes. Mean follow-up duration was 1556.50 ± 1470.75 days. Vision significantly improved in 11 patients (78.6%; p = 0.005). CONCLUSION Postsurgical SO is a rare entity, but it is a bilateral blinding disease and SO following surgical intervention can have variable presentations. Rapid, effective management of postsurgical sympathetic ophthalmia can give improved visual outcomes.
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Affiliation(s)
| | - Eliza Anthony
- Department of Uvea, Medical Research Foundation, Sankara Nethralaya, Chennai, 600006, India
| | - Amala Elizabeth George
- Department of Uvea, Medical Research Foundation, Sankara Nethralaya, Chennai, 600006, India
| | - Sudha K Ganesh
- Department of Uvea, Medical Research Foundation, Sankara Nethralaya, Chennai, 600006, India
| | - Jyotirmay Biswas
- Department of Uvea, Medical Research Foundation, Sankara Nethralaya, Chennai, 600006, India
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20
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Goudot M, Groh M, Salah S, Monnet D, Blanche P, Brézin AP. Lymphocytic Meningitis in Patients with Sympathetic Ophthalmia. Ocul Immunol Inflamm 2017; 25:196-201. [DOI: 10.1080/09273948.2017.1291841] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Mathilde Goudot
- Department of Ophthalmology, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Matthieu Groh
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Sawsen Salah
- Department of Ophthalmology, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Dominique Monnet
- Department of Ophthalmology, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Philippe Blanche
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Antoine P. Brézin
- Department of Ophthalmology, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Paris, France
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Rishi E, Rishi P, Appukuttan B, Walinjkar J, Biswas J, Sharma T. Sympathetic ophthalmitis following vitreoretinal surgery: Does antecedent trauma make a difference? Indian J Ophthalmol 2016; 63:692-8. [PMID: 26632123 PMCID: PMC4705703 DOI: 10.4103/0301-4738.170980] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Sympathetic ophthalmitis (SO) has been reported following vitrectomy; however, there is a lack of data on the role of antecedent penetrating ocular trauma impacting the disease manifestation in eyes developing SO following vitrectomy. Aim: To report differences in the presentation and outcomes of SO in eyes with or without a history of antecedent penetrating trauma; SO being diagnosed after vitreoretinal (VR) surgery. Design: Comparative case series. Methods: Seventeen consecutive patients presenting with SO following VR surgery, diagnosed between 1995 and 2011 were included. Eyes with and without prior penetrating injury were included in Group I (n = 7) and Group II (n = 10), respectively. All Group I patients had received systemic steroids prior to presentation. Demographic and clinical parameters were evaluated. Results: Differences were observed between Group I and Group II mainly with regards to time interval between VR surgery and diagnosis of SO (1.5 months vs. 8 months, P = 0.10), presence of neurosensory detachments (100% vs. 30%, P = 0.01), and the inciting eye vision at presentation (nil light perception in 28.5% vs. 80%, P = 0.049). Other differences observed though not statistically significant were optic disc and retinal vessel involvement (42% vs. 70%, P = 0.28), Dalen-Fuchs nodules (localized vs. diffuse) and leaks on fundus fluorescein angiography (pin-head vs. pin-point leak). Conclusion: SO in patients with antecedent penetrating ocular trauma present early with the central serous chorioretinopathy-like picture. Prior use of systemic steroids might have a bearing on the differences in presentation and the visual acuities between the two groups.
