1
|
Macarie SS, Huțu D. Sympathetic Ophthalmia – case report. Rom J Ophthalmol 2022; 66:84-88. [PMID: 35531457 PMCID: PMC9022153 DOI: 10.22336/rjo.2022.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose. To present the case of a 22-year-old man with a history of trauma on the right eye, followed by a sudden decrease of visual acuity on the left eye, but with a good recovery after surgical treatment. Material and methods. We reported a case of a 22-year-old patient with a sudden and painless decrease of visual acuity on the left eye, a month after a car accident, which led to the laceration of the right globe. At first, the patient received only medical treatment because he refused any surgical intervention. He had a favorable evolution during hospitalization, but he returned after a month with the same visual acuity as at his first admission. The patient accepted the medical treatment and the enucleation of the right eye, thus having a fast improvement in his visual acuity on the left eye. Conclusions. Although the enucleation was overdue, it had a strong favorable influence on the evolution of the disease. As a result of the surgery, the visual acuity has improved significantly in just a few days. Abbreviations: OCT = optical coherence tomography
Collapse
Affiliation(s)
- Sorin Simion Macarie
- Department of Ophthalmology, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Diana Huțu
- Department of Ophthalmology, Cluj County Emergency Hospital, Cluj-Napoca, Romania
| |
Collapse
|
2
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
Affiliation(s)
- Ollya V Fromal
- Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | | |
Collapse
|
3
|
López-Prats MJ, Salom D, Sanz-Marco E, García-Delpech S, Udaondo P, Díaz-Llopis M. [Biological therapy in sympathetic ophthalmia refractory to combined immunosuppressive treatment]. Arch Soc Esp Oftalmol 2011; 86:222-223. [PMID: 21798409 DOI: 10.1016/j.oftal.2011.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 02/04/2011] [Accepted: 02/22/2011] [Indexed: 05/31/2023]
|
4
|
Frolov AB, Grechanyĭ MP, Chentsova OB. [Use of plasmapheresis-based extracorporeal hemocorrection in the treatment of endogenic uveitis and autoimmune eye diseases]. Vestn Oftalmol 2009; 125:57-60. [PMID: 19916339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The paper gives the methods of plasmapheresis-based extracorporeal exposure to blood and its components to correct hemostatic disorders. Afferent methods, as well as quantum hemotherapy methods are outlined. The immunomodulating mechanism of their action, which favors a prompter elimination of inflammation, increases ocular functions, and reduces recurrences, is revealed. The mechanisms of action of plasmapheresis as a technique used alone and in combination with laser and ultraviolet blood irradiation and indications for and contraindications to the use of various hemocorrection methods are described.
Collapse
|
5
|
Ciucă C, Irimia A, Preda M, Damian C. [Sympathetic ophthalmia--clinical case]. Oftalmologia 2007; 51:49-51. [PMID: 17937034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This paper presents a case of Sympathetic ophthalmia following a penetrating ocular injury produced 30 days ago, of a patient who postponed the presentation to the ophthalmologist.
Collapse
|
6
|
Svozílková P, Ríhová E, Brichová M, Plsková J, Jenícková D, Kalvodová B. [Sympathetic ophthalmia]. Cesk Slov Oftalmol 2006; 62:218-23. [PMID: 16758762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
PURPOSE To evaluate the efficacy of treatment on prevention of disease development and protection of visual outcomes in patients suffering from sympathetic ophthalmia. METHODS Retrospective case. RESULTS Four patients with sympathetic ophthalmia were treated in our department from 1999 to 2004. All patients were men with the mean age 27.5 years (15-49 years). In two patients, there was a history of penetrating eye injury prior to the onset of sympathetic ophthalmia, in other two patients sympathetic ophthalmia occurred after eye surgery (pars plana vitrectomy), with no previous ocular trauma. Two patients were treated with monotherapy of corticosteroids; other two patients were commenced on combined immunosuppression. In all these cases, the therapy was effective. CONCLUSION Sympathetic ophthalmia is a rare, sight-threatening eye disease. Among the triggering factors dominates penetrating eye injury, however, there is currently an increase in the number of cases with sympathetic ophthalmia following eye surgery, mainly pars plana vitrectomy. Early introduction of immunosuppressive treatment can get the disease under control, prevent the development of intraocular inflammation and improve visual outcomes.
