Case Of Sympathetic Ophthalmia Research Articles

A Case of Sympathetic Ophthalmia After Corneal Perforation

A Case of Sympathetic Ophthalmia After Corneal Perforation

Aqueous Cytokines in Sympathetic Ophthalmia Following Complications of Intravitreal Aflibercept

Purpose: This article reports a case of sympathetic ophthalmia (SO) following complications from bilateral intravitreal aflibercept injections, including infectious endophthalmitis requiring vitreoretinal surgery in the left eye (OS) and sterile intraocular inflammation in the right eye (OD), and describes the aqueous cytokine profile of this patient. Methods: The patient was a 51-year-old man with SO. Cytokine levels in the aqueous humor of the sympathizing eye were measured at presentation. Results: A patient being treated with bilateral aflibercept injections for diabetic macular edema developed infectious endophthalmitis OS requiring a pars plana vitrectomy and sterile intraocular inflammation OD, which subsequently led to SO. Enucleation of the exciting eye (OS) was performed and histopathology confirmed the diagnosis. Cytokine levels in the sympathizing eye revealed high concentrations of intercellular adhesion molecule-1, inducible protein-10, and interleukin-8 and -10. Conclusions: SO can occur after vitreoretinal surgery for endophthalmitis in the exciting eye and sterile intraocular inflammation in the sympathizing eye following aflibercept injections.

Sympathetic Ophthalmia after Vitreoretinal Surgeries: Incidence, Clinical Presentations and Outcomes of a Rare Disease

Aim: To evaluate clinical presentation, course and outcomes in patients without a history of penetrating ocular trauma who developed Sympathetic Ophthalmia (SO) following vitreoretinal surgeriesMethods: 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 eyeConclusions: 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

Analysis on correlative factors of sympathetic ophthalmia after ocular trauma

Objective To analyse the correlative factors of sympathetic ophthalmia after ocular trauma. Methods The statistical data about 20 eyes of 20 cases of sympathetic ophthalmia secondary to ocular trauma were studied and the related factors were analyzed. Results The corneoscleral wound leading to sympathetic ophthalmia accounted for the highest proportion of 75.00%. The patients were aged 7-56 years old and patients aged 7-12 years accounted for 50.00%. The sex ratio of male versus female was 3∶1. Conclusion The corneal limbus wound is in the majority among patients with sympathetic ophthalmia secondary to ocular trauma .The ocular trauma in children should be paid more attention to because of its particularity. Key words: Sympathetic ophthalmia, ocular trauma; Analysis, correlative factors

Cirugía de evisceración ocular en un centro de alta especialidad en México: estudio retrospectivo de 7 años de experiencia

IntroductionEvisceration is currently becoming the technique of choice in the treatment of certain eye diseases, including, among others, painful blind eye and endophthalmitis. The most widely used implants are currently the hydroxyapatite and porous polyethylene for the rehabilitation of the anophthalmic socket. ObjectiveTo describe the indications, type of implant material used, and complications in evisceration surgery. MethodsA retrospective, observational, descriptive study based on clinical records of patients that underwent evisceration between 2008 and 2015 in the Instituto Fundación Conde de Valenciana, Mexico. ResultsA total of 186 evisceration surgeries were performed, of which 52.7% of the patients were men. The mean age was 54 years. The right eye was eviscerated in 53% of cases, and 79.2% had a vision of no light perception. Most patients had preoperative pain.The most common diagnosis for which evisceration was performed was endophthalmitis. Phthisis bulbi was reported in 20 eyes.A primary implant was inserted in 86.81% of the cases, with 34.81% of the implants being made of porous polyethylene.Four cases showed extrusion of the implant, with 2 cases of porous polyethylene.The ocular prosthesis was tolerated in 91% of cases. There were no cases of sympathetic ophthalmia. ConclusionEvisceration is shown to be a good alternative to enucleation in cases where the sclera can be preserved, showing a low incidence of sympathetic ophthalmia.

English

English

Cataract surgery in the exciting eye in sympathetic ophthalmia

Sympathetic ophthalmia (SO) is a rare, bilateral, non-necrotizing, granulomatous panuveitis that occurs following penetrating injury or a surgical procedure in one eye threatening sight in the fellow eye. Visual prognosis is reasonably good with prompt appropriate wound repair and corticosteroids pre and post-operatively. Only in a severely injured eye with no prognosis for vision is enucleation done within 2 weeks of injury to prevent the disease. We report a case of sympathetic ophthalmia with traumatic cataract following penetrating injury in the exciting eye. Cataract surgery with posterior chamber lens implant was done in the exciting eye, with pre-operative and post-operative cover of steroids, yielding good postoperative vision. If the injured eye has any vision, enucleation should be avoided as this may become the better eye if the fellow eye develops severe inflammation. We present this as a rare case report because after a thorough literature search in Pubmed, to the best of our knowledge, such a case has been rarely reported.