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Affiliation(s)
- Ekta Rishi
- Sankara Nethralaya, Chennai, Tamil Nadu, India
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22
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Payal AR, Foster CS. Long-Term Drug-Free Remission and Visual Outcomes in Sympathetic Ophthalmia. Ocul Immunol Inflamm 2016; 25:190-195. [DOI: 10.3109/09273948.2015.1092557] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Abhishek R. Payal
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
- Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - C. Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
- Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Sympathetic ophthalmia after diode laser cyclophotocoagulation: now an issue in informed consent. Can J Ophthalmol 2014; 49:e102-4. [PMID: 25103662 DOI: 10.1016/j.jcjo.2014.05.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 01/29/2014] [Accepted: 05/19/2014] [Indexed: 11/21/2022]
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Albahlal A, Al Dhibi H, Al Shahwan S, Khandekar R, Edward DP. Sympathetic ophthalmia following diode laser cyclophotocoagulation. Br J Ophthalmol 2014; 98:1101-6. [PMID: 24711656 DOI: 10.1136/bjophthalmol-2013-304257] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Sympathetic ophthalmia is a rare form of bilateral uveitis that develops following an ocular penetrating injury to one eye. Several cases of sympathetic ophthalmia have been reported after non-penetrating cyclodestructive procedures including Nd:YAG and diode laser cyclophotocoagulation (CPC) but information on inciting factors and outcome is limited. In this case series we investigated the inciting factors, clinical features, course and outcome of six patients who developed sympathetic ophthalmia after diode CPC. METHODS Six patients who developed sympathetic ophthalmia after diode CPC were identified from the King Khaled Eye Specialist Hospital uveitis database between 2008 and 2013. The medical records of these patients were reviewed for demographic information, ocular history, diode laser parameters, clinical presentation, treatment and outcome. RESULTS Six patients were diagnosed with sympathetic ophthalmia following treatment with diode laser CPC, an incidence of 0.001% during the study period. Two patients had a history of accidental trauma and all patients had undergone at least one ocular surgery that included a variety of procedures. At presentation, two patients had predominantly posterior segment findings in the sympathising eye, one patient had only anterior segment findings and the rest had panuveitis. All patients were treated with topical and systemic corticosteroids and/or immunosupressive therapy that resulted in complete resolution of inflammation and return to baseline vision in the sympathising eye within 2-48 months of treatment. CONCLUSIONS Sympathetic ophthalmia after diode CPC is rare and is seen in patients with a history of intraocular surgery with or without previous trauma. Early recognition of sympathetic ophthalmia and aggressive management with immunosuppressive therapy results in good outcomes for these patients.
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Affiliation(s)
- Abdullah Albahlal
- King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Hassan Al Dhibi
- King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Sami Al Shahwan
- King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Rajiv Khandekar
- King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Deepak P Edward
- King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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25
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Patel SS, Dodds EM, Echandi LV, Couto CA, Schlaen A, Tessler HH, Goldstein DA. Long-Term, Drug-Free Remission of Sympathetic Ophthalmia with High-Dose, Short-Term Chlorambucil Therapy. Ophthalmology 2014; 121:596-602. [DOI: 10.1016/j.ophtha.2013.09.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 08/26/2013] [Accepted: 09/08/2013] [Indexed: 11/24/2022] Open
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Kumar K, Mathai A, Murthy SI, Jalali S, Sangwan V, Reddy Pappuru R, Pathangay A. Sympathetic ophthalmia in pediatric age group: clinical features and challenges in management in a tertiary center in southern India. Ocul Immunol Inflamm 2013; 22:367-72. [PMID: 24131076 DOI: 10.3109/09273948.2013.841958] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To study the clinical features and visual outcome of sympathetic ophthalmia in pediatric patients attending a tertiary care center. METHODS Retrospective review of patients ≤16 years with sympathetic ophthalmia seen during the period 2001-2011. RESULTS During this period, 2511 pediatric patients with open globe injuries and 14 patients with sympathetic ophthalmia were seen. Six patients developed sympathetic ophthalmia during follow-up here. The incidence rate of sympathetic ophthalmia is 0.24% (6/2511, 95% CI:0.05-0.43%). The commonest presenting signs were anterior uveitis and exudative detachment. All patients were treated with systemic steroids, while 7 patients received additional immunosuppressive therapy. Eight patients had a follow-up of more than 6 months. Mean presenting best-corrected visual acuity (1.25 ± 1.03 logMAR) in the sympathizing eye improved significant following treatment (0.42 ± 0.80 logMAR, p = 0.003). CONCLUSIONS The incidence of sympathetic ophthalmia was 0.24%. Appropriate immunosuppression can lead to favorable visual outcomes in the sympathizing eye.