Collapse
|
7
|
Grigorescu A, Dinu D, David SUR. [Sympathetic ophthalmia, case report]. Oftalmologia 2006; 50:48-51. [PMID: 17144506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
We present the case of a 61 years old male, who developed symphathetic ophthalmia, following a penetrating injury in one eye. After the injury had been sutured, the traumatized eye was red and painful. Considering the risk of sympathetic ophthalmia, the doctor decided the enucleation of the injured eye, but the patient refused and he had not come back to the recommended follow-ups. He returned to the hospital seven months later with decreased visual acuity in both eyes, caused by bilateral uveitis. The diagnosis was sympathetic ophthalmia. He improved and recovered an acceptable visual acuity after enucleation of the injured eye and the administration of both topical and systemic steroids. But the premature stopping of the maintenance therapy with low-dose systemic steroids, results in a relapse--a worse uveitis.
Collapse
|
8
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
Affiliation(s)
- Daniel Hsien-Wen Su
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore.
| | | |
Collapse
|
9
|
Abstract
Sympathetic ophthalmia is a rare, bilateral granulomatous uveitis that occurs after either surgical or accidental trauma to one eye. The ocular inflammation in the fellow eye becomes apparent usually within 3 months after injury. Clinical presentation is an insidious or acute anterior uveitis with mutton-fat keratic precipitates. The posterior segment manifests moderate to severe vitritis, usually accompanied by multiple yellowish-white choroidal lesions. Evidence suggests that sympathetic ophthalmia represents an autoimmune inflammatory response against choroidal melanocytes mediated by T cells. Diagnosis is based on clinical findings and a history of previous ocular trauma or surgery. Other causes of granulomatous uveitis, such as Vogt-Koyanagi-Harada disease, sarcoidosis, tuberculosis, and syphilis should be considered. Treatment of sympathetic ophthalmia consists of systemic anti-inflammatory agents with high dose oral corticosteroid as the drug of choice. However, if the inflammation cannot be controlled, cyclosporine is then used. Other immunosuppressive agents, such as chlorambucil, cyclophosphamide or azathioprine, may be necessary for the control of inflammation. The role of enucleation after the diagnosis of sympathetic ophthalmia remains controversial. Visual prognosis is reasonably good with prompt wound repair and appropriate immunomodulatory therapy.
Collapse
Affiliation(s)
- Francisco Max Damico
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
| | | | | |
Collapse
|
10
|
Alikadić-Husović A, Karcić S, Saković A, Nisić F. [Sympathetic ophthalmia as complication of perforated wound of the eye]. Med Arh 2005; 59:135-6. [PMID: 15875482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Symphatetic uveitis was a fairly common and described disease in 19th century. Many cases of bilateral blindncss associated with injury and inflammation were diagnosed as sympathetic ophthalmia. A penetrating wound appears to be essential for the development of symphathetic ophthalmia. Since the antigen-presenting cell, of the eye appear to be functionally suppressed in situ, these antigens normaly would produce an inactivation signal. Authors present a case of 7 years old boy, who had injury of the right eye in the school. We performed surgery, but that right eye after several months went to subatrophy. Three months later, he come again with problems in left eye. We diagnosed symphatetic ophthalmia and included high doses of steroids. Two years after he is still on high dose of steroids due to two times of egxazcrbation. A month ago we perfomed phacoecmulsofication cataract syrgery, because a cataract developed due to high doses of steroid therapy.
