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Krakauer M, Jennings E, Gupta L, Si Z, Yu D, Lu X, Prendes MA, Shah H. A comparison of primary and secondary eye removal after open globe injury: A multi-centre study. Eye (Lond) 2023; 37:1249-1253. [PMID: 35606549 PMCID: PMC10101944 DOI: 10.1038/s41433-022-02098-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/19/2022] [Accepted: 05/09/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/OBJECTIVES Our goal was to compare the characteristics and surgical outcomes of patients who underwent primary eye removal surgery after open globe injury with those who underwent secondary eye removal surgery after open globe repair. SUBJECTS/METHODS This was a retrospective review of subjects who underwent evisceration or enucleation within 3 months of an open globe injury, at three Level I trauma centres in three U.S. cities between July 2014 and July 2020. RESULTS 19 patients underwent primary eye removal and 20 underwent secondary eye removal. The most common mechanism of trauma in patients who underwent primary eye removal was gunshot. Compared to the secondary eye removal group, patients who underwent primary eye removal were significantly more likely to be male; have longer hospital stays; be discharged to another care facility rather than home; have facial fractures; suffer intracranial injury; and be unable to consent themselves for surgery. Both groups had a low surgical complication rate with one case of socket contracture in each group. CONCLUSIONS The standard of care for an open globe injury is prompt repair, but there are occasions when the globe is so damaged that it is deemed unrepairable. We found that globes that required primary eye removal were more often due to gunshot wounds, and that there was greater morbidity associated with these injuries. The authors' preferred surgical approach was evisceration with placement of a silicone sphere; patient outcomes demonstrate that this method was found to be safe, with a low complication and infection rate.
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Affiliation(s)
- Mark Krakauer
- Department of Ophthalmology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
| | - Erin Jennings
- Department of Ophthalmology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Lalita Gupta
- Department of Ophthalmology and Visual Sciences, Case Western Reserve/University Hospitals Eye Institute, Cleveland, OH, USA
| | - Zhuangjun Si
- Department of Ophthalmology and Visual Sciences, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Daohai Yu
- Center for Biostatistics and Epidemiology, Department of Biomedical Education and Data Science, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Xiaoning Lu
- Center for Biostatistics and Epidemiology, Department of Biomedical Education and Data Science, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Mark A Prendes
- Department of Ophthalmology and Visual Sciences, Case Western Reserve/University Hospitals Eye Institute, Cleveland, OH, USA
| | - Hassan Shah
- Department of Ophthalmology and Visual Sciences, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
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Parchand S, Agrawal D, Ayyadurai N, Agarwal A, Gangwe A, Behera S, Bhatia P, Mulkutkar S, Barwar G, Singh R, Sen A, Agarwal M. Sympathetic ophthalmia: A comprehensive update. Indian J Ophthalmol 2022; 70:1931-1944. [PMID: 35647958 PMCID: PMC9359263 DOI: 10.4103/ijo.ijo_2363_21] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/05/2021] [Accepted: 12/07/2021] [Indexed: 11/17/2022] Open
Abstract
Sympathetic ophthalmia is a rare, bilateral, granulomatous, panuveitis following penetrating trauma or surgery to one eye. Clinical presentation commonly occurs within the first year of trauma occurrence but can be delayed by several years. It manifests as acute/chronic granulomatous uveitis with yellowish-white choroidal lesions or Dalen-Fuchs nodules. Initially, patients respond rapidly to corticosteroid therapy, but a majority require long-term use of corticosteroid-sparing agents to prevent recurrences. The purpose of this review is to elaborate on the current understanding of the pathophysiology, the importance of multimodal imaging in early diagnosis, and the role of newer immunomodulatory and biological agents in recalcitrant cases.
