Sympathetic Ophthalmia: Demographic Characteristics, Clinical Findings, and Treatment Results

Abstract

Objectives: To evaluate the demographic characteristics, clinical findings, and treatment approach of patients with sympathetic ophthalmia (SO).

Materials and methods: The records of 14 patients with SO between 2000 and 2020 were retrospectively reviewed. The patients' Snellen best corrected visual acuity (BCVA), detailed ophthalmological examination, optical coherence tomography (OCT), enhanced depth imaging-OCT (EDI-OCT), fundus fluorescein angiography findings, and treatment approaches were recorded.

Results: The study included the 14 sympathizing eyes of 14 patients with SO (7 female, 7 male). The mean age was 48.5±15.4 years (range: 28-75), and the mean follow-up duration was 55.1±48.7 months (range: 6-204). Ten patients (71%) had a history of ocular trauma and 4 (29%) had a history of ocular surgery. The time to symptom onset in the sympathizing eye after trauma or ocular surgery ranged from 15 days to 60 years. The most common posterior segment findings were optic disc edema (36%) and exudative retinal detachment (36%). In the acute period, the mean choroidal thickness value on EDI-OCT was 716.5±63.6 μm (range: 635-772) and decreased to 296±81.6 μm (range: 240-415) after treatment. Treatment with high-dose systemic corticosteroid was given to 8 patients (57%), azathioprine (AZA) to 7 (50%), AZA and cyclosporine-A combination to 7 (50%), and tumor necrosis factor-alpha inhibitors to 3 patients (21%). Recurrence was observed in 4 patients (29%) during follow-up. At last follow-up, BCVA values were better than 20/50 in 11 (79%) of the sympathizing eyes. Remission was achieved in 13 patients (93%), but 1 patient (7%) lost her vision due to acute retinal necrosis.

Conclusion: SO is a bilateral inflammatory disease that presents with granulomatous panuveitis after ocular trauma or surgery. Favorable functional and anatomical results can be obtained with early diagnosis and initiation of appropriate treatment.

Keywords: Imaging; Vogt-Koyanagi-Harada; optical coherence tomography; sympathetic ophthalmia; treatment.

Figure 1

Case 3: Anterior segment images of the sympathizing (a) and sympathetic (b) eye. Fundus image of the sympathizing eye in the acute stage showing hyperemia and edema of the optic disc, and exudative macular detachment (c). Fluorescein angiography showing multiple pinpoint leakage areas, optic disc hyperfluorescence, and dye pooling with exudative retinal detachment (white arrows) (d). Enhanced depth imaging-optical coherence tomography showing serous macular detachment and diffuse choroidal thickening (e)

Figure 2

Case 10: Anterior segment image of the sympathetic eye (a). Enhanced depth imaging-optical coherence tomography of the sympathizing eye in the acute stage showing serous macular detachment with septa and choroidal folds, and diffuse choroidal thickening (b). Fundus image showing the optic disc hyperemia and exudative retinal detachment (c). Fluorescein angiography showing optic disc hyperfluorescence and dye pooling due to exudative retinal detachment (d)

Figure 3

Case 6: Anterior segment (a) and fundus (b) images of the sympathetic eye. Fundus images of the sympathizing eye in the chronic stage showing sunset glow fundus (c) and Dalen-Fuchs (D-F) nodules (d) at presentation. Fundus image 2.5 years after treatment showing peripapillary chorioretinal atrophy, retinal pigment epithelial changes, and D-F nodules with hyperpigmentation (e)