Collapse
|
11
|
Affiliation(s)
- David S Chu
- Department of Opthalmology, Massachusetts Eye and Ear Infirmary, Boston, 02114, USA
| | | |
Collapse
|
12
|
Ishihara M, Ohno S. [Sympathetic ophthalmia]. Ryoikibetsu Shokogun Shirizu 2001:305-7. [PMID: 11269088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- M Ishihara
- Department of Ophthalmology, Yokohama City University, School of Medicine
| | | |
Collapse
|
13
|
Abstract
PURPOSE To report a case of sympathetic ophthalmia (SO) associated with cataract surgery and intraocular lens (IOL) implantation. METHODS Case report. RESULTS A 50-year-old man developed SO two months after complicated cataract surgery and IOL implantation. Adequate and prompt use of immunosuppressive medications and removal of the IOL by pars plana vitrectomy techniques resulted in control of the uveitis with significant visual improvement. CONCLUSIONS Sympathetic ophthalmia should be included as one of the devastating complications of IOL insertion. A high index of suspicion must be maintained whenever inflammation occurs in the fellow eye of an eye that has undergone intraocular surgery.
Collapse
Affiliation(s)
- A M El-Asrar
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | | |
Collapse
|
14
|
Abstract
AIMS To establish current epidemiological data, risks, and interventional outcomes of newly diagnosed sympathetic ophthalmia (SO). METHODS Prospective surveillance took place of all permanently employed ophthalmologists in the UK and Republic of Ireland by a monthly reporting card through the British Ophthalmological Surveillance Unit. Case ascertainment was made of newly diagnosed SO from July 1997 and questionnaire data were returned at baseline, 6 months, and 1 year after diagnosis. RESULTS 23 patients with newly diagnosed SO were recruited over 15 months, corresponding to a minimum estimated incidence of 0.03/100 000. Baseline data were available on 18 patients, in whom SO occurred after surgery in 11 patients, after retinal surgery alone in six patients, and after accidental trauma in seven patients. 12 of the 16 patients with 1 year follow up had a visual acuity of 6/12 or better. Good visual outcome was related to prompt and adequate systemic immunosuppressive therapy. CONCLUSIONS The incidence of sympathetic ophthalmia is very low. The main current risk is surgery, particularly retinal surgery, but visual prognosis is good if early diagnosis is made and rapid, adequate immunotherapy is commenced.
Collapse
Affiliation(s)
- D J Kilmartin
- Department of Ophthalmology, University of Aberdeen Medical School, Foresterhill, Aberdeen AB25 2ZD, UK
| | | | | |
Collapse
|
15
|
Affiliation(s)
- C C Chan
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892-1857, USA
| | | |
Collapse
|
16
|
Abstract
BACKGROUND Sympathetic ophthalmia is a rare form of autoimmune uveitis and manifests in 90% of cases within the first year after penetrating injuries or surgical interventions. PATIENTS AND METHODS In the present case the sympathetic ophthalmia started 50 years after a penetrating injury by a shell splinter. The injured eye was amaurotic and phthitic and the sympathizing eye showed an anterior uveitis. After an initial treatment with local and systemic corticosteroids the uveitis improved. The clinical diagnosis of sympathetic ophthalmia was made after a second inflammation course with substantial visual loss and subtotal chorioidal detachment. After enucleation of the exciting eye the diagnosis was confirmed by histological examination. An immunosuppressive therapy including azathioprine and cyclosporine became necessary to control the uveitis. RESULTS After enucleation the corticosteroid treatment was not sufficient. Additional therapy with azathioprine resulted in a recovery of the symptoms but had to be stopped because of adverse reactions. The alternative therapy by means of cyclosporine was tolerated well, but dose reduction was difficult because of recurrences. After a 30 month lasting cyclosporine therapy the patient shows stabile results since 6 months with visual acuity of 20/30. CONCLUSIONS The present case report demonstrates that a delayed onset of sympathetic ophthalmia 50 years after initial trauma may occur but can be controlled by an immediate, high dose immunotherapy.