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Affiliation(s)
- Swapnil Parchand
- Department of Vitreo-retina and Uvea Services, MGM Eye Institute, Raipur, Chandigarh, India
| | - Deepshikha Agrawal
- Department of Cornea and Anterior segment Services, MGM Eye Institute, Raipur, Chandigarh, India
| | - Nikitha Ayyadurai
- Department of Ophthalmology, Advanced Eye Center, PGIMER, Chandigarh, India
| | - Aniruddha Agarwal
- The Eye Institute, Cleveland Clinic, Abu Dhabi (CCAD), Abu Dhabi, United Arab Emirates (UAE)
| | - Anil Gangwe
- Department of Vitreo-retina and Uvea Services, MGM Eye Institute, Raipur, Chandigarh, India
| | - Shashwat Behera
- Department of Vitreo-retina and Uvea Services, MGM Eye Institute, Raipur, Chandigarh, India
| | - Priyavat Bhatia
- Department of Retina and Uvea Services, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Samyak Mulkutkar
- Department of Ophthalmology, PD Hinduja Hospital, Mumbai, Maharashtra, India
| | - Gulshan Barwar
- Department of Vitreo-retina and Uvea Services, MGM Eye Institute, Raipur, Chandigarh, India
| | - Ramandeep Singh
- Department of Ophthalmology, Advanced Eye Center, PGIMER, Chandigarh, India
| | - Alok Sen
- Department of Retina and Uvea Services, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Manisha Agarwal
- Department of Uvea Services, Dr Shroff’s Charity Eye Hospital, New Delhi, India
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3
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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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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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Espinosa G, Herreras JM, Muñoz-Fernández S, García Ruiz de Morales JM, Cordero-Coma M. Recommendations statement on the immunosuppressive treatment of non-infectious, non-neoplastic, non-anterior uveitis. Med Clin (Barc) 2020; 155:220.e1-220.e12. [PMID: 32199631 DOI: 10.1016/j.medcli.2019.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/04/2019] [Accepted: 10/10/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To generate recommendations on the use of immunomodulators in patients with non-infectious, non-neoplastic intermediate uveitis (IU), posterior uveitis (PU) and panuveitis (PanU) based on best evidence and experience. METHODS A multidisciplinary panel of 5 experts was established, who defined the scope, users, and sections of the document. A systematic literature review (SLR) was performed to assess the efficacy and safety of immunomodulatory drugs in patients with non-infectious, non-neoplastic, non-anterior uveitis. The results of the SLR were presented and discussed during an expert meeting in which 34 recommendations were generated. The level of agreement with the recommendations was also tested in 25 additional experts following a Delphi process. Recommendations were voted from 1 (total disagreement) to 10 (total agreement). We defined agreement if at least 70% of the experts voted ≥7. The level of evidence and grade or recommendation were assessed using the Oxford Centre for Evidence-based Medicine Levels of Evidence. RESULTS The SLR included 33 articles. The 34 recommendations were accepted after 2 Delphi rounds (3 of them were modified after the first round). They include specific recommendations on patients with non-infectious, non-neoplastic, PU and PanU, as well as different treatment guidelines. CONCLUSIONS In patients with non-infectious, non-neoplastic, non-anterior uveitis these recommendations might help treatment decision making, due to the lack of robust evidence or other globally accepted algorithms.
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Affiliation(s)
- Gerard Espinosa
- Servicio de Enfermedades Autoinmunes, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Barcelona, España
| | - José M Herreras
- IOBA (Instituto Universitario de Oftalmobiología), Universidad de Valladolid, Valladolid, España; Servicio de Oftalmología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Santiago Muñoz-Fernández
- Servicio de Reumatología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España; Universidad Europea, San Sebastián de los Reyes, Madrid, España
| | - José M García Ruiz de Morales
- Unidad de Uveítis, Servicio de Inmunología, Complejo Asistencial Universitario de León, León, España; Instituto de Biomedicina, Universidad de León (IBIOMED), León, España
| | - Miguel Cordero-Coma
- Instituto de Biomedicina, Universidad de León (IBIOMED), León, España; Unidad de uveítis, Servicio de Oftalmología, Complejo Asistencial Universitario de León, León, España.