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Affiliation(s)
- Kshitiz Kumar
- Srimati. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute , Hyderabad , India
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27
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Chu XK, Chan CC. Sympathetic ophthalmia: to the twenty-first century and beyond. J Ophthalmic Inflamm Infect 2013; 3:49. [PMID: 23724856 PMCID: PMC3679835 DOI: 10.1186/1869-5760-3-49] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 05/23/2013] [Indexed: 12/20/2022] Open
Abstract
Sympathetic ophthalmia is a rare bilateral granulomatous inflammation that follows accidental or surgical insult to the uvea of one eye. Onset of sympathetic ophthalmia can be insidious or acute, with recurrent periods of exacerbation. Clinical presentation shows mutton-fat keratic precipitates, choroidal infiltrations, and Dalen-Fuchs nodules. Histopathology reveals diffuse or nodular granulomatous inflammation of the uvea. Prevention and treatment strategies for sympathetic ophthalmia are currently limited to two modalities, enucleation of the injured eye and immunosuppressive therapy, aimed at controlling inflammation. The etiology and pathophysiology of the disease is still unclear but is largely thought to be autoimmune in nature. Recent insight on the molecular pathology of the disease as well as developments in imaging technology have furthered both the understanding on the autoimmune process in sympathetic ophthalmia and the targeting of prevention and treatment strategies for the future.
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Affiliation(s)
- Xi K Chu
- Immunopathology Section, Laboratory of Immunology, National Eye Institute, National Institutes of Health, 10 Center Drive, Room 10N103, Bethesda, MD 20892, USA.
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Aujla JS, Lee GA, Vincent SJ, Thomas R. Incidence of hypotony and sympathetic ophthalmia following trans-scleral cyclophotocoagulation for glaucoma and a report of risk factors. Clin Exp Ophthalmol 2013; 41:761-72. [DOI: 10.1111/ceo.12088] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 02/12/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Jaskirat S Aujla
- City Eye Centre; Brisbane Queensland Australia
- University of Queensland; Brisbane Queensland Australia
| | - Graham A Lee
- City Eye Centre; Brisbane Queensland Australia
- University of Queensland; Brisbane Queensland Australia
- Royal Brisbane Hospital; Brisbane Queensland Australia
| | - Stephen J Vincent
- School of Optometry and Vision Science; Queensland University of Technology; Kelvin Grove Queensland Australia
| | - Ravi Thomas
- University of Queensland; Brisbane Queensland Australia
- Queensland Eye Institute; Brisbane Queensland Australia
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Wender JD, Johnson RN, McDonald HR, Jumper JM, Fu AD, Lujan BJ, Cunningham ET. Continued vision loss from progressive expansion of inactive chorioretinal scars in a myopic patient with well-controlled sympathetic ophthalmia. Retin Cases Brief Rep 2012; 6:383-387. [PMID: 25389936 DOI: 10.1097/icb.0b013e31823f09bb] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To describe significant vision loss caused by enlargement of chorioretinal scars related to sympathetic ophthalmia despite adequate control of intraocular inflammation. METHODS A case report of a 62-year-old man who developed sympathetic ophthalmia after a vitrectomy, which was successful in repairing a rhegmatogenous retinal detachment. RESULTS Progressive expansion of chorioretinal scars occurred despite successful control of intraocular inflammation related to sympathetic ophthalmia. The visual acuity declined from 20/20 to no light perception in the right eye and from 20/400 to light perception in the left eye over 11 years of follow-up. CONCLUSION Progressive enlargement of chorioretinal scars and visual loss may occur despite adequate control of intraocular inflammation in patients with sympathetic ophthalmia. Similar patterns of scar expansion have been reported in eyes after laser photocoagulation, but we believe this is the first report of scar enlargement in the setting of well-controlled sympathetic ophthalmia.
