Long-term clinical outcomes of patients with sympathetic ophthalmia

Abstract

Purpose: To present the long-term clinical outcomes of patients with sympathetic ophthalmia (SO).

Methods: Retrospective review of patients' medical files between 2002 and 2022.

Results: Included were seven patients (four males). The mean ± SD age at presentation was 37.9 ± 22.5 years. Four patients had co-morbidities: three had diabetes mellitus type 2 and one had Turner Syndrome. Trauma was the inciting event in six patients and postoperative endophthalmitis in one patient. Decreased visual acuity (VA) was the leading symptom in the sympathizing eye and all of the patients presented with panuveitis. The mean ± SD interval between the triggering incident and the onset of SO in six cases was 4.3 ± 4.2 months. One case presented 30 years following the eye injury. Five patients underwent enucleation/evisceration of the exciting eye. The mean ± SD presenting LogMAR BCVA in the sympathizing eye was 0.57 ± 0.82, and the final LogMAR BCVA was 0.61 ± 0.95. Inflammation was completely controlled in 5 patients at a mean ± SD of 8.55 ± 9.21 months following the institution of immunomodulatory therapy, and it was partially controlled in 2 patients. VA deteriorated in all 3 diabetic patients and improved or remained stable in the 4 young and healthy patients. The mean ± SD follow-up period after achieving drug-free remission was 28 ± 22.8 months. The mean ± SD follow-up time was 6.8 ± 5.6 years.

Conclusions: SO is one of the most sight-threatening conditions, affecting the healthy eye. In this cohort, the favorable visual outcome was especially seen in young and healthy individuals. Visual prognosis is directly related to prompt diagnosis and treatment.

Keywords: Dalen-Fuchs nodules; Granulomatous uveitis; Ocular trauma; Sympathetic ophthalmia.

Fig. 1

Initial and final Best Corrected Visual Acuity (LogMAR) of the sympathizing eye

Fig. 2

a Colour fundus photos of both eyes. A hazy fundus view and blurred margins of optic disc are noted in the right eye, left image. Blunt foveal reflex is noted in the left fundus, right image, with faint gray subretinal lesions temporal to fovea. b Fluorescein angiogram of both eyes. Late leakage around and at the optic discs is seen bilaterally. Hyperfluorescent areas of pooling compatible with exudative retinal detachment are noted in the left fundus, right image

Fig. 3

a OCT of both eyes. On the upper left side is the traumatized, exciting right eye, with subretinal fluid; on the upper right, the sympathizing left eye has exudative retinal detachment. b OCT of the exciting (lower left image) and sympathizing (lower right image) eyes showing complete resolution of subretinal fluid after the institution of systemic corticosteroids

Fig. 4

a Color fundus picture of the LE showing exudative retinal detachment along the superotemporal arcade. b A pseudocolor fundus photograph of the LE shows clear vitreous, normal optic disc and inferotemporal peripheral choroidal pigmentary lesions

Fig. 5

a A frontal photograph of the inciting right eye showing chemosis, scleral perforation with iris prolapse, and corectopia. b A well-sealed scleral wound is noted following primary repair

Fig. 6

Color fundus photography of both eyes. a On the left, the right eye has a hazy fundus view and blurry optic disc borders. b On the right, the left fundus is clearly observed with normal-looking optic disc and a blunt foveal reflex

Fig. 7

a OCT of the right eye shows exudative retinal detachment on both sides of the optic disc. b OCT shows normal foveal contour with resolved subretinal fluid

Fig. 8

Fluorescein angiography shows bilateral optic disc hyperfluorescence

Fig. 9

a Color fundus photography of the right eye shows a hazy view secondary to vitritis, optic disc edema and choroidal lesions along the inferotemporal arcade. b Fluorescein angiography of the right eye shows hypofluorescent lesions in the early phase and c marked leakage of the posterior pole lesions in the late phase with marked optic disc leakage

Fig.10

OCT of the right eye six years after presentation shows thinning of retinal layers and scars at the level of retinal pigment epithelium

Fig. 11

a Pseudo-color fundus photo of the right eye shows clear vitreous, peripapillary scarring, and peripheral hypo and hyperpigmented choroidal lesions. b The visual field of the RE shows a constricted field of 30 degrees at maximal light intensity (4dB) and 20 degrees at less light intensity (3dB)