Report of a case of sympathetic ophthalmia with special regard to ultrastructural examination

A case of sympathetic ophthalmia (SO) is reported. A long lasting stable result was obtained for this patient treated basically with traditional Chinese medicine. His exciting eye was investigated under light and transmission electron microscopes. Prominent granulomatous lesions in the choroid, Dalen-Fuchs nodules (DFNs) and disruption of outer and inner basement membrane of Bruch's membrane under DFNs are found, plasma cells are not few and melanocytes and retinal pigment epithelial cells are possibly the target cells. In various cells, nuclear bodies (NBs) are ubiquitous and sometimes multiple in an individual cell nucleus. Microtubule-like structures are present inside and outside the NBs and parallel lines composed of relatively uniform high electron dense granules as lattice-like structures can be seen. It was surmised that a virus induced autoimmune process might be involved in the pathogenesis of SO.

[Further investigations for the demonstration of a specific microorganism in sympathetik ophthalmia]

19 Following the inoculation of tissue culture cells with material obtained from 3 human eyes suffering from sympathetic ophthalmia (2 sympathizing = sy-l, 1 sympathized = sy-2), no growth of bacteria was observed. On the other hand, changes occurred such as are typical for a massive infection with mycoplasmas. The morphology of these microbes corresponds, down to the details, with micro-organisms which the author has frequently demonstrated and illustrated since 1948 in human, chicken and monkey eyes suffering from sympathetic ophthalmia. 2. With the cultures of mycoplasmas obtained from the eyes of human patients suffering from sympathetic ophthalmia, it was possible to produce the same symptoms in chickens as were described by the author in 1950 in sympathizing and sympathized human eyes, namely: torpid uveitis and papillitis, which dragged on for months, and affected not only the inoculated right eye, but also, after 3 weeks and more, the untouched left eye. 3. Identical phenomena involving both eyes have been observed in chickens, the right eyes of which were inoculated with a strain of mycoplasma hominis orale 1 cultivated from other material in the Institut für medizinische Mikrobiologie der Universität Mainz (Prof. Bredt) and given to the author. A chronic intraocular inflammation, which persisted for several months--up to 6 months and more--developed not only in the inoculated right eye of the animals, but also, after an interval of several weeks, in the untouched left eye. 4. Viewed critically and with due care, these findings suggest that mycoplasmas might well play a role in triggering off sympathetic ophthalmia. 5. The results reported on here indicate that intraocular inoculation with mycoplasmas is of importance both in microbiology and in general medicine.