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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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Chawla R, Kapoor M, Mehta A, Tripathy K, Vohra R, Venkatesh P. Sympathetic Ophthalmia: Experience from a Tertiary Care Center in Northern India. J Ophthalmic Vis Res 2018; 13:439-446. [PMID: 30479714 PMCID: PMC6210884 DOI: 10.4103/jovr.jovr_86_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Purpose: To describe our clinical experience with sympathetic ophthalmia (SO) at a tertiary eye care center in north India. Methods: In this retrospective case series, analysis of the clinical features and visual outcomes of patients diagnosed with SO between March 2012 and March 2016 were performed. Results: Ten male and four female patients (median age, 15.5 years) with SO following penetrating trauma (10 patients) or ocular surgery (four patients) were included. SO developed 2 weeks to 3 years after the insult. Mean presenting visual acuity of the sympathizing eyes was 1.086 (LogMAR). Anterior chamber reaction was documented in all eyes in which it could be assessed (14 sympathizing eyes; five exciting eyes). Neurosensory detachment was seen in 10 of 14 patients (71.5%). Five patients (35.7%) were managed with oral steroids alone, whereas nine (64.3%) were treated with intravenous pulse dexamethasone followed by oral steroids. Inflammation recurred in three patients during steroid tapering, necessitating restarting of steroid therapy with or without additional immunosuppressants. At the last follow-up, all 14 patients were in remission with low-dose oral steroids; seven patients were also on immunosuppressants. At the final follow-up, 12 of 14 (85.7%) sympathizing eyes achieved 20/40 or better visual acuity and three exciting eyes achieved at least 6/24 visual acuity. Conclusion: Although SO is a potentially blinding disorder, early detection and individualized treatment allow most patients achieve good final visual acuity.
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Affiliation(s)
- Rohan Chawla
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Monika Kapoor
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Aditi Mehta
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Koushik Tripathy
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rajpal Vohra
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Venkatesh
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Dogra M, Samanta R, Singh P, Singh SR, Bajgai P, Sharma A, Bansal R, Gupta V, Dogra MR, Singh R. Surgical Intervention in Inciting Eyes of Patients with Sympathetic Ophthalmia: A Case Series and Review of Literature. Ocul Immunol Inflamm 2018; 27:1154-1159. [PMID: 30081702 DOI: 10.1080/09273948.2018.1497663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: To analyze the outcomes of surgical procedures on inciting eye of patients with Sympathetic ophthalmia (SO). Methods: Retrospective study of patients with SO who underwent surgical procedures on inciting eyes between January 2000 and December 2015. Outcome measures included flare up of inflammation in either eye and change in visual acuity in the inciting eye. Results: Four SO patients underwent surgeries in their inciting eyes after adequate control of inflammation. Surgical procedures included penetrating keratoplasty, glaucoma drainage device implantation, pars plana vitrectomy, and silicon oil removal. Keratoplasty, glaucoma surgery, and silicon oil removal were well tolerated, with no flare up of disease. The patient who underwent pars plana vitrectomy, however, had a poor outcome. Conclusions: Surgical intervention in inciting eyes of patients with SO, after being adequately treated with oral steroids and immunosuppression, is a viable option for improving anatomic and functional outcomes in these eyes.