A Case of Sympathetic Ophthalmia due to Corneal Perforation in a Patient with Meningioma

A Case of Sympathetic Ophthalmia due to Corneal Perforation in a Patient with Meningioma

Sympathetic Ophthalmia Successfully Controlled with Methotrexate

This is a case of sympathetic ophthalmia in a 31 year old man presenting five months after a penetrating globe injury to his left eye. Vision loss in the right eye was unexpected and the patient’s uveitis became refractory to prednisone treatment. The patient was successfully treated and his uveitis remains quiet with combined methotrexate and prednisone therapy. This case was well documented with fluorescein angiography and fundus photography throughout the treatment course.

Sympathetic ophthalmia following diode laser cyclophotocoagulation

BackgroundSympathetic ophthalmia is a rare form of bilateral uveitis that develops following an ocular penetrating injury to one eye. Several cases of sympathetic ophthalmia have been reported after non-penetrating cyclodestructive...

Enucleation versus Evisceration in Ocular Trauma: A Retrospective Review and Study of Current Literature

Purpose: To compare variables and outcomes from ocular trauma leading to either enucleation or evisceration to better inform surgical decision making.Design: Retrospective chart review.Methods: We reviewed 441 patients between 2001 and 2012 presenting with ocular trauma to a Level 1 trauma center in Queens, New York; of these, there were 16 enucleations and 6 eviscerations. Retrospective chart review noted age, gender, mechanism of injury, initial and final visual acuity, time to surgery, length of follow-up, pain, degree of motility, and complications. A review of literature in the context of our study was performed.Results: 20 patients were male and 2 patients were female; average age was 44 (SD: 20.0, range 18–91). 9/16 patients were enucleated to prevent sympathetic ophthalmia, whereas only 1/5 patient was eviscerated for this indication (p = 0.1619). No cases of sympathetic ophthalmia were reported over an average follow-up of 316 days. Average length of follow-up varied significantly between the two groups, with an average of 370.4 days (SD: 566.9, range 0–1870) for enucleated eyes and 172.7 days (SD: 146.3, range 0–422) for eviscerated eyes (p = 0.42). Medpor implants were preferred in eviscerations (5/6 eviscerations), whereas hydroxyapatite implants were preferred in enucleations (10/16 enucleations, p = 0.04).Conclusions: Surgical decision-making in ocular trauma is largely based on surgeon preference and experience, with minimal evidence in the literature to support either enucleation or evisceration. We recommend evisceration over enucleation in cases of reliable patient follow-up due to the low incidence of sympathetic ophthalmia.

Clinical analysis of sympathetic ophthalmia

Objective To study the diagnosis and treatment of sympathetic ophthalmia.Methods 24 cases of sympathetic ophthalmia were retrospectively analyzed to observe the clinical effect of the treatment and the preventive measures.Results All cases had good effect and no recurrent cases were detected.Conclusion Early diagnosis,standard and active treatment,active treatment of traumatic eyes,controlling inflammation can prevent the recurrence of sympathetic ophthalmia and avoid the visual impairment. Key words: Ophthalmia, sympathetic ; Diagnosis ; Treatment

Enucleation and Evisceration: 20 Years of Experience

Objective: To determine the indications, relative frequencies, surgical times, and complications for enucleation and evisceration performed at a single academic center.Methods: Medical records of all patients who underwent an enucleation or evisceration between January 1st, 1990 and December 31st, 2009 at a single academic center were reviewed. Patient demographics and surgical indications, times, and complications were recorded.Results: A total of 85 eyes in 85 patients underwent enucleation (n = 31; 36%) or evisceration (n = 54; 64%) during the study period. Almost all patients were of African descent (96%). The most common underlying cause leading to eye removal was trauma. On average, eviscerations (47.3 ± 10.3 minutes) took significantly less time to perform than enucleations (89.6 ± 10.1 minutes; p < 0.01). Complications included implant exposure, infection, lower lid laxity, fornix insufficiency, and need for subsequent surgery; the occurrence of these complications was found to be similar between the two groups (p = 0.77). No case of sympathetic ophthalmia or inadvertent evisceration of an eye with an occult intraocular malignancy was noted. From the first decade for which data were available (1990− 1999) to the second decade (2000− 2009), the average number of enucleations decreased (p = 0.02) and the average number of eviscerations (p = 0.04) increased.Conclusion: Evisceration was found to be a safe and quicker alternative to enucleation in our study. A change in surgical preference from enucleation to evisceration was seen during the 20-year study period.

