1/58. Sympathetic ophthalmia associated with cyclitis: case report.We present a case of sympathetic ophthalmia. A 41-year-old man suffered a penetrating injury to his right eye. Six weeks after the injury he complained of photophobia and redness in his left eye. visual acuity without correction was: right eye (RE), no light perception; and left eye (LE), 1.0. Ocular examination of the left eye revealed a shallow anterior chamber and mildly elevated intraocular pressure (25 mmHg). An initial diagnosis of narrow angle glaucoma was made and antiglaucomatous agents were prescribed. One month after diagnosis the vision in his left eye suddenly dropped to 0.04. Ocular examination showed annular serous retinal detachment and scattered yellow-white lesions (Dalen-Fuchs Nodules). Under the diagnosis of sympathetic ophthalmia, high dose intravenous corticosteroid (methylprednisolone, 200 mg daily) and subtenon dexamethasone (4 mg/0.8 cc) were used. Ten days after beginning treatment the vision improved to 0.1 but the retinal detachment was not sealed completely. Oral prednisolone (100 mg daily) and cyclosporine (125 mg bid) therapy replaced the intravenous corticosteroids. The serum level of cyclosporine was 118 ng/ml. After 3 months the vision improved to 0.6 and the retinal detachment subsided. Renal function and hematocrit status were monitored closely and no abnormal conditions were noted.- - - - - - - - - - ranking = 1keywords = ophthalmia (Clic here for more details about this article) |
2/58. Sympathetic ophthalmia associated with pars plana vitrectomy without antecedent penetrating trauma.PURPOSE: To evaluate, describe, and categorize the clinical presentation, clinical course, histopathology, and response to therapy in patients without a history of penetrating ocular trauma who developed sympathetic ophthalmia following pars plana vitrectomy. methods: The records of patients without a history of trauma who underwent pars plana vitrectomy and developed sympathetic ophthalmia were retrospectively reviewed. Cases were analyzed with respect to clinical presentation, fluorescein angiographic findings, anatomic and visual outcomes, histopathology, and response to therapy. RESULTS: Eight eyes were identified. The median age at presentation was 55 years, with a range of 14 to 62 years. The time from vitrectomy to diagnosis of sympathetic ophthalmia ranged from 2 months to greater than 2 years, with a median of 7 months. Six of eight patients (75%) presented with anterior chamber reaction. All eight patients presented with a vitreous inflammatory response. The optic nerve was inflamed clinically or angiographically in four of eight cases (50%). Small yellow-white sub-retinal pigment epithelial deposits were present in four of eight cases (50%). Two eyes had lesions characterized as multifocal choroiditis. One eye had larger yellow placoid-like lesions. One eye presented with vitritis but no retinal lesions. Subretinal choroidal neovascularization was noted in the inciting eye of one patient. Vision improved in the sympathizing eye with immunosuppressive therapy in five of eight cases (62.5%). CONCLUSIONS: Sympathetic ophthalmia can be seen following pars plana vitrectomy in patients without penetrating injuries or a history of trauma. Indeed, it may be seen after successful vitrectomy for retinal detachment. Diverse clinical presentations are possible, and persistent or atypical uveitis following vitrectomy should alert the surgeon to the development of sympathetic ophthalmia.- - - - - - - - - - ranking = 1.5keywords = ophthalmia (Clic here for more details about this article) |
3/58. Sympathetic ophthalmia after complicated cataract surgery and intraocular lens implantation.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.- - - - - - - - - - ranking = 1keywords = ophthalmia (Clic here for more details about this article) |