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Affiliation(s)
- Mohit Dogra
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Ramanuj Samanta
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Pallavi Singh
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Simar Rajan Singh
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Priya Bajgai
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Aman Sharma
- Department of Rheumatology, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Reema Bansal
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Vishali Gupta
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Mangat R Dogra
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Ramandeep Singh
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
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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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Rahman Z, Ali S, Dutta Majumder P. Sympathetic Ophthalmia Following Accidental Burn with Hot Water Involving the Other Eye. Ocul Immunol Inflamm 2017; 26:1225-1227. [PMID: 28910553 DOI: 10.1080/09273948.2017.1340960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Zahedur Rahman
- a Department of Uveitis , Bangladesh Eye Hospital , Dhanmondi , Dhaka , Bangladesh
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12
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Mukkamala LK, Soni N, Zarbin MA, Langer PD, Bhagat N. Posterior Segment Intraocular Foreign Bodies: A 10-Year Review. Ophthalmol Retina 2017; 1:272-277. [PMID: 31047510 DOI: 10.1016/j.oret.2017.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 01/07/2017] [Accepted: 01/10/2017] [Indexed: 06/09/2023]
Abstract
PURPOSE To describe the characteristics of open-globe injuries with posterior segment intraocular foreign bodies (IOFBs). DESIGN Retrospective chart review study. PARTICIPANTS Patients treated for posterior segment IOFB injuries. METHODS Retrospective analysis of all patients with posterior segment IOFBs from 2003 to 2014 was conducted. Data including demographics, mechanism of injury, type of IOFB, method of diagnosis, presenting examination, medical and surgical treatment, visual outcomes, and complications were recorded. MAIN OUTCOME MEASURES Visual acuity (VA); anatomically successful retinal reattachment; need for additional surgery; frequency of post-traumatic complications, such as sympathetic ophthalmia (SO), endophthalmitis, and enucleations; and accuracy of Ocular Trauma Score (OTS). RESULTS Thirty-one patients (28 male; mean age, 36.6 years; 42% Hispanic) had posterior segment IOFB injuries, 23 (74%) of which were construction work related. Twenty-five IOFBs (81%) were metallic. Twenty-four IOFBs (77%) had Zone I entry. Computed tomography (CT) scan detected an IOFB in 21 of 22 eyes in which it was performed, with 1 scan highly suspicious for an IOFB. Average size of the IOFB was 10 mm3; size or initial VA did not have any correlation with final VA. The OTS had 60% accuracy in predicting final VA (n = 20). The majority of patients had traumatic cataract and vitreous hemorrhage (VH) on presentation (77% and 61%, respectively); 65% had a retinal tear or retinal detachment (RD), and these patients had worse final VA than those with no retinal pathology. Average time from injury to IOFB removal was 3 days because of the delay in presentation to our facility; 27 of 31 patients (87%) had IOFBs removed within 24 hours of presentation with pars plana vitrectomy (PPV) and either gas or silicone oil tamponade. Patients were admitted for an average of 4 days of intravenous antibiotics. The most common complication was recurrent RD in 11 patients (35%), which portended worse final VA. One patient (3%) developed SO. There were no cases of postoperative endophthalmitis or enucleation. CONCLUSIONS Open-globe injuries with posterior segment IOFBs have a guarded visual prognosis, particularly when associated with RD. Increased awareness of the importance of eye protection can help minimize the occurrence of these injuries.
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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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Moppett IK, Moppett SH. Surgical caseload and the risk of surgical Never Events in England. Anaesthesia 2016; 71:17-30. [DOI: 10.1111/anae.13290] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- I. K. Moppett
- Anaesthesia and Critical Care Section; Division of Clinical Neuroscience; Queen's Medical Centre; University of Nottingham; Nottingham UK
- Department of Anaesthesia; Nottingham University Hospitals; Nottingham UK
| | - S. H. Moppett
- Clinical Support Division; Nottingham University Hospitals; Nottingham UK
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Haggerty CJ, Roman P. Repositioning of a traumatically displaced globe with maxillary antrostomy: review of the literature and treatment recommendations. J Oral Maxillofac Surg 2013; 71:1915-22. [PMID: 23993226 DOI: 10.1016/j.joms.2013.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Revised: 07/01/2013] [Accepted: 07/01/2013] [Indexed: 01/31/2023]
Abstract
Complete dislocation of the globe, inferiorly into the maxillary sinus, medially into the ethmoid sinus, or superiorly into the anterior cranial fossa, can occur with significant blunt facial trauma. The degree of injury to the globe, its adnexal structures, and the optic nerve is dependent on the extent of the dislocation. Complete traumatic subluxation of the globe into the maxillary sinus is associated with severe injury to the periocular structures and represents a challenging and unique reconstructive process rarely encountered in published studies. The present case report represents only the 15th reported case of complete orbital prolapse into the maxillary sinus. Controversy exists regarding the definitive treatment of traumatic globe dislocations, the risk of sympathetic ophthalmia (SO), the sequela of postenucleation socket syndrome, and prophylactic steroid treatment to decrease the incidence of SO and traumatic optic neuropathy.