Collapse
Affiliation(s)
- K Hellmund
- Augenklinik im Universitätsklinikum C. G. Carus, TU Dresden
| | | | | | | |
Collapse
|
17
|
Tachfouti S, Khermane A, Cherkaoui O, Mohcine Z. [Sympathetic ophthalmia. Apropos of 5 cases]. J Fr Ophtalmol 1998; 20:515-20. [PMID: 9499975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The objective of this study was to show the severity of sympathetic ophthalmia and the need for immunosuppressive treatment. METHODS The study included five cases of sympathetic ophthalmia following ocular injury in three cases and evisceration in two cases. The ocular lesions included total uveitis in all cases with papillary oedema in two cases. The treatment was based on corticosteroid therapy, with immunodepressants in four cases. RESULTS Functional prognosis was good in four cases, with final visual acuity between 3/10 and 10/10. CONCLUSION Immunosuppressive treatment must be used on all cases of sympathetic ophthalmia with the goal of improving visual prognosis.
Collapse
Affiliation(s)
- S Tachfouti
- Clinique ophtalmologique A, Hôpital des Spécialités, CHU, Rabat, Maroc
| | | | | | | |
Collapse
|
18
|
Tsvetkov AL, Filippova SV, Radzivil TT. [Cataract extraction in a patient with sympathetic uveitis after immunity correcting therapy]. Vestn Oftalmol 1998; 114:51-52. [PMID: 9584644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A complicated cataract on the only eye was effectively extracted in a patient with uveitis running a sluggish course with manifest disorders of T-cell immunity. Immune correction in combination with routine therapy of uveitis helped prepare the patient to surgery for cataract and attain good results.
Collapse
|
19
|
Arkhipova LT, Gundorova RA, Khvatova AV. [Epidemiological characteristics and risk factors of sympathetic ophthalmia]. Vestn Oftalmol 1996; 112:12-4. [PMID: 9019902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Clinical factors of risk of sympathic ophthalmia (SO) determined by the type of injury, methods of surgical and drug treatment, and supported by published data were distinguished as a result of treating 158 patients with SO at the Helmholts Research Institute of Ophthalmic Diseases from 1965 to 1994. Special attention is paid to the possibility of SO development during steroid therapy of posttraumatic uveitis. In such cases SO develops in case of 1) sudden discontinuation of a course of steroids; 2) discontinuation of a short course of steroid therapy in the presence of persisting signs of posttraumatic uveitis; and 3) in surgery on the traumatized (operated on) eyes and low steroid doses.
Collapse
|
20
|
Abstract
Sympathetic ophthalmia is probably the ocular disorder best known to practitioners outside of ophthalmology. It is characterized by a bilateral, nonnecrotizing granulomatous panuveitis that occurs after intentional or unintentional trauma to the exciting eye. So far, the identity of the inciting antigen has not been delineated with certainty. The sequelae from sympathetic ophthalmia have declined markedly in this century as a result of earlier diagnosis, use of corticosteroids, and better management of ocular injuries, in large part due to improved surgical techniques. Cases of sympathetic ophthalmia, however, still occur with their severe sight-threatening complications, which impose on ophthalmologists the importance of prompt diagnosis and aggressive treatment in order to achieve good visual outcome.
Collapse
Affiliation(s)
- A Ramadan
- National Eye Institute, Laboratory of Immunology, National Institutes of Health, Bethesda, MD 20892-1858, USA
| | | |
Collapse
|
21
|
Affiliation(s)
- H M Towler
- Department of Clinical Ophthalmology, Moorfields Eye Hospital, London, United Kingdom
| | | |
Collapse
|
22
|
Affiliation(s)
- J D Sheppard
- Department of Ophthalmology, Eastern Virginia Medical School, Medical College of Hampton Roads, Norfolk, Virginia, USA
| |
Collapse
|
23
|
Ignat F, Simionescu C. [Sympathetic ophthalmia in a case of neurilemmoma of the ciliary body]. Oftalmologia 1993; 37:315-20. [PMID: 8286315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The paper presents the case of a 62-year-old male patient, which has been hospitalized with the symptomatology of a acute glaucoma through intumescent lens. After the lens extraction, the globe evolution was to atrophy with chronic irrigation, starting a hypertensive cyclitis at the other eye, assumed to be a sympathetic ophthalmia. After several acute evolutive episodes at both eyes, the enucleation of the primal eye was made and a ciliary body tumour (neurinoma) was discovered. After enucleation under general and local cortisone treatment, the inflammatory phenomena at the sympathetic eye were entering in remission; but the hypertony, which was considered to be an open-angle pre-existent glaucoma, was persistent. The paper also discusses the sympathetic ophthalmia producing mechanism the characteristics of the ciliary body tumour and the diagnosis problems raised by this case.
