Dexamethasone Implant as Sole Therapy in Sympathetic Ophthalmia

Abstract

We present the case of a 46-year-old woman with sympathetic ophthalmia occurring 27 years after complicated juvenile cataract surgeries. The patient declined systemic immunosuppressive therapy. Dexamethasone implant in the sympathizing eye allowed good visual recovery up to 18 months of follow-up with a total of 6 implants. Intraocular pressure rise was controlled medically. This is a unique report of sympathetic ophthalmia treated solely with slow-release dexamethasone implant without systemic therapies.

Keywords: Dexamethasone implant; Miosis; Sympathetic ophthalmia; Uveitis.

Fig. 1.

On presentation, macular spectral-domain OCT (Topcon 3D OCT-2000 FA plus, Topcon Inc., Tokyo, Japan) shows serous elevation (vertical arrow) of the sensory retina (a) that resolved after intravitreal dexamethasone injection (b) with the implant (horizontal arrow) occasionally blocking part of the central field and altering the OCT exam (c). OCT, optical coherence tomography.

Fig. 2.

Venous phase of the fluorescein angiogram of the left eye. There are multiple sites of subretinal dye leakage most marked in the temporal peripapillary area.

Fig. 3.

Upon recurrence of inflammation, diffuse multiple small tiny creamish subretinal lesions were noted along with early disc swelling nasally (a). Fundus autofluorescence failed to detect any pathology (b).

Fig. 4.

Anterior OCT (Topcon 3D OCT-2000 FA plus, Topcon Inc., Tokyo, Japan) of the cornea (a) showed new onset of round keratic precipitates (arrows) as one of the clinical signs of recurrence of inflammation. Anterior OCT localized the position of the biodegradable dexamethasone implant (b). Note the superior peripheral iridectomy. OCT, optical coherence tomography.