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Affiliation(s)
- Christopher J Haggerty
- Private Practice, Lakewood Oral and Maxillofacial Surgery Specialists, Lees Summit, MO; Clinical Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Missouri-Kansas City Medical Center, Kansas City, MO.
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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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Chaithanyaa N, Devireddy SK, Kishore Kumar R, Gali RS, Aneja V. Sympathetic ophthalmia: a review of literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113:172-6. [DOI: 10.1016/j.tripleo.2011.01.036] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 01/11/2011] [Accepted: 01/27/2011] [Indexed: 11/16/2022]
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Management and clinical outcome of penetrating keratoplasty for long-term corneal changes in sympathetic ophthalmia. J Ophthalmol 2011; 2011:439025. [PMID: 21772984 PMCID: PMC3136120 DOI: 10.1155/2011/439025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Accepted: 02/12/2011] [Indexed: 12/25/2022] Open
Abstract
Purpose. To report the visual outcome of penetrating keratoplasty performed on the sympathizing eye in three cases of sympathetic ophthalmitis. Methods. Interventional case series of three patients, diagnosed with sympathetic ophthalmitis, with corneal changes in the form of band keratopathy and decompensation underwent penetrating keratoplasty to the sympathizing eye. They had each sustained penetrating trauma as a child and had undergone previous cataract surgery and superficial keratectomy. Two patients had undergone lamellar keratoplasty prior to this procedure. One patient had undergone trabeculectomy for glaucoma, and she was on antiglaucoma medication. The preoperative visual acuity was 1/60 in the affected eye of each patient. Penetrating keratoplasty was performed in the sympathizing eye and the donor graft size was 7.50 mm, and the host graft size was 7.25 mm. Our patients were immunosuppressed prior to the procedure to help prevent graft rejection. Result. At one year follow-up, a BCVA of 6/36 or better was achieved in all three patients. Postoperative examination of the fundus showed peripheral chorioretinal atrophy with pigmentary changes at the macula, accounting for the limited vision. The grafts remain clear to date, and there has been no recurrence of uveitis or rejection. Conclusion. Penetrating keratoplasty can be considered as a surgical option to restore useful vision in a stable sympathizing eye in sympathetic ophthalmitis, and this depends on the extent of the pathology. However, these cases require treatment with immunosuppressives to prevent graft rejection and to prolong graft survival.
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Enucleation for open globe injury. Am J Ophthalmol 2009; 147:595-600.e1. [PMID: 19181305 DOI: 10.1016/j.ajo.2008.10.017] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Revised: 10/13/2008] [Accepted: 10/16/2008] [Indexed: 02/03/2023]
Abstract
PURPOSE To report the experience of enucleation after open globe at an ophthalmic trauma referral center. DESIGN Retrospective, observational study. METHODS In an ophthalmic trauma referral center the charts of all patients having suffered an open globe injury between January 1, 2000 and June 30, 2007 were reviewed. Variables assessed were age, gender, type of injury (rupture or laceration [penetrating, intraocular foreign body, or perforating]), ocular trauma score, visual acuity, subsequent enucleation, indication for and timing of enucleation, presence of sympathetic ophthalmia, and length of follow-up. RESULTS Among 660 open globe injuries, 55 have undergone enucleation (including 4 eviscerations), 11 primarily and 44 secondarily. Eyes with ruptures were significantly more likely to be enucleated than those with injuries attributable to lacerations (P < .001). The most common reason for secondary enucleation was a blind, painful eye. Two patients (0.3%) developed sympathetic ophthalmia and have maintained good vision in the sympathizing eye. CONCLUSIONS The vast majority of open globes can be repaired without requiring primary enucleation. Secondary enucleation is most commonly carried out for pain. Eyes with no light perception can be closely observed if the patient chooses.