Collapse
Affiliation(s)
- F Ignat
- Clinica de Oftalmologie, Facultatea de Medicină, Craiova
| | | |
Collapse
|
24
|
Chentsova OB, Grechanyĭ MP, Riabtseva AA, Kil'diushevskiĭ AV. [Immuno-correcting therapy of sympathetic ophthalmia]. Vestn Oftalmol 1991; 107:38-9. [PMID: 1858229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Exchange plasmapheresis was used in correction of the immune homeostasis in 5 patients with sympathetic ophthalmia. The inflammatory process ceased in all the cases. Exchange plasmapheresis resulted in improvement of the blood supply to ocular vessels, of intraocular vessel function, and of metabolic processes in the external layers of the retina. Cellular and humoral immunity parameters normalized. The hemo- and hydrodynamic parameters of the eye improved; all these results evidence that exchange plasmapheresis is an effective method in the treatment of sympathetic ophthalmia.
Collapse
|
25
|
Abstract
Ophthalmologists are daily confronted with intraocular inflammation following trauma and/or intraocular surgery. In rare cases, this may lead to the loss of visual function in both eyes, i.e. sympathetic ophthalmia (SO). In order to reduce the scope of responsible action between enucleation of the exciting eye (EE), which still has good vision, and progressive inflammation of the second eye (SE) resulting in blindness if action is delayed, a score system was established based on all SO symptoms which had become known from the literature and personal communications up the end of 1988. The score system developed by HANNE et al. allows causal differentiation between SO or uveitis of other genesis in the partner eye taking into account the prior history and findings in the EE and the occurrence of symptoms after the last accident/operation and findings in the SE. If the last eye is involved, the presence of SO should be assumed in every case where there are signs of intraocular inflammation in order to allow immediate commencement of anti-inflammatory therapy, the more so since it is known that corticosteroids and cytostatics (this also applies to cyclosporin A) can only arrest the immunopathologic processes in the initial phase of the disease.
Collapse
Affiliation(s)
- E Kraus-Mackiw
- Abteilungsgruppe Augenklinik, Ruprecht-Karls-Universität, Heidelberg, FRG
| |
Collapse
|
26
|
Svácová H, Izák M, Tímová S, Svác J, Bieliková A. [Sympathetic ophthalmia]. Cesk Oftalmol 1990; 46:218-22. [PMID: 2354539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The authors give an account of a case of sympathetic ophthalmia which was successfully managed by reoperation of the injured eye, corticoids and immunosuppressive drugs. Sympathetic ophthalmia developed after perforation of the cornea along with traumatic cataract one month following the accident. It was manifested by irritation of the anterior segment of both eyes and marked exudation into the area of the posterior pole of the sympathizing eye. On the injured eye surgical reconstruction of the anterior segment was performed and concurrently broad spectrum antibiotics and corticoids were administered. On this therapy the anterior segment of both eyes began to improve, while the exudation into the area of the posterior pole of the sympathizing eye proceeded; therefore immunosuppressive therapy was started. The manifestations of sympathetic ophthalmia receded gradually. After an alternative way of corticoid reduction was started, a relapse of sympathetic ophthalmia occurred. The relapse was suppressed by a temporary increase of the dosage. Three months after the development of sympathetic ophthalmia, using the treatment described, the uveal inflammation of both eyes receded. At present, two years after the accident, both eyes are in a satisfactory condition with normal visual acuity--on the injured eye with an aphakic correction.