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Affiliation(s)
- Jon D Wender
- *Pacific Vision Foundation, California Pacific Medical Center, San Francisco, California †West Coast Retina Medical Group, San Francisco, California ‡Department of Ophthalmology, Stanford University School of Medicine, Stanford, California
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Galor A, Davis JL, Flynn HW, Feuer WJ, Dubovy SR, Setlur V, Kesen MR, Goldstein DA, Tessler HH, Ganelis IB, Jabs DA, Thorne JE. Sympathetic ophthalmia: incidence of ocular complications and vision loss in the sympathizing eye. Am J Ophthalmol 2009; 148:704-710.e2. [PMID: 19665105 DOI: 10.1016/j.ajo.2009.05.033] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Revised: 05/27/2009] [Accepted: 05/27/2009] [Indexed: 11/29/2022]
Abstract
PURPOSE To report the frequency on presentation and subsequent incidence of ocular complications and vision loss in patients with sympathetic ophthalmia (SO) and to describe factors associated with decreased vision in the sympathizing eye. DESIGN Multicenter retrospective case series. METHODS SETTING Three academic tertiary care uveitis clinics. STUDY POPULATION Eighty-five patients with SO from 1976 to 2006. OBSERVATION PROCEDURES Review of existing medical records. MAIN OUTCOME MEASURES Incident visual acuity (VA) loss to 20/50 or worse and 20/200 or worse and the median acuity over time. RESULTS Twenty-six percent of patients with SO presented with a VA of 20/200 or worse in their sympathizing eye. Further development of vision loss to 20/200 or worse occurred at the rate of 10% per person-year (PY). Ocular complications were seen in the sympathizing eye in 47% of patients at presentation; further development of new complications occurred at the rate of 40%/PY. The ocular complications most often associated with decreased vision were cataract and optic nerve abnormality. Exudative retinal detachment and active intraocular inflammation were significantly associated with poorer VA in the sympathizing eye. The benefits of corticosteroids were indirectly demonstrated as their use led to more rapid disease inactivation. Fifty-nine percent of patients maintained a VA of better than 20/50 in their sympathizing eye; and 75% maintained a VA of better than 20/200. CONCLUSIONS Although ocular complications were seen in many sympathizing eyes with SO, most patients maintained functional VA. The presence of an exudative retinal detachment and active intraocular inflammation correlated with poorer vision in the sympathizing eye.
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Affiliation(s)
- Anat Galor
- Bascom Palmer Eye Institute, University of Miami, Miami, FL 33136, USA
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Sen HN, Nussenblatt RB. Sympathetic ophthalmia: what have we learned? Am J Ophthalmol 2009; 148:632-3. [PMID: 19878754 DOI: 10.1016/j.ajo.2009.07.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Revised: 07/21/2009] [Accepted: 07/22/2009] [Indexed: 11/26/2022]
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Roberts MA, Rajkumar V, Morgan G, Laws D. Sympathetic ophthalmia secondary to cyclodiode laser in a 10-year-old boy. J AAPOS 2009; 13:299-300. [PMID: 19285891 DOI: 10.1016/j.jaapos.2008.12.135] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Revised: 11/14/2008] [Accepted: 12/30/2008] [Indexed: 10/21/2022]
Abstract
A 10-year-old boy with tuberous sclerosis was treated with cyclodiode laser for right rubeotic glaucoma. Five months after treatment, he developed a bilateral granulomatous uveitis. Enucleation of the exciting eye demonstrated sympathetic ophthalmia.
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Abstract
Sympathetic ophthalmia is a rare, bilateral granulomatous uveitis that occurs after either surgical or accidental trauma to one eye. The etiology is still not completely clear, but evidence suggests that sympathetic ophthalmia represents an autoimmune inflammatory response against choroidal melanocytes mediated by T cells. Key features are vision impairment and symptoms associated with inflammation. The diagnosis is based on a history of previous ocular trauma or surgery and clinical findings. Differential diagnoses include other causes of granulomatous uveitis, such as Vogt-Koyanagi-Harada disease, sarcoidosis, tuberculosis, and syphilis. Depending on the suspected etiology, treatment of sympathetic ophthalmia consists of systemic anti-inflammatory agents, including corticosteroids and immunomodulating drugs. The role of enucleation after the diagnosis of sympathetic ophthalmia remains controversial. Visual prognosis is reasonably good with prompt appropriate wound repair and immunomodulatory therapy. As the occurrence of sympathetic ophthalmia is probably more frequent following vitreoretinal surgery, more attention has to be paid to this potentially bilateral blinding disorder.
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