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Abstract
PURPOSE We report a case of sympathetic ophthalmitis where we performed penetrating keratoplasty on the exciting eye many years after the initial injury. METHODS Case report. RESULTS After penetrating keratoplasty, the patient achieved vision of 3/60 from preoperative perception of light. CONCLUSIONS Our experience shows that penetrating keratoplasty can restore useful vision in the previously injured exciting eye in sympathetic ophthalmitis. This case highlights a unique example where the inciting eye has ultimately become the eye with the better vision as the damage was limited.
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Castiblanco CP, Adelman RA. Sympathetic ophthalmia. Graefes Arch Clin Exp Ophthalmol 2008; 247:289-302. [PMID: 18795315 DOI: 10.1007/s00417-008-0939-8] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Revised: 08/12/2008] [Accepted: 08/13/2008] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Sympathetic ophthalmia (SO) is a rare, bilateral, non-necrotizing, granulomatous uveitis that occurs after ocular trauma or surgical procedures to one eye threatening sight in the fellow eye. The pathophysiology is not clearly understood, but it appears that the disrupted integrity of the inciting eye leads to an autoimmune hypersensitivity reaction against the exposed ocular antigens in the injured eye as well as in the sympathizing eye. More recently, vitreoretinal surgery has been noted to be a risk factor for the development of SO. METHODS Medline search for case reports of sympathetic ophthalmia with links to full text in English yielded articles for review of patient demographics, clinical presentation and examination, therapies and final visual acuity. RESULTS Eighty-six patients with SO were included in this review. Sixty-two patients were male and 24 were female with an average age of 46 years. Injuries accounted for 47% of patients while ocular surgery was reported in 44% of patients with pars plana vitrectomy occurring in 21%. Most patients reported reduced vision and presented with uveitis. Ninety-five percent of them received systemic corticosteroid therapy and 75% of patients also received immunomodulators. About 70% of patients had improved visual acuity in their sympathizing eye at their last reported evaluation. CONCLUSIONS Sympathetic ophthalmia warrants prompt evaluation and treatment to maintain a favorable visual outcome. Ocular surgeries including vitreoretinal surgery and cyclodestructive procedures have been noted to be risk factors for the development of sympathetic ophthalmia. With current medical management including corticosteroids and immunomodulators visual prognosis is relatively good.
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Affiliation(s)
- Claudia Patricia Castiblanco
- Retina Service, Yale University Eye Center, 330 Cedar Street, Boardman Building 110, New Haven, CT 06510-3218, USA
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Lambe T, Leung JCH, Ferry H, Bouriez-Jones T, Makinen K, Crockford TL, Jiang HR, Nickerson JM, Peltonen L, Forrester JV, Cornall RJ. Limited peripheral T cell anergy predisposes to retinal autoimmunity. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2007; 178:4276-83. [PMID: 17371984 DOI: 10.4049/jimmunol.178.7.4276] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Autoimmune uveoretinitis accounts for at least 10% of worldwide blindness, yet it is unclear why tolerance to retinal Ags is so fragile and, particularly, to what extent this might be due to defects in peripheral tolerance. To address this issue, we generated double-transgenic mice expressing hen egg lysozyme, under the retinal interphotoreceptor retinoid-binding promoter, and a hen egg lysozyme-specific CD4(+) TCR transgene. In this manner, we have tracked autoreactive CD4(+) T cells from their development in the thymus to their involvement in uveoretinitis and compared tolerogenic mechanisms induced in a variety of organs to the same self-Ag. Our findings show that central tolerance to retinal and pancreatic Ags is qualitatively similar and equally dependent on the transcriptional regulator protein AIRE. However, the lack of Ag presentation in the eye-draining lymph nodes results in a failure to induce high levels of T cell anergy. Under these circumstances, despite considerable central deletion, low levels of retinal-specific autoreactive CD4(+) T cells can induce severe autoimmune disease. The relative lack of anergy induction by retinal Ags, in contrast to the same Ag in other organs, helps to explain the unique susceptibility of the eye to spontaneous and experimentally induced autoimmune disease.
