Sympathetic ophthalmia in Singapore: new trends in an old disease

Short Communication

Abstract

Background

Sympathetic ophthalmia (SO) is an uncommon uveitic condition that occurs after injury to the uvea of one eye and may occur after accidental ocular trauma or ocular surgery. We sought to investigate the common causes of SO in Singapore and the demographic profile as well as the final visual acuity after treatment in these patients.

Methods

This was a retrospective, non-comparative case series in which patients with SO were identified from the Singapore National Eye Centre uveitis database in the period between 1993 and 2003. The patients' case records were examined for a history of ocular trauma or surgery and subsequent development of bilateral or contralateral uveitis consistent with SO or histopathological evidence of SO in enucleated eyes. The medical records of these patients were reviewed for details of the inciting event, presentation, treatment, and visual acuity.

Results

A total of ten patients (six men and four women) were diagnosed with SO in the period of study. SO occurred after accidental trauma in three patients and following ocular surgery in seven. Vitreoretinal surgery was responsible for four of these cases, and diode laser cyclophotoablation for another two, whereas neodymium:yttrium–aluminium–garnet (Nd:YAG) laser cyclotherapy was the cause in the last patient. Overall, six of ten patients underwent at least one vitreoretinal procedure. Four of the patients had a final visual acuity of 6/15 or better, whereas five had a visual acuity of 6/30 or worse. Good final visual acuity appeared to be associated with early initiation of immunosuppressive therapy.

Conclusion

In this series, ocular surgery, especially vitreoretinal surgery, had overtaken non-surgical trauma as the major cause of SO. A good outcome was possible in most cases if an early diagnosis was made and immunosuppressive treatment started promptly.

Keywords

Ocular trauma Sympathetic ophthalmia Ocular surgery Vitreoretinal surgery Diode laser cyclophototherapy 

References

  1. 1.
    Bechrakis NE, Muller-Stolzenburg NW, Helbig H, Foerster MH (1994) Sympathetic ophthalmia following laser cyclocoagulation. Arch Ophthalmol 112:80–84PubMedGoogle Scholar
  2. 2.
    Bernasioni O, Auer C, Zografos L, Herbort CP (1998) Indocyanine green angiographic findings in sympathetic ophthalmia. Graefe Arch Clin Exp Ophthalmol 236:635–638CrossRefGoogle Scholar
  3. 3.
    Boyd SR, Young S, Lightman S (2001) Immunopathology of the noninfectious posterior and intermediate uveitides. Surv Ophthalmol 46:209–233CrossRefPubMedGoogle Scholar
  4. 4.
    Brancato R, Carassa RG, Bettin P, Fiori M, Trabucchi G (1995) Contact laser transscleral cyclophotocoagulation with diode laser in refractory glaucoma. Eur J Ophthalmol 5:32–39PubMedGoogle Scholar
  5. 5.
    Chan CC, Roberge FG, Whitcup SM, Nussenblatt RB (1995) 32 Cases of sympathetic ophthalmia. A retrospective study at the National Eye Institute, Bethesda, Md, from 1982 to 1992. Arch Ophthalmol 113:597–600PubMedGoogle Scholar
  6. 6.
    Chu DS, Foster CS (2002) Sympathetic ophthalmia. Int Ophthalmol Clin 42:179–185PubMedGoogle Scholar
  7. 7.
    Easom HA, Zimmerman LE (1964) Sympathetic ophthalmia and bilateral phacoanaphylaxis. A clinicopathological correlation of the sympathogenic and sympathizing eyes. Arch Ophthalmol 72:9–15PubMedGoogle Scholar
  8. 8.
    Gasch AT, Foster CS, Grosskreutz CL, Pasquale LR (2000) Postoperative sympathetic ophthalmia. Int Ophthalmol Clin 40:69–84PubMedCrossRefGoogle Scholar
  9. 9.
    Goto H, Rao NA (1990) Sympathetic ophthalmia and Vogt–Koyanagi–Harada's syndrome. Int Ophthalmol Clin 30:280–285CrossRefGoogle Scholar
  10. 10.
    Hakin KN, Pearson RV, Lightman SL (1992) Sympathetic ophthalmia: visual results with modern immunosuppressive therapy. Eye 6:453–455PubMedGoogle Scholar
  11. 11.
    Jennings T, Tessler HH (1989) Twenty cases of sympathetic ophthalmia. Br J Ophthalmol 73:140–145PubMedCrossRefGoogle Scholar
  12. 12.
    Jonas JB, Holbach LM, Schonherr U, Naumann GOH (2000) Sympathetic ophthalmia after three pars plana vitrectomies without prior ocular injury. Retina 20:405–406PubMedCrossRefGoogle Scholar
  13. 13.
    Jonas JB, Kreissig I, Sofker A, Degenring RF (2003) Intravitreal injection of triamcinolone acetonide for diffuse diabetic macular edema. Arch Ophthalmol 121:57–61CrossRefPubMedGoogle Scholar
  14. 14.
    Kilmartin DJ, Dick AD, Forrester JV (2000) Prospective surveillance of sympathetic ophthalmia in the UK and Republic of Ireland. Br J Ophthalmol 84:259–263CrossRefPubMedGoogle Scholar
  15. 15.
    Kumar N, Chang A, Beaumont P (2004) Sympathetic ophthalmia following ciliary body laser cyclophotocoagulation for rubeotic glaucoma. Clin Exp Ophthalmol 32:196–198CrossRefGoogle Scholar
  16. 16.
    Lam S, Tessler HH, Lam BL, Wilensky JT (1992) High incidence of sympathetic ophthalmia after contact and non-contact neodymium:YAG cyclotherapy. Ophthalmology 99:1818–1822PubMedGoogle Scholar
  17. 17.
    Liddy BSTL, Stuart J (1972) Sympathetic ophthalmia in Canada. Can J Ophthalmol 7:157–159PubMedGoogle Scholar
  18. 18.
    McKelvie PA, Walland MJ (2002) Pathology of cyclodiode laser: a series of nine enucleated eyes. Br J Ophthalmol 86:381–386CrossRefPubMedGoogle Scholar
  19. 19.
    Pollack AL, McDonald HR, Ai E, Green WR, Halpern LS, Jampol LM, Leahy JM, Johnson RN, Spencer WH, Stern WH, Weinberg DV, Werner JC, Williams GA (2001) Sympathetic ophthalmia associated with pars plana vitrectomy without antecedent trauma. Retina 21:146–154CrossRefPubMedGoogle Scholar
  20. 20.
    Ranson NT, Danis RP, Ciulla TA, Pratt L (2002) Intravitreal triamcinolone in subfoveal recurrence of choroidal neovascularisation after laser treatment in macular degeneration. Br J Ophthalmol 86:527–529CrossRefPubMedGoogle Scholar
  21. 21.
    Rao NA (1997) Mechanisms of inflammatory response in sympathetic ophthalmia and VKH syndrome. Eye 11:213–216PubMedGoogle Scholar
  22. 22.
    Sharp DC, Bell RA, Patterson E, Pinkerton RM (1984) Sympathetic ophthalmia—histopathologic and fluorescein angiographic correlation. Arch Ophthalmol 102:232–235PubMedGoogle Scholar
  23. 23.
    The Eyetech Study Group (2003) Anti-vascular endothelial growth factor therapy for subfoveal choroidal neovascularization secondary to age-related macular degeneration. Phase II study results. Ophthalmology 110:979–986CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  1. 1.Singapore National Eye CentreSingaporeSingapore
  2. 2.National University of SingaporeSingaporeSingapore
  3. 3.Singapore Eye Research InstituteSingaporeSingapore

Personalised recommendations