Collapse
Affiliation(s)
- H Svácová
- Ocné oddelenie KNsP, Banská Bystrica
| | | | | | | | | |
Collapse
|
27
|
Affiliation(s)
- H Goto
- A. Ray Irvine, Jr, MD, Eye Pathology Laboratory, Doheny Eye Institute, Los Angeles, CA 90033
| | | |
Collapse
|
28
|
Abstract
Sympathetic ophthalmia was given its complete clinical description by William Mackenzic in 1840, and fully described in terms of its histopathology by Ernst Fuchs in 1905. A review of epidemiologic data from the 19th and 20th centuries reveals that acceptable statistical studies have yet to be carried out, but suggests that the disease has always been of extremely low incidence. Further, there does not appear to be a markedly decreased incidence in the "modern era." The etiology of the disease remains elusive, although the pathogenesis appears to be due to delayed hypersensitivity (cell-mediated immunity), possibly directed at a surface membrane antigen that is shared by photoreceptors, retinal pigment epithelium and choroidal melanocytes. The only effective therapy remains preventive enucleation of the injured eye, despite modern usage of immunosuppressive agents. Studies have suggested that early enucleation of a blind exciting eye can improve the prognosis for the sympathizing eye.
Collapse
Affiliation(s)
- D M Albert
- David G. Cogan Eye Pathology Laboratory, Howe Laboratories of Ophthalmology, Harvard Medical School, Massachusetts Eye & Ear Infirmary, Boston
| | | |
Collapse
|
29
|
Abstract
We reviewed the charts of 20 patients with sympathetic ophthalmia who were seen in the uveitis clinic at the Eye and Ear Infirmary within an 11-year period. Of these 20 patients 14 maintained 20/50 or better visual acuity in at least one eye. We found early enucleation to be associated with a better visual prognosis, possibly due to earlier diagnosis and faster, more aggressive therapy rather than a reduction in antigenic load. The clinical appearance of Dalen-Fuchs nodules appears to indicate a more severe stage of disease. Chlorambucil was useful in patients with severe disease. To be effective and to lessen its side effects chlorambucil was given in daily dosages that were increased weekly over a short period to achieve bone marrow suppression. After a course of chlorambucil therapy intraocular inflammation could be controlled with topical steroids alone.
Collapse
Affiliation(s)
- T Jennings
- Department of Ophthalmology, University of Illinois Eye and Ear Infirmary, College of Medicine, Chicago 60612
| | | |
Collapse
|
30
|
Bao LL, Fan XD. Long-term follow-up of sympathetic ophthalmia treated by combination of Chinese traditional and Western medicine. J TRADIT CHIN MED 1988; 8:89-93. [PMID: 3412019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
31
|
Dubois C, Kantelip B, Bacin F. [Sympathetic ophthalmia: current clinical data apropos of 3 cases]. Bull Soc Ophtalmol Fr 1988; 88:725-30. [PMID: 3228957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
32
|
Inouye S, Ideta H, Ishikawa M, Yoshino Y. [Sympathetic ophthalmia following vitrectomy and/or retinal detachment surgery]. Nippon Ganka Gakkai Zasshi 1988; 92:372-6. [PMID: 3046261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
33
|
Charlin JF, Brasseur G, Hauville C, Hubault D, Langlois J. [Sympathetic ophthalmia. Treatment with plasma exchange]. Ophtalmologie 1987; 1:305-7. [PMID: 3153878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
34
|
Abstract
A retrospective clinicopathologic study, conducted to determine the course of disease in 30 cases of sympathetic ophthalmia with clinical follow-up of at least six months (average, 12.7 years), showed that 21 of 30 patients retained visual acuities of 20/50 or better in the sympathizing eye. The severity of inflammation graded histologically in the exciting eye did not correlate with the clinical course of final visual acuity in the sympathizing eye. Enucleation of the exciting eye within two weeks of the onset of symptoms was associated with a relatively benign clinical course (P = .008). Corticosteroid treatment in patients who underwent enucleation more than two weeks after the onset of symptoms was associated with a good visual outcome (P = .009). Early enucleation of a blind exciting eye and corticosteroid treatment appear to be important variables that influence the visual prognosis in the sympathizing eye.