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Affiliation(s)
- Teresa Lambe
- Henry Wellcome Building of Molecular Physiology, Roosevelt Drive, Oxford, UK
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Chan RVP, Seiff BD, Lincoff HA, Coleman DJ. Rapid recovery of sympathetic ophthalmia with treatment augmented by intravitreal steroids. Retina 2006; 26:243-7. [PMID: 16467694 DOI: 10.1097/00006982-200602000-00029] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- R V Paul Chan
- Retina Service of the New York-Presbyterian Hospital, Weill Medical College of Cornell University, 520 East 70th Street, New York, NY 10021, USA
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House JW, Doherty JK, Fisher LM, Derebery MJ, Berliner KI. Meniere's Disease: Prevalence of Contralateral Ear Involvement. Otol Neurotol 2006; 27:355-61. [PMID: 16639274 DOI: 10.1097/00129492-200604000-00011] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Determine the prevalence and time interval for conversion from unilateral to bilateral involvement in Meniere's disease and cochlear hydrops. STUDY DESIGN AND SETTING Retrospective chart review in a tertiary otologic referral center. PATIENTS 232 patients diagnosed with Meniere's Disease (n=186) or cochlear hydrops (n=46) between 1959 and 2001, who visited the clinic over a five-year period between 1997-2001 and have at least 2 audiograms more than 12 months apart. MAIN OUTCOME MEASURES Prevalence of cochlear hydrops relative to Meniere's Disease, rate of progression from unilateral to bilateral involvement; interval between unilateral onset of symptoms and bilateral involvement; and rate of progression from cochlear hydrops to Meniere's disease. RESULTS Initial diagnosis was Meniere's disease in 71% and cochlear hydrops in 29% of all 950 hydropic patients presenting between 1997 and 2001. In the study sample, Meniere's disease was bilateral at presentation in 11%; an additional 12% (14% of unilaterals) became bilateral during the follow-up period. At presentation, 6.5% of cochlear hydrops patients were bilateral, with another 26% becoming bilateral. Conversion from cochlear hydrops to Meniere's disease occurred in 33% and some of these are included among the bilateral. The average time interval for conversion from unilateral to bilateral Meniere's was 7.6 years (SD=7.0 years). CONCLUSION Most otologists are aware of the potential for contralateral ear involvement and conversion from cochlear hydrops to Meniere's disease after diagnosis. These changes are significant, require long-term follow-up for detection, and may necessitate further treatment. Patients should be counseled regarding this potential when interventions are considered, especially with respect to ablative treatments.
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Affiliation(s)
- John W House
- House Clinic and House Ear Institute, Clinical Studies Department, Los Angeles, CA 90057, USA.