4/58. Laser photocoagulation for choroidal neovascularization associated with sympathetic ophthalmia.PURPOSE: To present a case of choroidal neovascularization associated with sympathetic ophthalmia successfully treated with photocoagulation. DESIGN: Interventional case report. methods: A 41-year-old man with a history of penetrating injury right eye, as well as sympathetic ophthalmia left eye, developed a classic choroidal neovascular membrane that threatened the center of the fovea. RESULTS: The patient was treated with argon laser photocoagulation. He has maintained stable visual acuity without evidence of recurrence of the membrane with 4 years' follow-up. CONCLUSION: Thermal laser should be considered as a treatment option in cases of choroidal neovascularization associated with sympathetic ophthalmia.- - - - - - - - - - ranking = 1.1666666666667keywords = ophthalmia (Clic here for more details about this article) |
5/58. Progressive subretinal fibrosis and blindness associated with multifocal granulomatous chorioretinitis: A variant of sympathetic ophthalmia.OBJECTIVE: To report a case of bilateral progressive subretinal fibrosis and blindness with multifocal granulomatous chorioretinitis occurring after intraocular surgery. We propose that this is a variant of sympathetic ophthalmia. DESIGN: Clinicopathologic case report. methods: The left enucleated globe was examined by histopathologic methods. The patient's sera were subjected to immunohistochemical studies against retinal antigens, and collagen 2 types in areas of fibrosis were identified. polymerase chain reaction was used to test for herpes virus dna in microdissected, formalin-fixed, paraffin-embedded tissue. RESULTS: The enucleated globe demonstrated histopathologic features similar to an entity previously described as progressive subretinal fibrosis with multifocal granulomatous chorioretinitis. The patient's sera demonstrated antibodies directed against retinal photoreceptors and pigment epithelium. Polymerase chain reaction for herpes virus was negative. Immunohistochemical studies demonstrated types III, IV, V, and VI collagen in areas of fibrosis. CONCLUSIONS: The clinical history along with the histopathologic and immunohistochemical findings suggest that progressive subretinal fibrosis with multifocal granulomatous chorioretinitis may represent a variant of sympathetic ophthalmia and that retinal autoimmunity may play a role in its pathogenesis.- - - - - - - - - - ranking = 1keywords = ophthalmia (Clic here for more details about this article) |
6/58. Peripapillary choroidal atrophy in sympathetic ophthalmia and management with triple-agent immunosuppression.PURPOSE: To describe the occurrence of peripapillary choroidal atrophy and experience with triple-agent immunosuppression in three cases of sympathetic ophthalmia. MATERIALS AND methods: Retrospective chart review of three cases of sympathetic ophthalmia with peripapillary choroidal atrophy. RESULTS: Three patients with sympathetic ophthalmia were managed with steroid pulse therapy and triple-agent immunosuppression. All three patients subsequently developed peripapillary choroidal atrophy. Conclusions: Peripapillary choroidal atrophy can occur in sympathetic ophthalmia and may indicate a severe form of inflammation which would benefit from triple-agent immunosuppression.- - - - - - - - - - ranking = 1.3333333333333keywords = ophthalmia (Clic here for more details about this article) |
7/58. Sympathetic ophthalmia associated with ocular and cerebral vasculitis: an angiographic and radiologic study.PURPOSE: To describe a case of sympathetic ophthalmia (SO) associated with ocular and cerebral vasculitis. methods: The authors report a 38-year-old woman who presented with bilateral uveitis 7 years after a penetrating trauma to the right eye. Ocular examination included fundus fluorescein and indocyanine green angiography. Medical history disclosed an episode of dysarthria and right-sided weakness. RESULTS: Anterior uveitis was present in the previously injured pseudophakic right eye, which harbored a piece of glass stuck in the lower temporal iris. In the left eye, vitreal inflammation with retinal sheathing and subretinal lesions was predominant. Besides retinal vasculitis, fundus angiography showed choroidal vasculitis. Neurologic studies were compatible with cerebral vasculitis. CONCLUSIONS: In SO, choroidal vasculitis that is invisible clinically can be demonstrated angiographically. Although rare, inflammation can also affect the nervous system.- - - - - - - - - - ranking = 0.83333333333333keywords = ophthalmia (Clic here for more details about this article) |