Collapse
|
35
|
Lardenet F, You B, Schooneman F, Raspiller A. [Sympathetic ophthalmia treated by plasma exchange]. Bull Soc Ophtalmol Fr 1983; 83:239-41. [PMID: 6616734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
36
|
Bronner A, Kosmann P, Kunnert C. [A case of confirmed sympathetic ophthalmia]. Bull Soc Ophtalmol Fr 1981; 81:635-7. [PMID: 7318097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|
37
|
Abstract
A retrospective clinicopathologic review of 105 cases of sympathetic ophthalmia showed histologic features of prognostic significance and evaluated the role of therapy. Classic descriptions omit retinal changes, but 58.0% of our cases had retinal detachment and 42.2% showed intraretinal inflammation. The optic nerve and/or meninges were inflamed in 51%. Optic atrophy was seen in 54.4%. Plasma cells are said to be characteristically absent, but 65.0% of steroid-treated and 85.7% of cases before the steroid era showed plasma cell infiltration. Severity of inflammation pathologically correlated with final visual outcome, and corticosteroid therapy changed both the character and severity of inflammation. Early enucleation of the exciting eye after onset of symptoms in the fellow eye was found to improve visual prognosis. Electron microscopy performed on fresh tissue and choroidal cell cultures revealed no viral particles, and viral and mycoplasma cultures all proved negative.
Collapse
|
38
|
|
39
|
|
40
|
Hamard H, Campinchi R, Fougères R, Douet B, Brègeat P. [Sympathetic ophthalmia and antilymphocyte serum]. Bull Soc Ophtalmol Fr 1972; 72:845-8. [PMID: 4353754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
41
|
Brendel W, Seifert J, Lob G. Effect of 'maximum immune suppression' with thoracic duct drainage, ALG, azathioprine and cortisone in some neurological disorders. Proc R Soc Med 1972; 65:531-5. [PMID: 5035906 PMCID: PMC1643939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
42
|
Tabor GL. Trauma to eye and orbit. J Trauma 1968; 8:1089-95. [PMID: 5722123 DOI: 10.1097/00005373-196811000-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
43
|
KOTARI M, KOIKE H. [2 cases of sympathetic ophthalmia showing a favorable response to treatment with Corson]. Rinsho Ganka 1962; 16:709-12. [PMID: 14458767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
|
44
|
TOKAREVA BA, GEIMOS EK. [The use of corticosteroids in the treatment of sympathetic ophthalmia]. Vestn Oftalmol 1961; 74:29-31. [PMID: 13777217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
|
45
|
|
46
|
ETIENNE-MARTIN P, KLEPPING C, PETIT A. [Hypoglycemia in peptic ulcer]. Ann Endocrinol (Paris) 1958; 19:524-30. [PMID: 13559786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
|
47
|
CRAWFORD JS. Sympathetic ophthalmia controlled by continuous cortisone therapy over a four-year period. Am J Ophthalmol 1957; 44:412-5. [PMID: 13458314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
|
48
|
STANKOVIC I. [Sympathetic ophthalmia as a therapeutic problem]. Med Glas 1957; 11:98-102. [PMID: 13482744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
|
49
|
PAEZ ALLENDE F. [2 Cases of sympathetic ophthalmia cured with cortisone, hydrocortisone and broad spectrum antibiotics]. Rev Asoc Med Argent 1956; 70:243-5. [PMID: 13379729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
|
50
|
STURMAN RM. Sympathetic ophthalmia cured by cortisone and ACTH. Eye Ear Nose Throat Mon 1956; 35:372-5. [PMID: 13317956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
|