CUTANEOUS MELANOMA METASTATIC TO THE VITREOUS CAVITY

Purpose A clinical case of a postoperative sympathetic ophthalmia is presented and its response to the monoclonal antibody infliximab. Patients A 61-year-old woman. Results The treatment with prednisone, cyclosporine, azathioprine, and mycophenolate mofetil did not completely control the loss of visual acuity caused by the disease. Monthly intravenous infusions of infliximab (5 mg/kg) significantly improved the condition of the patient, allowing the cyclosporine and azathioprine to be withdrawn and the prednisone to be reduced to 10 mg/d. Conclusion The use of the immunosuppressive drug infliximab in combination with prednisone improved the prognosis of a patient suffering from sympathetic ophthalmia. The reported effectiveness of infliximab in the treatment of T lymphocyte-mediated diseases suggests that it could be used earlier in cases of sympathetic ophthalmia when treatment with corticosteroids must be shortened.

Imaging of Dalen-Fuchs Nodules in a Likely Case of Sympathetic Ophthalmia by Fluorescein Angiography and OCT.

Sympathetic ophthalmia (SO) is a well-known but rare autoimmune disease in which the sympathizing eye suffers granulomatous panuveitis after trauma to the fellow eye. An unusual case of SO occurring 32 years after trauma to the fellow eye, and 1 year after unsuccessful vitrectomy/scleral buckle repair of an acute retinal detachment in the inciting eye was presented. An optical coherence tomography imagery of Dalen-Fuchs nodules, not previously reported, and rare angiographic imaging of SO in its acute phase was demonstrated.

Subretinal Hypopyon in Sympathetic Ophthalmia

Purpose: To describe a rare case of sympathetic ophthalmia with subretinal hypopyon. Methods: Observational case report. Results: A 41-year-old man was diagnosed with sympathetic ophthalmia in his left eye. Oral prednisone was started. Three days later, he developed an inferior exudative retinal detachment with an underlying hypopyon. The exudative retinal detachment and hypopyon resolved completely within 48 hours. Conclusions: A subretinal hypopyon in sympathetic ophthalmia is a rare clinical finding. It is probably the result of acute inflammation in the subretinal space.

Change in the course of blindness in childhood

In the course of the 20th century there have been major changes in the causes of blindness in childhood. This is illustrated by the example of the 1271 children born between 1885 and 1976 who attended the Bavarian State School for the Blind. The following developments became apparent: Until 1940 the most common cause of blindness, accounting for 25% of the cases, was corneal disease, almost exclusively of infectious origin. This cause has been reduced most, to 2%. There has also been a clear reduction in blindness due to anterior uveitis (mainly due to infection) and chorioretinitis. There were fewer such cases -5% and 3%, respectively. Since the 1960s there have been no further cases of blindness due to ocular injury in children, and no case of sympathetic ophthalmia has occurred since 1950. While the incidence of congenital cataract and buphthalmos has remained constant, they now only lead to blindness in a small proportion of those affected, thanks to improvements in therapy. The incidence of blindness caused by retinal detachment, usually associated with myopia, is also unchanged, though rare (2-3%). The same applies to bilateral retinoblastoma, while the frequency of optic nerve atrophy (20%) and tapetoretinal degeneration (16-19%) has remained both constant and high. There has been a drastic increase in ocular malformations and developmental anomalies. These include retrolental fibroplasia, which was responsible for blindness in 38% of the children born between 1967 and 1976. Overall, there has been a major reduction in the number of blind children in the population since the 1960s and especially since the 1970s.

Sympathetic Ophthalmia Following Vitrectomy for Endophthalmitis After Intravitreal Bevacizumab

Purpose: To describe a case of sympathetic ophthalmia following vitrectomy for endophthalmitis after an intravitreal injection of bevacizumab. Design: Retrospective case report. Methods: An 84-year-old male developed sympathetic ophthalmia 4 months after vitrectomy for endophthalmitis following an intravitreal injection. The inciting blind eye was enucleated. Results: Histopathology demonstrated sympathetic ophthalmia and phacoanaphylactic endophthalmitis. Visual acuity improved from 20/200 to 20/30 in the sympathizing eye with a combination of oral prednisone and azathioprine. Conclusions: Sympathetic ophthalmia can develop following exogenous endophthalmitis but has a good visual prognosis with appropriate treatment.

The risk of sympathetic ophthalmia following evisceration for penetrating eye injuries at Groote Schuur Hospital

Background/aims:The aim of this study was to assess the incidence of sympathetic ophthalmia following evisceration for penetrating eye injuries and to assess whether evisceration is safe in this setting.Methods:Data were...

Sympathetic Ophthalmia After Injury in the Iraq War

A 21-year-old US soldier received a penetrating eye injury while fighting in Iraq and was treated with evisceration. Sympathetic ophthalmia developed, which responded well to steroid treatment. This is the first case of sympathetic ophthalmia after a war injury reported since World War II.