Sympathetic Ophthalmia - An Overview

A Case of Sympathetic Ophthalmia After Corneal Perforation

We report a case of sympathetic ophthalmia that developed in the fellow eye following therapeutic corneal transplantation and amniotic membrane transplantation for corneal perforation caused by corneal ulceration. A 62-year-old man presented with discharge, lacrimation, and decreased visual acuity in the left eye. He was diagnosed with a corneal ulcer and treated with antimicrobial agents, but corneal epithelial erosion persisted, leading to nontraumatic corneal perforation. The patient underwent therapeutic lamellar keratoplasty and amniotic membrane transplantation, but corneal epithelial erosion remained. Subsequently, conjunctival flap surgery and tarsorrhaphy were performed. Soon after, sympathetic ophthalmia developed in the fellow eye, and pulse steroid therapy was initiated. Although recurrence occurred during steroid tapering, a second pulse steroid therapy with a gradual dosage reduction over about one year successfully prevented further recurrence. The patient completed steroid therapy with a good visual prognosis. This case highlights the development of sympathetic ophthalmia in the fellow eye after multiple surgeries for nontraumatic corneal perforation, and immediate steroid therapy proved effective.

Acute and Chronic Manifestations of Sympathetic Ophthalmia on Multimodal Imaging

PURPOSE

To report the clinical and multimodal imaging features of sympathetic ophthalmia in the acute and chronic phases.

METHODS

Retrospective cohort study of consecutive patients with sympathetic ophthalmia seen at a tertiary referral center. Charts, imaging studies, and histopathological specimens were reviewed. The clinical features and multimodal imaging in the sympathizing eye were analyzed by sorting features into those seen in the acute and chronic phase.

RESULTS

Ten patients were included in the analysis and all of them had previous ocular trauma or complicated retinal detachment. In the acute phase, 70% had anterior uveitis, 70% had vitritis, and 100% had active posterior uveitis; posterior uveitis included multifocal choroiditis (80%), optic disc swelling (40%), multiple serous retinal detachments (20%), MEWDS-like findings (10%), and retinal vasculitis with chorioretinitis (10%). In the chronic phase, posterior manifestations included widespread patches of chorioretinal atrophy in the mid- and far-periphery (80%), peripapillary subretinal fibrosis (50%), and nummular perivascular atrophy (50%).

CONCLUSIONS

Sympathetic ophthalmia shows different posterior segment manifestations in the acute and chronic phase. Active sympathetic ophthalmia should be ruled out in eyes with a MEWDS-like presentation or rapidly progressing chorioretinitis, and history of trauma in the fellow eye. Peripapillary subretinal fibrosis and perivascular nummular atrophy may be useful features to suspect SO once acute inflammation has resolved.

Surgical Outcomes of Children with Unilateral Congenital Cataract and Persistent Fetal Vasculature

Purpose

To delineate the characteristics, surgical interventions, and visual outcomes among children diagnosed with congenital cataract and persistent fetal vasculature (PFV).

Patients and Methods

Retrospective observational single-center study was conducted between January 1, 2009, and December 31, 2019, at Helsinki University Hospital. The national cohort encompassed 82 children aged from birth to 15 years who underwent lensectomy, 3-port vitrectomy, or a combined procedure, with the objective of achieving visual rehabilitation. Among the surgical cohort, paediatric cases with International Classification of Disease (ICD-10) codes Q14.0 for PFV and Q12.0 for congenital cataract were identified and analyzed. Data were collected through a comprehensive review of medical records, encompassing clinical history (birth weight), gender distribution, ocular parameters (laterality, intraocular pressure [IOP], visual acuity [VA]), details of cataract and vitreoretinal surgical interventions, indications for surgery, postoperative ophthalmic complications, as well as evaluations of functional and anatomical outcomes.

Results

The cohort consisted of 11 children, ranging in age from 6 months to 12 years. Surgical intervention resulted in the attainment of at least light perception vision in nine of the operated eyes, representing 81.8% of cases. Among these, two eyes (18.2%) achieved hand motion vision, while 5 eyes (55.6%) achieved vision of finger counting or better. Additionally, two eyes (18.2%) achieved visual acuity measurable on the Snellen chart. However, one eye (9.1%) experienced complete vision loss, while the contralateral eye developed sympathetic ophthalmia.

Conclusions

Congenital cataract with PHV without anterior segment pathology associated with best postoperative VA, while eyes with anterior segment pathology or a complex posterior segment pathology had poor visual prognosis. Case selection for surgery is considered of great importance, since sympathetic ophthalmia may occur postoperatively. Understanding more deeply pathogenesis of PFV is warranted.