Sympathetic Ophthalmia After Complicated Cataract Surgery

Abstract

Background: Sympathetic ophthalmia (SO) is a bilateral, diffuse granulomatous panuveitis that can occur after a penetrating trauma or intraocular surgery. The time from ocular injury to the onset of sympathetic ophthalmia varies greatly, ranging from several days to decades.

Objective: We report on the diagnostic dilemma and clinical outcome of patient with sympathetic ophthalmia within 2 weeks of cataract surgery.

Case presentation: A patient underwent left eye cataract surgery that was complicated by postoperative iris prolapse through the corneal wound. The wound was sutures with iris still entrapped, and he presented to our clinic 1 week later with bilateral vision loss and panuveitis. After workup for other inflammatory or infectious causes, sympathetic ophthalmia was diagnosed, and the patient was treated with topical and systemic corticosteroids. One month later, visual acuity improved markedly in both eyes, and inflammatory symptoms and findings resolved. Sympathetic ophthalmia may occur soon after cataract surgery and can be confused with infectious endophthalmitis, which must be considered.

Conclusion: Prompt diagnosis and institution of corticosteroid therapy is essential and may result in significant visual improvement in both eyes.

Keywords: Cataract surgery; Endophthalmitis; Ocular inflammation; Sympathetic ophthalmia.

Figure 1.. B-scan ultrasonography of the right eye (A) and the left eye (B) before receiving treatment. Vitreous opacities and multifocal serous retinal detachments were demonstrated in both eyes.

Figure 2. Fundus images of the right eye (A) and the left eye (B) after a week of treatment. Multiple serous detachments are now evident. Details were still difficult to appreciate in the left eye.

Figure 3. Fundus images of the right eye (A) and the left eye (B) after a month of treatment. Disc oedema in the right eye was gone; multifocal serous retinal detachments were still present but less severe. In the left eye, disc oedema and serous detachments were noted. OCT of the right eye (C) and the left eye (D) after a month of treatment showed minimal subretinal fluid left eye more than right eye.