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Affiliation(s)
- Szilard Kiss
- Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA
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Su DHW, Chee SP. Sympathetic ophthalmia in Singapore: new trends in an old disease. Graefes Arch Clin Exp Ophthalmol 2005; 244:243-7. [PMID: 16028023 DOI: 10.1007/s00417-005-0009-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2005] [Revised: 03/20/2005] [Accepted: 04/10/2005] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Sympathetic ophthalmia (SO) is an uncommon uveitic condition that occurs after injury to the uvea of one eye and may occur after accidental ocular trauma or ocular surgery. We sought to investigate the common causes of SO in Singapore and the demographic profile as well as the final visual acuity after treatment in these patients. METHODS This was a retrospective, non-comparative case series in which patients with SO were identified from the Singapore National Eye Centre uveitis database in the period between 1993 and 2003. The patients' case records were examined for a history of ocular trauma or surgery and subsequent development of bilateral or contralateral uveitis consistent with SO or histopathological evidence of SO in enucleated eyes. The medical records of these patients were reviewed for details of the inciting event, presentation, treatment, and visual acuity. RESULTS A total of ten patients (six men and four women) were diagnosed with SO in the period of study. SO occurred after accidental trauma in three patients and following ocular surgery in seven. Vitreoretinal surgery was responsible for four of these cases, and diode laser cyclophotoablation for another two, whereas neodymium:yttrium-aluminium-garnet (Nd:YAG) laser cyclotherapy was the cause in the last patient. Overall, six of ten patients underwent at least one vitreoretinal procedure. Four of the patients had a final visual acuity of 6/15 or better, whereas five had a visual acuity of 6/30 or worse. Good final visual acuity appeared to be associated with early initiation of immunosuppressive therapy. CONCLUSION In this series, ocular surgery, especially vitreoretinal surgery, had overtaken non-surgical trauma as the major cause of SO. A good outcome was possible in most cases if an early diagnosis was made and immunosuppressive treatment started promptly.
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Affiliation(s)
- Daniel Hsien-Wen Su
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore.
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Abstract
BACKGROUND Damage to one inner ear is occasionally followed by contralateral sensorineural hearing loss. This has been defined as sympathetic hearing loss. HYPOTHESIS It is hypothesized that autoimmunity can play a role in the pathogenesis of sympathetic hearing loss. METHODS A male patient who developed right-sided sympathetic hearing loss at 20 years of age, 11 years after deafness of the left ear caused by a temporal bone fracture, is described. The patient's serum was analyzed for the presence of autoantibodies against inner ear tissues by immunocytochemistry and Western blotting using rat inner ear tissues. The patient's serum was tested specifically for antibodies against heat shock protein 70 by immunodot blot. The presence of autoantibodies known to play a role in systemic autoimmune disease was also examined. RESULTS Immunocytochemistry on rat temporal bone sections demonstrated autoantibodies in the patient's serum specifically targeted against cochlear outer hair cells. No reactivity of the patient's serum was observed with control tissues including kidney, brain, and liver. Western blotting using homogenized rat cochlear tissues showed that the patient's serum reacted with a 25- and 27-kDa protein. No reactivity was observed with heat shock protein 70 in the immunodot blot analysis. The patient's serum did not contain autoantibodies against antinuclear antibodies, double-stranded DNA, antineutrophil cytoplasmic antibodies, basement membrane, reticulin, intestinal mucosa, muscle, collagen, or mitochondria. CONCLUSION Observations indicate that this patient suffered sympathetic hearing loss caused by organospecific autoimmunity directed to cochlear outer hair cells.
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MESH Headings
- Adult
- Animals
- Audiometry, Pure-Tone
- Autoantibodies/blood
- Autoimmune Diseases/diagnosis
- Autoimmune Diseases/immunology
- Autoimmune Diseases/pathology
- Blotting, Western
- Diagnosis, Differential
- Hair Cells, Auditory, Outer/immunology
- Hair Cells, Auditory, Outer/pathology
- Hearing Loss, Bilateral/diagnosis
- Hearing Loss, Bilateral/immunology
- Hearing Loss, Bilateral/pathology
- Hearing Loss, Sensorineural/diagnosis
- Hearing Loss, Sensorineural/immunology
- Hearing Loss, Sensorineural/pathology
- Humans
- Immune Complex Diseases/diagnosis
- Immune Complex Diseases/immunology
- Immune Complex Diseases/pathology
- Immunoenzyme Techniques
- Male
- Rats
- Rats, Wistar
- Skull Fractures/complications
- Temporal Bone/injuries
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