8/58. High incidence of sympathetic ophthalmia after contact and noncontact neodymium:YAG cyclotherapy.BACKGROUND: Two cases of sympathetic ophthalmia occurring after noncontact neodymium:YAG (Nd:YAG) cyclotherapy have previously been reported. In each case, the patient had undergone filtering surgery in the exciting eye. Although in each case Nd:YAG cyclotherapy was the last surgery performed, the inciting event of sympathetic ophthalmia was unclear. methods: The authors studied three additional patients who developed sympathetic ophthalmia after Nd:YAG cyclotherapy for glaucoma. RESULTS: Two patients developed sympathetic ophthalmia 4 months after noncontact Nd:YAG cyclotherapy, and 1 patient developed sympathetic ophthalmia 18 months after contact Nd:YAG cyclotherapy. All patients had previous cataract extractions but no filtering surgery in the exciting eye. Clinical features included chronic iridocyclitis, choroidal folds, Dalen-Fuchs nodules, and optic disc edema. Combining these cases with the two previously reported cases, the incidence of sympathetic ophthalmia at our institution thus far is 5.8% (4 of 69) and 0.67% (1 of 150) after noncontact and contact Nd:YAG cyclotherapy, respectively. CONCLUSIONS: The incidence of sympathetic ophthalmia after Nd:YAG cyclotherapy is high compared with other ocular procedures. The clinician should vigilantly monitor patients after Nd:YAG cyclotherapy and report additional cases that may have occurred at other institutions.- - - - - - - - - - ranking = 1.8333333333333keywords = ophthalmia (Clic here for more details about this article) |
9/58. Intravitreal triamcinolone acetonide for treatment of sympathetic ophthalmia.PURPOSE: To report on the treatment of long-standing sympathetic ophthalmia by intravitreal triamcinolone acetonide. DESIGN: Clinical interventional case report. methods: A 47-year-old patient who suffered from sympathetic ophthalmia and who was treated with intensive systemic immunosuppressive therapy received an intravitreal injection of 25 mg of triamcinolone acetonide. Before injection, intraocular pressure ranged between 5 and 8 mm Hg; visual acuity measured 6/20. RESULTS: Within the first 4 weeks after the injection, visual acuity improved from 6/20 to 6/12, intraocular pressure increased to values between 10 mm Hg and 13 mm Hg, and intraocular flare measurements decreased by approximately 50%. Systemic immunosuppressive treatment was reduced to 10 mg prednisolone/day at the first postoperative day and could not be stopped due to an adrenal insufficiency. Three months after the injection, visual acuity regressed to 6/20, intraocular pressure was reduced to values between 5 mm Hg and 10 mm Hg, and anterior chamber flare increased. The patient received a second intravitreal injection of 25 mg of triamcinolone acetonide after which intraocular pressure increased again to values between 10 mm and 13 mm Hg, and anterior chamber flare decreased. After the injection, perimetry revealed a marked enlargement of the originally constricted visual field with a decrease in mean visual field defect from approximately 11 dB to values lower than 7 dB. CONCLUSIONS: intravitreal injections of triamcinolone acetonide may be an additional tool in the treatment for sympathetic ophthalmia.- - - - - - - - - - ranking = 1.1666666666667keywords = ophthalmia (Clic here for more details about this article) |
10/58. Sympathetic ophthalmia following ciliary body laser cyclophotocoagulation for rubeotic glaucoma.A 60-year-old Asian man presented with left rubeotic glaucoma secondary to a central retinal vein occlusion. He was successfully treated with laser diode cyclophotocoagulation of the ciliary body. Nine months later he developed right progressive visual loss, headache, corneal oedema, anterior chamber cells, flare, mutton fat keratic precipitates, a swollen disc, and a minimal inferior visual field defect. A diagnosis of sympathetic ophthalmia was made, which was confirmed by characteristic findings seen on fluorescein and indocyanine green angiography.- - - - - - - - - - ranking = 0.83333333333333keywords = ophthalmia (Clic here for more details about this article) |
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