1/24. 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 = 1keywords = uveitis (Clic here for more details about this article) |
2/24. 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 = uveitis (Clic here for more details about this article) |
3/24. 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 = 2keywords = uveitis (Clic here for more details about this article) |
4/24. Changing trends in sympathetic ophthalmia.Sympathetic ophthalmia is a rare and potentially visually devastating bilateral panuveitis, typically following non-surgical penetrating injury to one eye. Three patients are presented where sympathetic ophthalmia developed after repeated vitreoretinal surgery. Prompt and effective management with systemic immunosuppressive agents permitted control of their disease and retention of good visual acuity in their remaining eye. vitreoretinal surgery is an important risk factor in sympathetic ophthalmia. informed consent for vitreoretinal surgery (especially in the re-operation setting) should now include the risk of sympathetic ophthalmia (approximately 1 in 800). Diverse clinical presentations are possible in sympathetic ophthalmia and any bilateral uveitis following vitreoretinal surgery should alert the surgeon to the possibility of sympathetic ophthalmia. Modern immunosuppressive therapy with systemic steroids and steroid-sparing agents such as cyclosporin A and azathioprine have improved the prognosis. This is particularly so in cases where early diagnosis is made and prompt and suitable immunotherapy is commenced.- - - - - - - - - - ranking = 2keywords = uveitis (Clic here for more details about this article) |
5/24. Sympathetic ophthalmia after a hyphema due to nonpenetrating trauma.PURPOSE: To report a case of sympathetic ophthalmia occurring after nonpenetrating ocular trauma. methods: Interventional case report. RESULTS: An 18-year-old white male presented with sympathetic ophthalmia four weeks after a hyphema from a nonpenetrating bungee cord injury. Vision was 20/20; there were keratic precipitates, anterior chamber cells, vitritis, and discrete yellow deep choroidal lesions consistent with Dalen-Fuch's nodules OU. The uveitis was treated with topical, oral, and periocular corticosteroids and the oral immunosuppressives cyclosporine and mycophenolate mofetil. Vision remained 20/20 OU for the first year of follow-up; vision OD then deteriorated to 20/50 over the next year with the formation of a posterior subcapsular cataract OD. CONCLUSION: Sympathetic ophthalmia may result from nonpenetrating ocular trauma. Ophthalmologists should be aware of this as prompt intervention is warranted.- - - - - - - - - - ranking = 1keywords = uveitis (Clic here for more details about this article) |
6/24. Bilateral exudative retinal detachments as initial presentation of sympathetic ophthalmia in turner syndrome.CASE REPORT: Sympathetic ophthalmia typically presents as bilateral granulomatous panuveitis that occurs after penetrating ocular injury. We describe a case of bilateral exudative retinal detachments in a patient with turner syndrome and sympathetic ophthalmia. COMMENTS: To our knowledge, this is the first report of sympathetic ophthalmia in turner syndrome.- - - - - - - - - - ranking = 1keywords = uveitis (Clic here for more details about this article) |
7/24. Surgical treatment of sympathetic ophthalmia.We report the case of a 12-year-old girl who was hospitalized for bilateral uveitis that occurred 2 years after a penetrating injury of the left eye. On admission, all clinical signs of sympathetic ophthalmia were present with visual function reduced to light perception and intact projection in the right eye and light perception without intact projection in the left. ultrasonography confirmed that the retina was in its proper place in both eyes. Since abrasion of the corneal epithelium and decalcification of the cornea with ethylene diamine tetra-acetic acid had been performed on the right eye, it was decided to proceed with pars-plana lensectomy and vitrectomy in the same (better preserved) eye. The surgery was performed as planned, with an uneventful postoperative course. Three years later, the eye operated upon had no signs of inflammation, and the visual acuity achieved with the aphakic correction was 0.8.- - - - - - - - - - ranking = 1keywords = uveitis (Clic here for more details about this article) |
8/24. Sympathetic ophthalmia associated with anterior chamber intraocular lens implantation.We describe a rare case of sympathetic ophthalmia associated with intracapsular cataract extraction and anterior-chamber intraocular lens implantation. This occurred three months after an immediate postoperative complication of pupillary block, flat anterior chamber, and wound dehiscence with one of the lens haptics dissecting into the subconjunctival space. Both eyes developed granulomatous panuveitis, which partially responded to medical treatment. Removal of the anterior-chamber intraocular lens and pars plana vitrectomy resulted in control of the uveitis with significant visual improvement. A pathologic examination of material from the anterior chamber and vitreous showed lymphocytes, histiocytes, and pigment cells contributing to the diagnosis of sympathetic ophthalmia. To the best of our knowledge, this is the first report of an intraocular lens implicated as a cause of sympathetic ophthalmia.- - - - - - - - - - ranking = 2keywords = uveitis (Clic here for more details about this article) |
9/24. Sympathetic ophthalmia, a genuine autoimmune disease.Intraocular inflammation of exogenous origin, which may lead to the loss of visual function in both eyes, i.e. SO confronts ophthalmologists much less rarely than might be expected. Epidemiological studies comprising ergophthalmological aspects underscore this. Questions with regard to therapy should consider the fact that the T cell-mediated cytotoxic disease which causes the transition from the initially unilateral subthreshold exogenous uveitis into the bilateral progressive phase is by no means a rare disorder, especially in secondary surgical operations on predamaged eyes with fresh intraocular hemorrhages, vascular neoplasia and secondary glaucoma. This should be recalled again by practicing ophthalmologists, thus enabling the prevention of SO. If SO is a "forme fruste" of retinitis pigmentosa, as is very likely to be the case, further clarification requires clinicopathologic studies in close collaboration with immunologists.- - - - - - - - - - ranking = 1keywords = uveitis (Clic here for more details about this article) |
10/24. Granulomatous uveitis after treatment of a choroidal melanoma with proton-beam irradiation.Histologic examination of an eye removed 2 years after receiving proton-beam irradiation for a choroidal melanoma revealed residual tumor in the choroid and nonnecrotizing granulomatous inflammation, consistent with the diagnosis of early sympathetic ophthalmia. sutures that secured four tantulum rings to the sclera did not penetrate the uvea. Sympathetic ophthalmia without evidence of a perforating injury has been described previously after helium ion therapy. The findings in our case further support the hypothesis that there is a risk of developing sympathetic ophthalmia after charged-particle therapy in the absence of a penetrating injury of the uveal tract.- - - - - - - - - - ranking = 4keywords = uveitis (Clic here for more details about this article) |
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